How is this a picture of modern medicine?

The British have a long history of bravely venturing off into the unknown, and with cloud computing as their new frontier, they are forging ahead yet again. A hospital in the UK is testing a pilot program that has the capacity to host all electronic health records for patients on a cloud platform, placing control over medical information into the hands of its patients. With the new system, patients will be able to manage their own records and open up access to whomever they choose. While this is a huge thumbs-up for cloud technology, the news is somewhat dampened by the early June report that hackers obtained the passwords of admin accounts at the UK’s national healthcare system, raising concerns about how secure all this medical information will be when it’s all online.

But push on they must, with the panache of the British explorer Sir Ernest Shackleton, who once glibly said while crossing the Antarctic and facing many dangers, “Difficulties are just things to overcome, after all.”

The cloud platform being tested, known as Extility, has been a joint venture between the Scottish-software developer, Flexiant, and the Edinburgh Napier University along with the Collaboration for Leadership in Applied Health Research and Care, a partnership aimed at improving patient outcomes and applying health research. Flexiant has designed the scalable platform so that users can access information on numerous web and mobile devices in real time and as information becomes available. Additionally, the software is intended to play nice with other trusted web-based services, such as Facebook and Paypal.

After 18 months of collaborative development, the Chelsea and Westminster Hospital in London is launching the two-year program with a demonstration run of simulated patient data to test large-scale deployment. The program will also determine the feasibility of utilizing the same set of healthcare data across a broad range of services. In other words, the success of the program will depend on accessibility and cradle-to-the-grave usability. Another feature being tested is clinical diagnostics, which would use data to provide early warnings and risk assessment scores to patients and healthcare professionals for the goal of preventative medicine.

But one of the biggest aims of running the pilot is to build the public’s trust in healthcare managed via the cloud. And that’s a tall order when 2011 has seen its fair share of security breaches on the web. The success of the platform depends on the ability of Flexiant to keep data secure, which it intends to do through a multiple authentication system and new identity checking methods.

While the tech community can cheer at this move, it is a shame that implementation of electronic medical records is taking so long. For years it has been obvious that a transition to electronic records is warranted, seeing that paper-based medical records are one of the most antiquated systems in society today. Just visit a new doctor to be reminded of the amount of paperwork you have to fill out…again. You’ll spend precious time searching your brain for the name of the medical condition that your aunt had back when she was a child. The office also has to request copies of your old medical records so they have a complete background. If your doctor recommends you see a specialist, that office gets physical copies of your healthcare information as well. All of this paperwork, file keeping, record transmission, and archiving has to be done manually by staff of hospitals, doctors offices, pharmacies, and other healthcare services. That doesn’t even get into the insurance companies, government agencies, and law enforcement that need access to this information, to varying degrees.

This modest looking building may be the beginning of a healthcare revolution.

So what’s the delay? In light of the ease with which we can share files, photos, music, and video online through social networks, the current state of medical records, which are significantly more important, is frankly an embarrassment. A number of companies are providing services to digitize old medical files, create new systems for record keeping and set up medical office networks and databases to share that information internally and connect to external sites. One company, CliniComp, recently completed an electronic medical record system of all 59 U.S. military hospitals, but sadly, the software doesn’t currently connect to the military’s clinical information system.

This underscores a point: digitizing medical records is only half the problem — the other is easily utilizing them.

Cloud computing appears to be the solution that everyone has been looking for amidst all the concerns over digital records from doctors and patients alike. The cloud offers decentralized access to data using multiple Internet-ready devices, instead of end users depending upon specific software or a medical group’s IT support keeping the software in working order. Furthermore, it places the burden of responsibility for that information on users rather than staff members. Both cloud platforms and intranet systems can be hacked into, but the cloud is likely to be much safer when managed by a professional company whose primary goal is managing the cloud than a small company’s ability to keep a hospital or medical group’s systems up to date and completely secure while perpetually training staff members on proper protocol.

With all the great features that cloud-based medical records could provide, the biggest concern for the future is the unauthorized release of patient data. A New York Times article from 2009 indicates that it may not be hackers or disgruntled employees who are the biggest threat to someone releasing your medical records with your name on them, but the practice by companies of selling de-identified patient records for analysis and data mining by other companies. The article describes how the little footprints we leave behind on the web, in forums and personal profiles, for instance, can be correlated to de-identified data in order to re-identify a person’s name that the record belongs to. Clearly, once data are put out on the web, they’ll be there forever.

In the end, the hospital in the UK should be applauded for boldly moving forward into the proverbial Heart of Darkness that is electronic medical records. It will be exciting to see how the public warms to ‘cloud’ medicine and just maybe, a hospital in the U.S. might get the courage up to walk in their footprints. Or they could just start using Practice Fusion.

