A machine that can interpret electrical brain activity via a sensor placed on the patient’s forehead, a monitoring technique known as BIS (bispectral index technology), commonly used to measure patient reaction to anesthesia during surgery, has been repurposed to determine decline of cognitive function in normal elderly people. The BIS technique has been used on more than 15.2 million surgery patients. Monitoring consciousness helps clinicians determine the amount of a drug needed to provide adequate sedation during surgery. Patients wake up with minimal side effects from the anesthesia, since the system ensures that overmedication does not occur.

OUTSMARTING VERBAL SCORES. The electroencephalogram (EEG)-based technology, known in its new application as BIS-AD, was recently described at the International Conference on Alzheimer’s Disease and Related Disorders held in Philadelphia last summer, in an abstract entitled “Baseline Assessment of EEG-BIS-AD in Longitudinal Trial Predicts Subjects Who Later Sought Pharmacological Cognitive Therapy.” Aspect Medical System’s technology has shown to be superior to other methods of determining cognitive function, such as cognitive assessment tests. It seems, after sufficient repetition of these standardized tests, such as the Mini Mental State examination (MMSE) and the Alzheimer’s disease Assessment Scale (ADAS-cog), patients improve their performance. Consequently, their scores have sometimes been shown to improve with each reiteration of a verbal test.

The BIS-AD technology, on the other hand, cannot be fooled and does not show the variable results common with verbal scores over time. The Cape Cod Memory Study conducted by Aspect Medical Systems was able to measure cognitive function accurately across three readings over a six-month period. The study was conducted to examine the potential of the technology as a predictor of mental decline in normal elderly patients. Of 205 patients in the study, four were subsequently prescribed treatment with Alzheimer’s disease medications. The baseline BIS-AD values for these four subjects were significantly lower than that of other study subjects. In fact, the BIS-AD values later increased for three subjects who were given medication for Alzheimer’s disease, correlating with improved cognitive function resulting from their medication. However, the scores continued to decrease for the remaining patient who continued to decline despite medication. Thus, findings of the Cape Cod Memory Study confirmed the notion of a learning effect associated with verbal tests used to determine cognitive function and that the accuracy of the MMSE and the ADAS-cog scores is compromised over time.

Verbal tests are further dependent upon verbal skills, knowledge of the language, and educational level. A patient unfamiliar with the language or having a low educational level might not do well on a verbal cognitive function test independent of cognitive function. Thus, determining the presence of a disease such as Alzheimer’s as well as the efficacy of medication for the disease through an independent assessment tool could prove invaluable.

OTHER SCANNERS IN THE WORKS. Researchers at the University of Pennsylvania, Division of Nuclear Medicine, have also examined a system for evaluating cognitive impairment. Using the PENN-PET (positron emission tomography) scanner, researchers were able to verify the severity of cognitive impairment in patients with different types of dementing illnesses. Their study validated a scoring system for evaluating fluorodeoxyglucose (FDG) positron emission tomographic (PET) scans that can be used to assess cognitive impairment in patients. The PENN-PET scanner was used to acquire FDG-PET scans of 106 patients with cognitive impairment (65 with Alzheimer’s disease, 16 with frontal lobe dementia, and 25 atypical cases). The imaging scores were compared with results from the MMSE and Dementia Severity Rating Scale (DSRS) written tests. The scanning scores correlated with both of the written tests.

VAST POTENTIAL. Noninvasive testing will likely be used more frequently to determine the extent or potential for cognitive decline. Now, a century after Alois Alzheimer first imaged amyloid plaques under a microscope, investigators may be able to image these plaques in the brains of live patients using PET scans and magnetic resonance imaging (MRI).

Noninvasive technology promises to surpass objective calculations of mental function and is certainly superior to postmortem examination of brain tissue to confirm the presence of Alzheimer’s disease.

