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Medical Technology

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Joanna Bello

on 11 April 2016

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Transcript of Medical Technology

Open Appendectomy (OA)
-McBurney 1894
-Procedure: Incision, dissection, revealing & removing
-Traditional practice

Laparoscopic Appendectomy (LA)
-Kurt Semm 1980
-Tools: laparoscope, tv monitor, EndoGrasp & Endo Babcock, EndoCatch trocars.

Closing:
-DS Ligation Clip System,
-Stapling tool, P
-ercutaneous thread loop,
-Surgical glue.
The Past of EHRs
Electronic Health Records
EHRs are designed to contain and share patient information for the purpose of delivering health care services.
Can be created, managed, and consulted by authorized providers and staff across more than one health care organization.
Allows patients records to move with them to other providers, nursing homes and across states.


Medical Technology
What is Medical Technology?
Practical application of the scientific body of knowledge in order to:

Improve health

Create efficiencies in the delivery of health care

Information Technology:

Deals with the transformation of data into useful information.

Examples: clinical information Systems (Electronic Medical Records Systems),administrative information systems (Billing), and decision support systems CPOE (computerized physician order entry). Reduction of medical errors.

Advantages of EHRs
Improved Health Care Quality and convenience for providers
Improve Information Availability
Support Provider Decision Making
Improve accessibility of record for provider, patients, and family caregivers
Definition
1920s: Medical records were documented on paper by “record librarians."
1960 & 1970s: American universities began exploring ways for combining computer and medical records.
1980s: For the first time, patients use computerized check in. Medical record departments start using the master patient index (MPI).
1990s: Computer applications were used within healthcare but none of them could associate,be viewed by other departments, and most used their own computer hardware.
2000: Re-emphasis for EHRs emerges due to medical errors and increasing numbers of patient deaths and injuries caused by healthcare providers.
Paper Records
Group 1:
Beatriz Saiz
Gissel Suarez-Jofre
Jessica Bini
Joanna Bello
Marian Glynn
Margarita Lopera Noguera
Nicole Vargas
Pablo Doria

Laws & Incentives
Confidentiality & Security Concerns
Health Insurance Portability and Accountability Act,(HIPPA)of 1996 protects
The privacy of individually identifiable health information or PHI.
Ensures confidentiality & integrity of all PHI that is created, received, maintained or transmitted.
Ensures compliance by workforce.
Breach Notification Rule: requires providers to notify individuals of loss,theft,or other unauthorized disclosures of unsecured PHI.
Reduce Risk to PHI
Three Safeguards
Administrative
Develop policies & procedures
Internal audits
Define levels of access and Provide training
Physical

Secure location and workspace
Develop policies for verifying access authorizations, equipment control, and handling visitors.
Provide protection against fire and other hazards
Technical

Unique user id, passwords & pin numbers
Automatic log off
Encryption controls
In the past, each hospital department purchased and installed software tailored to that specific department's function.
As EHRs became more sophisticated, they tried to link each of the internal departments together.
The hospital’s EHR is locally-housed.
Large multi-hospital systems, modifications can cost billions of dollars.
Hospital EHR
Examples of Hospital EHR
The U.S. and Medical Technology
Medical technology and research ranks with the best in the world.
High-tech procedures.*
High-tech equipment.*
The U.S.spends the most amount of money in Research and Development.*
Government Policy FDA
Federal Drug Administration Agency: Safety and Effectiveness of medical devices and drugs.
Medical Technology's Applications:

Diagnostic
Survival
Illness
Cure
Prevention
System Management
Facilities and Clinical Settings
Organizational Delivery Structure
Topics
Medical Records: Electronic Health Records
A. Definition, Advantages, and
Hospital EHR
B. Paper Records, Physician Office EHR,
and Incentives

Surgical Procedures
A. Minimally Invasive Procedures
B. Non-Invasive Procedures

Medical Technology in Pharmacies
A. Pharmacy Computer System
B. Automated Pharmacy Dispensing
Systems

Artificial Devices and Replacement Parts
A. Prosthetics
B. Transplants
Non-invasive Medical Procedures
GAMMA KNIFE
STEREOTACTIC RADIOSURGERY
Invented in 1968 in Sweden where the first clinical treatment was delivered, the first U.S. unit was installed in 1988 at the University of Pittsburgh
Approved by the FDA in 1988.
Gamma Knife® is not a knife at all. No scalpels.
Stereotactic radiosurgery (SRS) Stereotactic refers to precise positioning in three-dimensional space. In Gamma Knife surgery, this means a 3-D reference frame is attached to the patient’s head during the procedure. 
Non-invasive method for treating brain disorders.