[Images: Daily Mail, sxc]

[Sources: Flexiant, Guardian, Information Week, New York Times, The Telegraph, US News]

Ultra low temperatures could help patients survive surgery for trauma.

Freeze a life to save a life. Medical researchers at Massachusetts General Hospital in Boston are planning to temporarily replace the blood of trauma patients with an icy saline solution. The hope will be that by rapidly cooling the human body, surgeons will have time to repair the damage that is killing it. Led by Dr. Hasan Alam of Harvard Medical School, the emergency preservation resuscitation project will cool patients as low as 50°F (10°C), well below normal levels (98.6°F, 37°C) and below the temperatures that would normally induce death (71.6°F, 22°C). At low temperatures, major organs, perhaps especially the brain, may be preserved from injury as metabolic functions cease. Whereas serious trauma patients may normally have just a few minutes to have a gunshot wound or other major injury repaired, Alam hopes that cooled patients will have 60 to 190 minutes of extended time in the OR. While trials at MGH are likely to involve just a few patients in the next year or two, Alam is already discussing the possibilities of how his practice might save lives. Listen to his interview on NPR in the audio clip below. Suspended animation isn’t science fiction anymore.

Alam isn’t the only researcher looking to cool human bodies for trauma repair. According to BBC News, Dr. John Elefteriades at Yale University New Haven Hospital has used hypothermia of a similar nature on heart patients. In fact, hypothermia for organ transplants and other surgeries has been fairly common at times – it goes in and out of style due to its high risks. Yet low temperature procedures of patient’s after major trauma – that’s pretty edgy. Alam is planning to work on patients that are often bleeding out. Instead of pumping blood back in, you remove the need for blood (oxygen really) through extreme cold. Fix the patient, then give them blood and warm them up. It’s an ingenious, and still very risky technique. While he hasn’t worked on a human in this manner, Alam has had great success with large animals. He explains more to NPR’s Guy Raz

(If player does not load, you can find the original NPR story and audio file here)

The technique Alam plans to use to cool patients sounds downright gory. Using a pump inserted near the heart, Alam will remove the patient’s blood while adding in ice-cold saline solution (near 10°C). As that solution circulates, the body’s cells will shut down, slowing or stopping their metabolic activity. With no action going on, there will be no need for oxygen, and the cells should be able to hold tight without blood as the body’s trauma is repaired. Yet during that operation, the patient will be effectively dead. That’s an aspect that the recent BBC Two program “Horizon: Back from the Dead” explores quite thoroughly. The full show, which discusses the work of Alam, Elefteriades, and others, isn’t available to viewers outside the UK. I can, however, show you a clip from the show which tells the story of Anna Bagenholm, a skier who’s icy near-death experience was the inspiration for many of the modern hypothermia techniques:

There’s more than one way to freeze a patient – other researchers have explored how hypothermia can help those in surgery. Besides Alam, there’s also Mark Roth who is working on techniques to place people into suspended animation so they can survive on the way to hospitals. Roth has had success using a hydrogren sulfide compound to enable the body of mammals to suspend metabolic activity. Along with cooling, which Roth has explored thoroughly with lower order animals, the hydrogen sulfide cocktail could help humans recover from near-death states with great success. Roth’s work is just part of a larger initiative at DARPA designed to help injured soldiers live long enough to make it to surgery after being wounded on the battlefield.

Medical hypothermia will eventually lead to a more general use of suspended animation. The emergency preservation resuscitation that Alam is exploring, or the hydrogen sulfide solutions from Roth, or some as yet undiscovered procedure, should allow us to place the body in a prolonged state of inactivity with little to no ill effects. The classic application for this type of suspended animation is space travel, but who knows where it will ultimately be applied. For now, freezing humans is so risky it really only makes sense if they are about to die anyway. One day, however, going into cold storage may be just another way humans extend their lives. Work like Alam’s goes to show that our understanding of death is still developing. For now, it’s kind of cool to know that being close to freezing can actually be good for you. After all, “you’re not dead until you’re warm and dead.”

[image credit: BBC News]
[media credit: NPR, BBC Two]
[source: Telegraph.co.uk, NPR, BBC News]

By color-coding stem cells, reserachers isolated those that would form different parts of the heart.

It’s Alive! Researchers at Harvard University and Massachusetts General Hospital have succeeded in taking embryonic stem cells from mice and growing cardiovascular tissue. The research team, led by Dr. Kenneth Chien, believes that a similar process may one day serve to repair cardiac damage in humans. The work was recently published in the journal Science. You can see the mouse heart cells beating at different speeds in the video from Boston.com after the break.