Results from a survey of hospitals using electronic adverse event and error reporting systems indicate that 92,547 medical errors or adverse events occurred between Jan. 1, 2001 and Sept. 30, 2003. The findings, based on a study by Tufts-New England Medical Center in Boston, come from analyses of 2.5 million patient days at 26 acute care, nonprofit hospitals. Among the errors that reached patients, 67 percent caused no harm. Fortunately, of the remaining third that caused injury, 32 percent resulted in only temporary harm, less than 1 percent in permanent or life threatening harm and less than .05 percent contributed to patient death. The secure, Web-based reporting system was accessible to all hospital employees. Registered nurses, however, reported nearly half of all medical errors (47 percent), while physicians entered only 1.4 percent.

Back in the late 70’s, Supertramp’s “Give a Little Bit” was an international hit. The song remains popular today, perhaps because its message remains both wise and simple (and the tune is quite catchy). In today’s techie world, it’s easy to get caught up in all of the flashy MP3 players and phones, trendy gaming systems and souped-up computers. Yet, it all seems quite insignificant, given the fact that disease, hunger, and homelessness plague our world.

Whether it’s feeding a starving child in Africa or planting a tree right here in the United States of America, each one of us can make a difference. Isn’t it time we all lent a helping hand? Fortunately, technology provides plenty of ways to give back.

We’ve gathered a selection of products and Web sites aimed at making a difference.

Here are a couple of the products you’ll find in today’s 10 Ways Technology Can Make a Difference slideshow:

SanDisk & the Alzheimer’s Association Every 72 seconds, a person develops Alzheimer’s. Medical care for Alzheimer’s and other dementia patients costs more than $148 billion annually, according to the Alzheimer’s Association . Today, September 21, marks “World Alzheimer’s Day”: a day to acknowledge the millions of people living with the disease, and to participate in the Memory Walk. SanDisk recently joined in the fight by actively contributing $1 to the Alzheimer’s Association for every sale of “Purple Take Action Against Alzheimer’s” 2 GB SanDisk Ultra II SD memory cards ($44.99) and 2 GB Cruzer Micro USB flash drives ($39.99).

Donate Your Old Phone through PhonesForLife.org Lately, it seems like there’s a new flavor-of-the-month phone. You’ve got the iPhone, RAZR2, Chocolate, etc. So what can you do with your old one once you’ve upgraded to the new hot phone? Phones4Life.org is a non-profit group that accepts mobile phone donations in order to protect the environment and to assist seniors, support victims of domestic violence, and save kids. The EPA reports that over 180 million mobile phones are discarded annually, producing over 65,000 tons of waste. That’s way too much for our earth to handle. By donating your phone, you’re giving an individual a sense of security, knowing that help is only a phone call away. To get started, find the nearest drop-off location, have your own collection drive.

Now check out the rest of our 10 Ways Technology Can Make a Difference story, including (PRODUCT) RED iPod Models, Mobile Edge & Boomer Esiason Foundation Collection Bags, The PC Magazine Digital Love Program, Sony’s Take Back Recycling Program, CharityNavigator.org, Dell’s Plant a Tree for Me Program, Belkin’s iPod Cases Support Breast Cancer Research, and LexJet’s Inkjet Cartridge Recycling Program.

The University of California, Irvine (UCI) signed a multiyear agreement to deploy Medical Present Value Inc.’s MPV Phynance for payer contract management and payment verification. UCI physicians billing group will use MPV Phynance to define the terms of 40 payer contracts and to evaluate overall payer contract compliance for 300 of the group’s 1,200 physicians.

UCI is the second practice associated with the University of California Healthcare System to implement the San Antonio-based vendor’s solution.

St. Luke’s Health System in Texas selected Dialog Medical’s iMedConsent application to standardize and automate the informed consent process. The application includes procedure-specific consent forms for most medical and surgical procedures; patient education documents for thousands of diagnoses and treatments; and an extensive anatomical image gallery that allows the physician to annotate images and simplify complex topics for the patient, iMedConsent also automates the completion of patient documentation, ranging from HIPAA disclosures to advance directives.