Why is Gamma Knife Used?
Patients for whom traditional brain surgery is not an option

Conditions
Treated
AVM (Arteriovenous Malformation)
Trigeminal Neuralgia
Brain Tumors:
Bening:
Acoustic Neuroma
Craniopharyngioma
Hemangioblastoma
Meningioma
Pituitary Adenoma  
Malignant:
Brain Metastasis
Glioblastoma
Glioma

AVM
Pituitary Tumor
Risks
Swelling of the brain
Headache
Nausea
Numbness

Advantages
Gamma Knife® is a neurosurgical tool designed exclusively for the treatment of brain disorders.
The lesion being treated receives a high dose of radiation with minimum risk to nearby tissue and structures.
The cost of a Gamma Knife® procedure is often 25% to 30% less than traditional neurosurgery.
Patients experience little discomfort.
The absence of an incision eliminates the risk of hemorrhage and infection.
Hospitalization is short, typically an overnight stay or an outpatient surgical procedure. Patients can immediately resume their previous activities.
Gamma Knife® technology allows treatment of inoperable lesions. The procedure offers hope to patients who were formerly considered untreatable or at very high risk during open skull surgery.

How is The Surgery Done?
The Head Frame
Imaging: MRI, CT, Angiography
Treatment Planning
The Treatment

1,2,3,4.
STEPS
Results
The treatment effect of Gamma Knife radiosurgery occurs gradually, depending on the condition being treated:

Benign tumors.
Gamma Knife radiosurgery results in the failure of tumor cells to reproduce. The tumor may shrink over a period of 18 months to two years, but the main goal of Gamma Knife radiosurgery for benign tumors is to prevent any future tumor growth.

Malignant tumors.
Cancerous (malignant) tumors may shrink more rapidly, often within a few months.

Arteriovenous malformations (AVMs)
. The radiation therapy causes the abnormal blood vessels of brain AVMs to thicken and close off. This process may take two years or more.

Trigeminal neuralgia
. Gamma Knife radiosurgery creates a lesion that blocks transmission of pain signals along the trigeminal nerve. Pain relief may take several months.

A picture is worth a thousand words.
Section 2
Non-invasive Surgical Procedures
GAMMA KNIFE
Leksell Gamma Knife® Perfexion™
From 192 up to 201 Beams of Gamma Rays
Pharmacy
Intercom Plus is Walgreen's proprietary pharmacy computer system
EHR: Electronic Health Records is where we process vaccines such as: Pneumonia, Flu, Shingles, and Meningitis
Filling Process
Step 1:
Step 2:
Step 3:
Step 4:
Step 5:
Step 6:
Step 7:
Pharmacy Back Then
Cost:
Staffing.
Storage:
More vs. Less space.
Security:
Safety.
Access:
Documents needed would have to be recovered from a huge warehouse then mailed or scanned and sent via e-mail which is time consuming.
Readability and Accuracy:
Paper records don’t necessarily have enough space for physician’s to write down all the necessary information and since all the information is written it is also difficult to understand the majority of the information.

Minimal Invasive Surgery
Outpatient/Physician Office EHR
Patient Portal
HealthFusion's MediTouch
Nextgen
Mobile Application
Meditech
EPIC Systems
Cerner
The Future of EHRs:
Smart Card Technology

Germany & Austria
Since 2006, the smart card eGK is used.
Enables secure data storage.
Two cards involved.
-1st card: Holds patient specific applications & prescriptions.
-2nd card: Issued to healthcare professionals

France
In 1998/1999, France distributed smart cards to each family.
In 2006, Carte Vitale 2 cards given with enhanced security features and larger memory.

United States
St.Thomas Hospital in Nashville, TN uses smart card with patient's ID, medical history, personal and insurance information.
VA Hospitals have immediate access to patient files by inserting a smart card and entering a password.
References
Medical Records: Electronic Health Records
A. EHR- Definition/Advantages/Hospital EHR (Jessica)
5 Benefits of EMR vs. Paper Medical Records. (2013, March 19). Retrieved October 10, 2014,
from Carpathia website: http://carpathia.com/blog/5-benefits-of-emr-vs-paper-medical-records/

Fleet, D. (n.d.). Heath Information Management (HIM) History: Past to Current Day. Retrieved
October 10, 2014, from Ramussen College website: http://www.rasmussen.edu/degrees/health-sciences/blog/health-information-management-history/

The French way to smarter health. (n.d.). Retrieved October 15, 2014, from gemalto.com
website: http://www.gemalto.com/brochures-site/download-site/Documents/france_health.pdf

Learn EHR basics. (2014, May 21). Retrieved October 9, 2014, from HealthIT.gov website:
http://www.healthit.gov/providers-professionals/learn-ehr-basics

Patient Records Health Insurance Service Smartcard Data. (n.d.). Retrieved October 15, 2014,
from Smartcardscanada.com website: http://www.smartcardscanada.com/applications/health_service.htm

