MEDICAL TECHNOLOGY n DEFINITION MEDICAL TECHNOLOGY IS THE

MEDICAL TECHNOLOGY

n DEFINITION: MEDICAL TECHNOLOGY IS THE PRACTICAL APPLICATION OF THE SCIENTIFIC BODY OF KNOWLEDGE PRODUCED BY BIOMEDICAL RESEARCH.

n WHEN GROWTH IN SCIENTIFIC KNOWLEDGE IS DEPLOYED FOR THE PURPOSE OF IMPROVING MEDICAL CARE, IT LEADS TO:

¨ ADVANCED TECHNIQUES FOR A MORE PRECISE MEDICAL DIAGNOSIS THAN WHAT HAD BEEN POSSIBLE EARLIER,

¨ MORE EFFECTIVE AND LESS INVASIVE THERAPEUTIC AND PREVENTIVE MEDICAL PROCEDURES;

¨ MORE ADVANCED EQUIPMENT, ¨ MORE ADVANCED CARE DELIVERY SETTINGS AND PROGRAMS TO FACILITATE THE DELIVERY OF HEALTH SERVICES.

n TYPES OF MEDICAL TECHNOLOGIES

n DIAGNOSTIC: n CAT SCANNER n FETAL MONITOR

n COMPUTERIZED ELECTROCARDIOGRAPHY AUTOMATED CLINICAL LABORATORIES MAGNETIC RESONANCE IMAGING (MRI)

n AMBULATORY BLOOD PRESSURE MONITOR

n SURVIVAL (LIFE SAVING): q. INTENSIVE (ICU) CARE UNIT q. CARDIOPULMONARY RESUSCITATION (CPR) q. BONE MARROW TRANSPLANT

q. LIVER TRANSPLANT q. AUTOLOGOUS BONE MARROW TRANSPLANT

n ILLNESS MANAGEMENT: q. RENAL DIALYSIS q. PACEMAKER

q. PTCA (ANGIOPLASTY) q. STEREOTACTIC CINGULOTOMY

q. HIP JOINT REPLACEMENT q. ORGAN TRANSPLANT q. LITHOTRIPTER

n PREVENTION: q. IMPLANTABLE AUTOMATIC CARDIOVERTERDEFIBRILATOR

Artificial Heart

Infusion Pump

MRI SCAN OF THE BRAIN

ARTIFICIAL HIP

PROSTHETICS

l FACILITIES AND CLINICAL SETTINGS: q HOSPITALS q SATELLITE CENTERS

q. CLINICAL LABORATORIES q. SUBACUTE q. MODERN CARE UNITS HOME HEALTH

n ORGANIZATIONAL DELIVERY STRUCTURE: q. MANAGED CARE q. INTEGRATED NETWORKS DELIVERY

n PROTON BEAM FACILITY n n SHANDS HEALTHCARE, JACKSONVILLE, FLORIDA

§ IN FISCAL YEAR 19992000 THE STATE OF FLORIDA FUNDED $6, 000 TO SUPPORT THE DEVELOPMENT OF A PROTON BEAM FACILITY IN JACKSONVILLE.

Proton Beam Generator

§ § THE ESTIMATED COST OF BUILDING A PROTON BEAM FACILITY IS $104, 000 TO BE EXPENDED OVER THE NEXT THREE YEARS. IT IS NOW OPERATIONAL IN JACKSONVILLE.

No, its not Stargate

§ BASED ON THE INCIDENCES OF NEW CASES OF CANCER YEARLY IN FLORIDA ALONE, THE FACILITY WOULD EXPECT TO TREAT 2, 500 – 2, 800 NEW PATIENTS BY THE END OF THE 5 TH YEAR OF OPERATION.

n

n WHAT IS PROTON CANCER TREATMENT?