For the past decade, the Health Plan Employer Data and Information Set (HEDIS) has been used to evaluate the quality of outpatient care in many large managed care systems. The HEDIS has profoundly influenced the way preventive care is delivered (Schneider et al. 1999). Although HEDIS established science as the basis of quality assessment (McDonald 1999), existing systems impose substantial limitations on quality assessment. The high cost of chart review and the lack of consistent methods for summarizing quality create barriers to effective quality assessment (Eddy 1998; McGlynn et al. 2003).
Within 10 to 15 years, electronic medical records (EMR) systems will probably become a standard of care in the United States (McDonald 1999; Schneider et al. 1999). These systems offer extraordinary opportunities to improve care through monitoring quality and placing key information at the fingertips of clinicians and managers. Because many health care systems are currently in the process of developing and implementing electronic medical records (EMR), this is a critical time for developing standardized formats for quality assessment and reporting. This paper proposes a methodology for using EMRs to assess quality of preventive care in the form of a Prevention Index (PI). Using this methodology, we created the PI by conducting paper chart reviews of 976 randomly selected charts from a large HMO. The PI is compared to HEDIS measures for the same services in the health plan and the same year. All of the data required for creating the PI can be captured by EMR systems if appropriately programmed. The approach is systematic, inexpensive, addresses the flaws of current quality measures, and includes all prevention services rated as effective by consensus groups (e.g., U.S. Preventive Services Task Force).

LIMITATIONS OF CURRENT SYSTEMS

Current prevention quality assessment is impaired by the following eight problems:

1. Because of limited access to electronic data, some high priority prevention services cannot be assessed. Surveys and chart reviews are expensive. Although counseling on risk behaviors is one of the most important prevention activities in a physician’s office (U.S. Preventive Services Task Force 1996), performance measurement systems rarely assess services that require a conversation between patient and clinician. The HEDIS measures only one such service (counseling of smokers), and that measure depends on the use of a patient survey. The survey methodology is costly and is associated with recall and nonresponse biases. It may also include advice from physicians that was not recorded in the medical record and, thus, would not be available to guide the next interaction of patient and clinician. The cost and biases associated with survey data are a key barrier to more robust quality assessment (Neumann and Levine 2002).

2. Nonmeasured services are neglected. Services not measured because of lack of data access receive less attention and fewer resources than those that are measured (Neumann and Levine 2002). Few HMOs perform well on strongly recommended lifestyle and mental health assessment and counseling recommendations not included in HEDIS (Garnick et al. 2002).

The extraordinary improvements in childhood immunization, mammography screening, and most other covered services after HEDIS was initiated illustrate the positive impact of quality evaluation as a part of accreditation. However, recommended services not included among HEDIS measures have low performance levels (see below). This results in patterns of service delivery that do not necessarily reflect priority of the services. For example, counseling on diet and physical activity are rarely documented in the medical record despite an almost obsessive fixation on weighing patients (Vogt and Stevens 2003). Recently, a methodology for assessing priority of different preventive services in terms of their relationship to quality-adjusted life-years saved per dollar spent has been developed (Coffield et al. 2001; Maciosek et al. 2001). This methodology can be used to direct resources to services that have the most benefit at the population level.

3. Little attention is given to the special high-risk status of persons not served for prolonged periods of time. Programs that focus on the rarely screened are uncommon even though some screening services (e.g., Pap screening, colorectal cancer screening) have very long lead times because they detect pre-malignant conditions that are fully curable. This long lead-time (i.e., the interval between onset of an abnormality detectable by screening and symptom development) means even occasional screening has substantial benefit. Colditz, Hoaglin, and Berkey (1997) estimated that Pap tests at intervals of 10 years could achieve nearly two-thirds of the lifetime benefit of annual screening. Benefits for outreach to those rarely tested with screening tests that detect extant disease (e.g., mammography) are not as impressive if performed infrequently because the lead-time is so much shorter. The cost effectiveness of mammography is highest when it is done every one to two years; the cost effectiveness of Pap smears is highest when performed every three to five years. This rarely recognized distinction is crucial to rational screening strategies with limited resources because the costs of screening are heavily influenced by the screening interval.

NEEDHAM, Mass. — Hospital Adds Substantial Efficiencies to Employee Call-in System That Receives 1,000+ Calls Per Day

Cantata Technology(TM), the world’s leading independent provider of enabling communications technology, announced today that The Ohio State University Medical Center (OSUMC) has successfully deployed the Brooktrout(R) TR1000(TM) for Microsoft(R) Speech Server to automate its call-in patient transportation system.