Ranking Top 10 Hospital by Number of Installed Systems. (2011, March 25). Retrieved October
10, 2014, from DarkDaily.com website: http://www.darkdaily.com/ranking-top-10-hospital-emr-vendors-by-number-of-installed-systems-32511#axzz3G8zTXkHh

Rodriguez, L. (2011, December 12). Privacy, Security, and Electronic Health Records.
Retrieved October 10, 2014, from HealthIT.gov website: http://www.healthit.gov/buzz-blog/privacy-and-security-of-ehrs/privacy-security-electronic-health-records/

Rowley, R. (2011, May 19). The difference between an ambulatory and hospital EHR. Retrieved
October 10, 2014, from KevinMD.com website: http://www.kevinmd.com/blog/2011/06/difference-ambulatory-hospital-ehr.html
What do these numbers mean?


It means we do not have enough donors
to cover the demands of recipients waiting
for organ transplants!

It means we need to find alternative
sources to donated organs!

Sirolimus/Rapamune
8/2000 FDA approves for
for use in transplant
recipients.

Tacrolimus/Prograf
Started in 1994

April 1997 FDA approves
for use in transplant
recipients.


The first successful lung transplant, performed on Nov. 7, 1983 at Toronto General Hospital on Tom Hall. He survived 6 years after his transplant.

Lung Transplant

The first Liver Transplant was performed in 1963.

Julie Rodriguez, transplanted in 1967, was the first Liver Transplant recipient to exceed survival of one year.



Liver Transplant


First Successful Kidney Transplant –
December 23rd, 1954 – Identical Twins- Ronald Herrick donated to Richard Herrick and succeeded because they were genetically identical.


Kidney Transplant

Deceased Individual Also Know as Cadaveric Donor
All Organs and Tissues Shown
1. Eyes 7. Blood Vessels
2. Lungs 8. Kidneys
3. Heart 9. Small & Large Intestine
4. Liver 10. Muscle
5. Pancreas 11. Skin
6. Bone 12. Tendons, Ligaments

Live Family Member or Friend
One Kidney
One Lung
Portion of Liver


Where do the Organs
And Tissue Come From?

Focusing on Solid Organ Transplant

Organ & Tissue
Transplant


Bio-gel scaffolds
ready for stem cells
to be added to make
a new ear or kidney

3D Organ Printing & Stem Cells

How many people are still waiting for an
organ transplant in the United States?

Today intestinal transplants are also sometimes combine with other abdominal organs, known as a Multi-visceral Transplant.
First performed in 1983 By Dr T. Starzl on a 6 year old at The University of Pittsburgh Medical Center.

1988 – First successful Small
Intestine transplant
performed in Kiel, Germany.


Intestinal & Multi-Visceral
Transplant

First Heart Transplant was performed in 1967
in Cape Town, South Africa, Dr C. Barnard,
on recipient Louis Washkansky, who only survived
18 days, dying of rejection.

The first successful Heart Transplant didn’t occur
until 1977 at Columbia University Medical Center
in New York. That patient survived 14 months.

In 1984, the world's first successful pediatric heart
transplant was performed at Columbia University
Medical Center on a four-year-old boy. He received
a second transplant in 1989 and continues to
live a productive life today.

Heart Transplant


Cyclosporine - First truly effective
immunosuppressive/anti rejection
medication. 1983 FDA approves for
use in transplant recipients,
dramatically reducing rates of
rejection and increasing
long term survival rates.

Azathioprine/Prednisone
1968 FDA approves for use in transplant recipients.
Helpful but most recipients still died from rejection.

Primary Immunosuppression/Anti-Rejection Medications

Dialysis started in 1943. It is still the leading treatment
for patients awaiting Kidney transplant.
Increase oxygen use.
Surgery to remove a portion of or whole diseases organs.

Increase medication dosages to maintain organ functionality and pain relief for the patient.

What Was Done Before Transplant?

1968 The Southeast Organ Procurement Foundation (SEOPF) is formed as a membership and scientific organization for transplant professionals.
1984 United Network for Organ Sharing (UNOS) separates from SEOPF.
1986 UNOS receives the initial Federal contract to operate
the Organ Procurement and Transplantation Network
(OPTN). Continuing their Federal Contract to the
day.
UNOS raises awareness about organ donation.
Establishes equitable policies.
Maintains the National Transplant Waiting List.
Maintains a scientific registry.
Facilitates organ distribution and transplantation.
Monitors members for compliance with Federal policies including HIPPA.

Who Controls Organ
Donation & Transplant?

Lungs

Heart

Kidneys

Liver

Large & Small
Intestines

Solid Organs for Transplant

As of 4:25pm on 10/19/2014 - 123,878 people need a lifesaving organ transplant (total waiting list candidates). Of those, 79,325 people are active waiting list candidates.
January to July 2014- 16,883 transplants performed.
January to July 2014- there were 8,277 donors.