§ PROTON BEAM THERAPY IS AN INNOVATIVE CONCEPT IN THE FIELD OF CANCER THERAPY AND DIFFERS GREATLY FROM TODAY’S CONVENTIONAL THERAPIES.

§ CONVENTIONAL CANCER RADIATION TREATMENT UTILIZES X-RAYS AND ELECTRON BEAMS THAT LOSE MOST OF THEIR ENERGY AS THEY TRAVEL THROUGH HEALTHY BODY TISSUE.

§ THE HEALTHY TISSUE IS FREQUENTLY DAMAGED LEADING TO SERIOUS SIDE EFFECTS.

§ PROTON ENERGY, HOWEVER, CAN PRODUCE A UNIFORM RADIATION DOSE THAT CAN BE DELIVERED TO DESTROY THE TUMOR WHILE EFFECTING VIRTUALLY NO INJURY TO NEARBY HEALTHY TISSUE.

n IMPROVED RESULTS FOR PATIENTS

§ MORE THAN 20, 000 PATIENTS HAVE RECEIVED PROTON BEAM TREATMENT IN RESEARCH INSTITUTIONS AROUND THE WORLD. RESULTS ACHIEVED WITH DIFFICULT TO TREAT TUMORS SHOW THE BENEFIT OF PROTON IRRADIATION.

n The Trilogy Machine

n n The Trilogy linear accelerator can treat cancer anywhere in the body. Quite simply, it targets tumors more precisely, delivers a high dose of radiation and requires fewer treatment sessions.

n What makes it special? Flexibility – treatment can be customized to target many different types of cancers, in many locations. n Accuracy – Radiation beams match the three-dimension shape of the tumor with a high degree of accuracy. n

n Higher Doses – Radiation goes only to the cancer cells sparing the health cells surrounding the tumor site. n Fewer sessions n Fewer side effects

n On board imager (OBI) helps synchronize treatment with the patient’s breathing cycles. Targets tumor more precisely, while sparing health tissue.

Gamma Knife

n Gamma Knife surgery is a minimally invasive alternative to conventional brain surgery. Considered the "gold standard" of radiosurgery technologies, this revolutionary surgical procedure allows safe and effective treatment for many types of intracranial tumors and vascular malformations. In fact, the Gamma Knife can often treat conditions once considered inoperable.

Gamma Knife is safe – no incision. n Precise – targets exact area. n Cost Effective – covered by Medicare and most insurance companies n Relative pain free n Successful n

Da Vinci Robot

n http: //www. floridaproton. org/can cer-treatment/proton-therapyvideo. html

n End of presentation for September 19 th , 2012, 6 th Period n Questions? n Discussion?

TELEMEDICINE AND TELEHEALTH

n Telemedicine is the use of electronic communications and information technologies to provide services when participants are at different locations.

n n Closely associated with telemedicine is the term telehealth. Telehealth is the umbrella term used to describe the ways service is delivered.

n n n n Telehealth encompasses a broader application of technologies to: Distance education Consumer oureach Videoconferencing Remote monitoring of vital signs Continuing medical education Nursing calls

Medical specialties more likely to be engaged in telehealth Radiology Dermatology Cardiology pathology

n n n Telemedicine does not represent a separate medical specialty. It extends the traditional practice of medicine. It encourages greater consumer involvement in decision making.

n Types of Services Specialist referral – involves a specialist assisting a general practitioner in rendering a diagnosis. n Involves diagnostic images or video for viewing later. n

n Types of Services Direct Patient Care – The sharing of audio, video and medical data between a patient and health professional for use in a diagnosis, treatment plan, prescription, or advice. n Remote clinic…at home. . physician’s office n

n n n Types of Services Remote patient monitoring: uses devices to remotely collect and send data to a monitoring station for interpretation. Home health applications may include a specific vital sign such as blood pressure.