Cantata Technology was established in 2006 through the combination of Excel Switching Corporation and Brooktrout Technology(R).
“In just one month of going live, we’ve already seen great improvements in our processes for transporting patients around our five hospitals,” said Chad Neal, director of technology engineering and deployment at OSUMC. “The new call-in system significantly streamlines employee communications for accepting and completing transport requests. We’re able to get to patients faster and bring them where they need to be, and significantly reduce the delays employees and patients had been experiencing,” Neal added.

OSU Medical’s transportation department receives more than 500 requests per day to transfer patients - whether it’s to X-Ray, to a different patient room or to be discharged from the hospital. Once a transportation employee is paged, each request requires two calls - one to accept the page and one to confirm the assignment has been completed - resulting in more than 1,000 calls per day that need to be managed and catalogued.
The automated Microsoft Speech IVR system allows transportation employees to call into a phone application, rather than a dispatcher, and, through text-to-speech technology, have a job assigned. The employee then enters the appropriate digit corresponding with accept, complete or delay. Employees are no longer subjected to hold times, and requests are automatically updated in the department’s database. In addition, when an employee calls in a job completion, a new job can be assigned at the same time, avoiding another page.

“Our biggest bottleneck was managing these calls,” added Neal. “It’s nearly a call per minute. What we’ve seen so far has been promising, and we feel speech applications like this provide a very compelling means to simplify routine processes, and could potentially save us dozens of hours each day on call scheduling. We’ll be exploring additional ways to expand Microsoft Speech Server into other areas.”

The OSUMC Technology Engineering department built the IVR system with Cantata’s T1 version of the Brooktrout TR1000 for Microsoft Speech Server, which provides best-of-breed media processing capabilities. The TR1000 for Microsoft Speech Server provides the telephony interface for the application and simplifies the installation and configuration of the underlying telephony protocols. Cantata was the first vendor to offer a telephony platform built specifically for Microsoft Speech Server.

“Because of the design of Microsoft Speech Server and Cantata’s easy to use telephony platform, we were able to quickly build and deploy an application that met our specific needs,” said Neal. “We have been very impressed with the accuracy of the communications between our employees and the application.”

“As the OSU Medical Center demonstrates, Microsoft Speech Server can make an immediate impact in the enterprise,” said Scott Wieder, director of market development at Cantata Technology. “The goal of the TR1000 is to make applications like this one created by OSU Medical Center easy to develop and deploy. We look forward to a continued partnership with the Medical Center as they discover ways in which Speech Server can enhance their business processes.”

About Cantata Technology, Inc.

Cantata Technology, established in 2006 through the combination of Brooktrout Technology and Excel Switching Corporation, provides enabling communications hardware and software that empowers the creation and delivery of anytime, anywhere IP-based communications applications. Leveraging more than 20 years of experience, Cantata offers the broadest range of products, along with a worldwide network of partners that allows service provider and enterprise customers to develop new products, introduce new services and cost-effectively transition networks to IP. Headquartered in Needham, Mass., Cantata maintains multiple locations worldwide in North America, Asia and Europe. For more information visit www.cantata.com

Cantata, Cantata Technology, Brooktrout, Brooktrout Technology, TR1000, and the stylized logo with and without the term Cantata Technology are trademarks of EAS Group, Inc., the parent company of Cantata Technology, Inc or its subsidiaries.

On its surface, the ripples of development activity generated by the Bayh-Dole Act seem to know no containment. The 1980 act has spurred technological development and led to massive reinvestments by the country’s universities. In the medical field, the policy preceded a wave of new pharmaceuticals development, with almost 400 new therapeutic agents in clinical trials in the field of ontology alone.