Cardiac injury is some of the most difficult damage to heal in the body. When the heart undergoes massive damage from a coronary, you have few options – replace broken parts, add a pacemaker, or get a whole new heart. The work done by Chien and his team focuses on creating a new way to repair tissue damage. Instead of adding in mechanical parts, or finding a donor organ, stem cells may be used to replace and heal the damaged cardiac tissue. Eventually, those patients that develop a myocardial injury could have pluripotent stem cells harvested from their skin, marrow, or fat which would then be introduced into the heart via injection. No open heart surgery, no pacemakers, just stem cells and a needle.

While the pulsing tissue in the video is cool looking, readers may recall that we’ve seen far more advanced stem cell creations on Singularity Hub. Researchers at the University of Minnesota have created entire mouse and pig hearts that beat. Those videos are much more impressive. What then, makes the Harvard/MGH research so noteworthy?

Unlike the Minnesota work, the Harvard project isn’t aimed at creating entirely new organs. Instead, Chien and his colleagues have developed a manner to differentiate between different pluripotent stem cells. They introduced a color coding system via genetic engineering so that the stem cells could be selected based on which part of the heart they will become. Using this technique, the appropriate mouse stem cells could be cultivated to replace/heal just one portion of the damaged organ. It’s that identification and isolation of stem cell types that is so unique for this work.

Using their technique, the team is ready to start the next step: developing a 3D collection of mouse cardiac tissue. After that, the team could start performing heart repair on living mice. If successful, it will likely take many years of research and clinical trials before such a stem cell therapy would become a publicly available treatment in humans. Still, these current results show that Chien and his team are able to find the right stem cells for the job.

Though watching a newly formed heart beat is more impressive than watching the same motion in a tiny strip of tissue, we should remember that we really need both. Some damage from heart attacks will be able to be repaired. Other damage or chronic forms of heart disease will require a full organ transplant. By pursuing both options, researchers in Massachusetts and Minnesota will eventually provide the best possible health care. And it’s needed. According to the CDC, heart disease is the leading cause of death in the US, about 27% of total lives lost. Similar rates are seen throughout the developed world, primarily because of poor lifestyle choices. C’mon little mouse heart tissue, keep beating! We’re all going to want your help real soon.

[Video Credit: Boston.com and Kenneth Chien et al]

Adequate levels of vitamin D may make the elderly three times less likely to die of heart disease.

In case you were wondering about whether or not to take that walk outside today, a new study has shown that vitamin D is linked to lower death rates among the elderly. The University of Colorado Denver, and Massachusetts General Hospital (MGH) recently published findings that patients over 65 with low levels of vitamin D are three times more likely to die of heart disease than their peers with adequate amounts. The same group was two and half times more likely to die no matter the cause. Holy crap! This research makes it sound like not taking vitamin D supplements is a guaranteed death sentence.

The study was quite appropriately published in the Journal of the American Geriatric Society, but it could have wider implications outside of geriatrics. Vitamin D’s ability to prevent heart disease and stroke could be useful for those in middle age or younger. UC Denver and MGH also completed an earlier study (in the Archives of Internal Medicine) that demonstrate how vitamin D could boost the immune system against colds and flu. The National Institute for Health is currently ramping up VITAL, a five year study to determine the effects of long term use of supplements of vitamin D and fish oil. VITAL is going to be huge.

Not that this trial was particularly small. UC Denver and MGH studied the data from the Third National Health and Nutrition Examination Survey conducted by the National Center for Health Statistics and the Center for Disease Control. In that survey, 3,400 volunteers over 65 years of age were selected to represent a cross section of America’s 24 million older adults. They were followed, on average, for more than seven years.

While the study highlights the connection between vitamin D and mortality, this doesn’t mean there’s necessarily a causal relation. As stated in the MGH press release, it is likely that one third of all older adults in the US have low levels of vitamin D, probably due to limited outdoor sun exposure. How do you get sun exposure? By being active. So connections between vitamin D and mortality may simply be demonstrating that active old people live longer. Or it could be that vitamin D supplements are the fountain of youth. We don’t know, and very wisely the authors of the study are calling for larger randomized trials.

Which is probably where VITAL is going to fit in. We have plenty of inconclusive proof that vitamin D (and fish oil) are linked to longer, healthier living. Inconclusive only because causal relationships can’t be determined in many of the studies. What we need now is a greater understanding of whether vitamin D and fish oil supplements can really help us, or if the behavior that naturally raises levels of these substances is the real cure-all. VITAL will help with that understanding, but in the following five years you and I can run our own experiment. Let’s enjoy more outdoor activities, eat a diet with more lean proteins from small fish and see where that gets us. Maybe we’ll create new Blue Zones.