n n Types of Services Medical education and mentoring

n n Types of Services Consumer medical and health information

n n n Delivery Mechanisms Networked programs link tertiary care hospitals and clinics with outlying or remote centers. Estimated there about 200 existing networks. Point-to-point connections

n n n Delivery Mechanisms Health provider to home connections – accomplished through phone line with interactive capabilities. Direct patient care – to monitor pacemaker and cardiac devices (example)

n n Delivery Mechanisms Web-based e-health patient service sites such as “web MD. ” http: //www. webmd. com/

n n Federal Funding for Telemedicine Grants and contracts: estimated about $270, 000 with one third for research contracts with the U. S. Department of Defense.

n n n Federal Funding Direct Services: Major users…Department of Defense, Indian Health Service, and Bureau of Prisons in the Department of Justice. Medicare: 10% of population is covered by Medicare and use 25% of the medical services. Largest use in teleradiology.

n Advantages of Telemedicine Make speciality care more available to underserved rural and urban populations n Alleviate cost and inconvenience of travel n Opportunities for In-service education n

n Barriers to Telemedicine States will not allow out-statephysicians to practice unless licensed in their state. n Issue of reimbursement n Fear of malpractice n Inadequate technology n

n n Telehealth or Telemedicine? Telehealth is generally used as an umbrella term to describe the various ways to use technology to aid the health care professional Telemedicine describes the direct provision of clinical via telecommunications. But wait…as time advances, so will the advent of new things and new terms.

n. Telehealth

n n MILESTONES IN THE EVOLUTION OF TECHNOLOGY FIRST MILESTONE – THE TELEPHONE

n NEBRASKA PSYCHIATRIC INSTITUTE (EARLY 1960’S) – IMPLEMENTATION OF AUDIOVISUAL TECHNOLOGY

n LOGAN AIRPORT TELEDERMATOLOGY PROJECT (LATE 60’S) – INTERACTIVE, CLOSEDCIRICUIT BLACK/WHITE TELEVISION.

n NASA USED TELEHEALTH TO MONITOR ASTRONAUTS IN SPACE AND PROVIDE EMERGENT CARE AS NECESSARY.

n USED AT ANARTIC SURVEY STATIONS BECAUSE THEY WERE UNABLE TO EASILY EVACUATE SICK PERSONNEL.

n n POTENTIAL BENEFITS: EXPAND ACCESS TO HEALTH CARE AND REHABILITATION SERVICES IMPROVE QUALITY OF CARE MORE FREQUENT VISITATIONS

n n n PROVIDE MORE ACCESS TO THOSE IN RURAL AREAS CONVENIENCE FOR BOTH PATIENT AND PROVIDER VAST NUMBER OF EXPANDED SERVICES PROVIDED

n n n PLETHORA OF HEALTH CARE INFORMATION WORLDWIDE DATABASES LIBRARIES CONFERENCES RECORDS SUPPORT COMMUNITIES

n n ENCOURAGE PATIENTS TO BECOME ACTIVE IN THEIR HEALTH CARE ALLOWS PHYSICIANS TO WORK COLLABORATIVELY WITH THEIR COLLEAGUES FROM DISTANT LOCATIONS.

n PHYSICIANS CAN DISCUSS NEW AND LATEST ADVANCES IN CARE, SEEK OPINIONS, CONDUCT RESEARCH, ETC.

n n PRIMARY CARE ON-LINE SERVICES SCHEDULING APPOINTMENTS E-MAIL PHYSICIAN – ALLEVIATES PHONE TAG, CONVENIENT, QUICK PRESCRIPTIONS, AS WELL AS THE CAPACITY TO DOUBLECHECK FOR ACCURACY

n n PURCHASE OF MEDICAL PRODUCTS LEAVES ROOM TO ASK PHYSICIAN QUICK QUESTIONS THAT DO NOT WARRANT A VISIT PATIENT MAY HAVE ACCESS TO MEDICAL RECORDS PATIENT CAN INPUT PERSONAL MEDICAL DATA, I. E. , BLOOD SUGARS, BLOOD PRESSURE, ETC.