The field of healthcare, in fact, is of singular note with regard to the Bayh-Dole Act. Medicine may be the one field wherein the principles of Bayh-Dole hit the wall of controversy–a controversy which has become more pronounced as a number of voluntary standards have emerged which seem to cut against the grain of the federal Law.
It all has to do with conflicts of interest. Recent trends may indicate an inherent contradiction in the Bayh-Dole Act’s policies, at least vis-a-vis medical care. For since a number of tragic deaths in the late 1990s, professional medical organizations have been devising conflict-of-interest rules for healthcare-related research, and in March 2003, the federal government followed suit with the publication by the U.S. Department of Health and Human Services (www.dhhs.gov) of a voluntary guidance on the subject. Last fall, the trend came full circle as the Association of American Medical Colleges (www.aamc.org) published its standards for institutional conflicts of interest in biomedical research.
Problem is, there are a lot of dollars attached to the patent interests in that research. According to the most recent license survey by the Association of University Technology Managers (www.autm.net), in the past 10 years, federal government research expenditures at U.S. hospitals and medical research institutions have nearly tripled, rising from just over half a billion dollars in 1991, to $1.47 billion in 2001. Patents filed by these institutions rose from 416 in 1991, to 1,212 in 2001, according to the survey.

American medical schools, some say, seem to have an inherent financial conflict whenever they host clinical trials on technology in which they hold a patent interest.

The Evolution of a New Standard?

Let’s step back a bit, for a refresher course on the Bayh-Dole Act itself.

The 1980 Act gives research institutions the right to seek a patent interest in discoveries made with federal funds. Institutions generally proceed to license the technology at a fairly early stage, thereby garnering more investment dollars to conduct clinical trials (eventually, on human subjects), as a drug, device, or discovery gradually makes its way from the level of basic science all the way to the marketplace.

And the law places other requirements on those institutions which choose to patent a discovery funded with federal money, reminds William Tew, assistant provost and assistant dean at Johns Hopkins School of Medicine (MD). “It requires that we seek licensees, that we show preference for small companies; and that we share the income with the inventor, for the inventor’s personal use,” he says. “Like some other institutions, Johns Hopkins shares 35 percent of the net value with the inventor,” he adds.

Still, it is because of this patent interest that some analysts theorize research institutions and their employees have a financial conflict of interest, which gives rise to two concerns in research: 1) the objectivity of the research itself, and 2) especially in the healthcare field, the protection of the human research subjects. Medical advances usually must undergo clinical testing on significant populations of human subjects before the FDA allows them to be marketed, but these clinical trials may be conducted at the patent-owning institution, at another institution, or independently by a “contract research organization” (CRO).

Since the tragic death of Jesse Gelsinger, a healthy teenager who participated in a gene therapy trial and died in 1999, it is the issue of human participant protection which has gotten the most attention. The financial interest of the individual inventors, as pointed out by Tew, has received regulatory attention for some time. By federal law, those conducting a clinical trial on human participants must disclose financial interests above a certain threshold amount ($10,000 or 5 percent equity, according to the U.S. Public Health Service regulations).

But it is not merely the share of the license interest that is relevant here, onlookers insist. Doctors running a clinical trial may also receive funding from the trial’s sponsor (the pharmaceutical company, which may have licensed the drug from the university). And in some circumstances, the doctor may receive speaking honoraria or other compensation from the trial sponsor. Yet, in all of this, the question of the independence of the research institution itself often went unaddressed. Even after the death of Jesse Gelsinger (as the American Society of Gene Therapists, the American Society of Clinical Oncology, and the Association of American Medical Colleges devised frameworks for regulating individual conflicts of interest in clinical research), nobody was really asking whether the institution itself could be objective.

Whether the impetus is finding engineers in Alaska or cutting turnover in 50 countries worldwide, organizations are getting serious about applying metrics, measurement and workforce performance management to achieve both individual and organizational goals.

To help automate that process, many companies are choosing workforce performance management (WPM) suite systems to link performance metrics to compensation, measure employee performance and track goals, and then automatically feed these data to compensation, learning, succession planning, recruiting and other HR systems. A few sophisticated solutions feed into financial/operations systems, and more will do so in the future.
The WPM systems also help employees gain insight into their goals, training and standing within the organization, monitor their progress and offer feedback.