n RAMPANT, CONTINUOUS, AND GROWING USE OF TELEHEALTH

n SHORTCOMINGS OF TELEHEALTH PRIVACY OF PATIENT INFORMATION IS QUESTIONED n HIGH COST OF TECHNOLOGY n DUE TO IMMENSE AMOUNT OF INFORMATION CREDITABILITY OF n

n POTENTIAL ABUSE

§ SINCE THE USE OF THE INTERNET FOR ACCESSING HEALTH INFORMATION IS NEW, THERE EXISTS LITTLE IN THE WAY OF SAFEGUARDS FOR CONSUMERS.

§ CONSUMERS SHOULD MAKE SURE THAT WEB SITES USED TO OBTAIN INFORMATION ABOUT HEALTH AND MEDICINE ARE PROVIDED BY A RELIABLE AND CREDIBLE SOURCE.

§ IN SOME CASES COMMERCIAL INTERESTS SUCH AS A DRUG MANUFACTURER MAY SPONSOR OR CONTRIBUTE INFORMATION TO THE WEB SITE. CONSUMERS SHOULD LOOK FOR ASSURANCES THAT THE INFORMATION PROVIDED IN THESE CASES IS OBJECTIVE AND DOES NOT FAVOR THE SPONSOR’S PRODUCTS.

§ AT THIS TIME CONSUMERS SHOULD EXERCISE CAUTION IN USING WEB SITES THAT OFFER ONLINE DIAGNOSIS AND PRESCRIBE TREATMENT AND MEDICATION FOR THE DIAGNOSED CONDITION. THERE ARE CURRENTLY NO RECOGNIZED AUTHORITIES OVERSEEING THE OPERATION OF THESE SITES.

§ CONSUMERS ARE CAUTIONED AGAIN OBTAINING PRESCRIBED MEDICINES FROM WEB SITES THAT OFFER BOTH DIAGNOSIS OF CONDITION AND DIRECT SALES OF THE PRESCRIBED MEDICINE.

§ CONSUMERS SEEKING MEDICAL TREATMENT FROM HEALTH PROFESSIONALS OVER THE INTERNET SHOULD RECEIVE CLEAR ASSURANCES THAT THEY WILL BE INTERACTING WITH A QUALIFIED PROFESSIONAL HOLDING THE APPROPRIATE CREDENTIALS AND THAT THE PROFESSIONAL IS ABLE TO LEGALLY PRACTICE MEDICINE IN THE CONSUMERS LOCATION.

§ CLINICAL CONSULTATION OVER THE WEB BY CREDENTIALED PROVIDERS SHOULD INCLUDE PROCEDURES THAT PROTECT THE PATIENT INCLUDING:

§ § § INFORMED CONSENT INFORMATION SECURITY AND PRIVACY PROTECTION MEASURES DOCUMENTATION OF THE CLINICAL ENCOUNTER

l CYBERCHONDRIA

§ A MAJOR DRIVER OF HEALTH CARE WILL BE A SPECIAL FORM OF ELECTRONIC COMMUNITY: THAT OF CYBERCHRONDRIACS, PEOPLE WHO USE THE INTERNET TO SEEK HEALTH CARE INFORMATION.

§ THE CYBERCHONDRIACS USING THE WEB TO SEARCH FOR HEALTH CARE INFORMATION THEREFORE ACCOUNT FOR 68 PERCENT OR SIXTY MILLION ADULTS, A STAGGERING NUMBER.

§ AS THE INTERNET CONTINUES TO GROW, WE ARE ALL LIKE TO BECOME CYBERCHRONDRIACS TO SOME DEGREE, FOREVER CHANGING THE WAY WE ACCESS MEDICAL CARE.

n END OF LECTURE FOR September 19 th , 2012, 7 th Period n QUESTIONS? n DISCUSSION?