“Businesses are much more metrics-oriented and investing in business intelligence and analytics–they want to align individual performances with the measures they’ve put in place for the business,” says analyst Paul Hamerman, vice president for enterprise applications at Forrester Research in Cambridge, Mass. Those metrics then get connected to both performance-based compensation and programs for retaining top performers. “Companies are looking at performance as a mission-critical process to improve the business performance,” Hamerman adds.
With labor costs making up as much as 60 percent of operational expenses, improving workforce performance by just 1 percent adds significant benefits to the bottom line, says Farhana Alarakhiya, director of analytic applications at Cognos, a software company based in Ottawa, Canada. Yet, some HR departments may take three weeks to three months to compile a head count by department. “Many in HR don’t even have access to base metrics they can trust and that don’t take an army to determine,” says Alarakhiya.

But that is changing. Performance management metrics and efforts are so critical to corporate well-being that several industry analysts predict they’ll become part of Wall Street critiques and corporate annual reports within the next five years. Such metrics, for example, might capture information about an organization’s performance by manager or region, improvement from one year over the previous year, or productivity by work unit or position.

HR professionals are finding that the right technology can be a critical factor in creating a performance management system that promotes business success.

The Growth of WPM

Delivered either as a licensed software package or as a hosted service called Software as a Service, today’s WPM systems exceed traditional annual performance appraisals by sharing information across an organization and integrating various HR systems, such as review and reward components.

Many organizations adopted WPM systems following unsuccessful attempts to cobble together stand-alone or so-called best-of-breed solutions. “Organizations today do a lot around workforce performance, but in many cases it’s not brought together in a single process–[such as] the performance appraisal linked to the right job requirements for a new position,” says Mark Smith, executive vice president at Ventana Research, a market research firm in San Mateo, Calif.

While experts estimate that less than 20 percent of organizations currently have some sort of automated performance management system, a study by Framingham, Mass.-based IDC Corp. found that the applications/services market for WPM is growing by about 16.5 percent annually, with the amount to be spent in 2009 projected at $1.8 billion.

Tying Performance To Key Results

At Anchorage, Alaska-based ASCG Inc., metrics or hard numbers/dollars-based measurements, such as sales generated or sales per client, are known as “key results.” These results make up the quantifiable piece of the performance evaluation that drives business at the engineering/architect firm, now with 700 employees throughout the western United States, says Juliana Cobb, chief administrative officer and corporate counsel (and former HR director).

“Key results are very metrics-based, very financial-based objectives that are tied to corporate objectives,” says Cobb. “We tie metrics into our bonuses and compensation reviews–everything ties back to the dollars.”

Until this year, ASCG maintained this information on paper, but the company now uses a web-based appraisal/performance system from Halogen Software. Partially at ASCG’s urging, Halogen added a metrics component to its eAppraisal product, which now has the capacity to measure key performance indicators. Since ASCG does work for many federal agencies, having these metrics is useful because it simplifies the process of consolidating information required by the U.S. Office of Federal Contract Compliance Programs.

Next, ASCG plans to add Halogen’s eSuccession component to its WPM suite to aid the company, not in replacing employees but in retaining them by identifying star performers as well as training opportunities for employees with various rankings. “We’re suffering from the inability to recruit engineers,” says Cobb. “And it’s going to be this way for the next 10 years, so we need to retain as many as we can and develop them.”

Time Warner Telecom announced the competitive award of a 3-year contract to deliver local switched metro Ethernet data services to Community Medical Centers in Fresno. Time Warner Telecom is scheduled to complete installation of switched Native LAN connections, to link six medical facility locations in the Fresno area, in October. The 1 Gbps backbone and 10/ 100 Mbps connections represent a 10-fold capacity increase, respectively.
Capacity will be further extended with the Centers’ migration from half-duplexed to fully-duplexed transmission capabilities. The additional capacity is required to implement the health care provider’s Picture Archiving and Communications System (PACS). PACS makes exam electronic images available to physicians for the effective diagnosis and treatment of their patients. High-capacity LANs, and the connections between multiple locations, are essential to supporting PACS applications because image files, such as a magnetic resonance L-Spine image, can average 200 megabytes.