What is the Appendix?
Definition
: The appendix is a tube-shaped, sacklike organ, situated in the right-hand part of the abdomen and is attached to the lower end of the large intestine.
No Known Function!!!
Acute Appendicitis:
A condition in which the appendix becomes infected and inflamed.
-If perferation or rupturing occurs, it must be removed before the infection spreads into the entire abdominal space.

One of the
most common
causes of emergency surgury.
- 1/2,000 people has an appendectomy at some point in their life.
Symptoms:
Abdominal pain
Loss of appetite
Constipation
Nausea and Vomiting
Fever

Diagnosis:
Rebound-tenderness test
Pull of Leg
CT scan of the abdomen

Treatment:
A surgical operation (appendectomy) is the only treatment for appendicitis.
Surgical Techniques: Open Appendectomy (OA) and Laparoscopic Appendectomy (LA)
Minimal Invasive Surgery
Open vs. Laparoscopic
OA:
Used for complicated Appendicitis
Severe appendicular inflamation
Significant adhesions from previous surgeries
Children under 5 & pregnancies
Less time consuming

LA:
less intraoperative and postoperative pain medication
less time in hospital
Quick return to normal bowel function
Improved cosmetic outcome
Only 10 minutes longer
Diagnostic ability
The Future "Scarless Surgery"
Single Incision Laparoscopic Appendectomy (SILA)
BENEFITS:
-decline in incisional complications
-improved patient convalescence
-specialized/conventional equipment
Natural Orifice Transumenal Endoscopic Surgery (NOTES)
- No external scarring!!!
Early man discoveries
Pharmacy in ancient Egypt
Terra Sigillata
Galen
First hospital in Colonial America

Orthotics
and Prothetics
Orthotics and Prosthetics (O&P) is the evaluation, fabrication, and custom fitting of artificial limbs and orthopedic braces.
Orthotics is the branch of medicine that deals with the provision and use of artificial devices such as prosthetic,splints, and braces.
Over 200,000 people in the United Stated us a prosthetic of some kind.
1902- while at The University of Lyon- France,
published the technique of vessel suture
now known as “Carrell’s seam”.
The Nobel Prize in Physiology or Medicine 1912
“ In recognition of his work on vascular
suture and the transplantation of blood
vessels and organs”
With out his work in the study vascular suturing-
modern organ transplant would not
be possible

Dr Alexis Carrel


Lungs at one time, could only be out of the
body, for a maximum of 4-5 hours while being stored
in an ice cold preservation solution.
August 12, 2014- FDA approves XVIVO Lung Perfusion
Preservation system developed out of
Englewood, CO.
This new preservation system will now allow lungs to
remain out side the body for up to 11 hours- this
will allow doctors to further examine the lungs before
transplant. It will also allow for greater distance of
travel to procure them and almost double the
available population of possible donors.


New Advancement in
Organ Preservation

Sweden- September 2014 - Vincent - the first
child born from a transplanted womb.
The uterus was donated by a 61 year
old family friend who was already
post-menopausal.
Currently two other women are pregnant with
wombs donated by their mothers and
are due to deliver before the end of
this year.

Creating a New Life

MediTouch
Types of Donors

Medicare
:

Run by CMS.
Maximum incentive amount is $44,000.
Payments over 5 consecutive years
Payment adjustments will begin in 2015 for providers who are eligible but decide not to participate
Providers must demonstrate meaningful use every year to receive incentive payments.
Medicaid
Run by your State Medicaid Agency.
Max incentive amount $63,750.
Payments over 6 years does not have to be consecutive
No payment adjustments for providers who are only eligible for the Medicaid program
In the first year providers can receive an incentive payment for adopting, implementing, or upgrading EHR technology.
Meaningful Use Regulations
13 required core objectives
5 menu objectives from a list of 9
Total of 18 objectives
Eligible Professionals
Eligible Hospitals
11 required core objectives
5 menu objectives from a list of 10
Total of 16 objectives
Stage 1
Stage 2
• Numerator and denominator
thresholds
• Exclusion criteria
• Definitions of important terms
• Requirements for achieving the
objectives
• Certification information that
corresponds with each objective
CMS developed specification sheets for eligible professionals and eligible hospitals.
Laws & Incentives
Rx Connect is the system that CVS pharmacy use to process prescriptions
Steps to insert a prescription to the system
Pharmacy In The Future
Pharmaceutical Robots
3 Million Dollar Robot "Ernie"
Prosthetics
Prosthetic – a prosthetic is an artificial body part.
There are many different types of prosthetics. The kind used depends on the placement and functionality necessity. The most common are:
Joint Prosthetics
Arm/Hand Prosthetics
Leg/Foot Prosthetics
Cosmetic Prosthetics
Cosmetic prosthetics often encompass both cosmetics and functionality but can be purely cosmetic.
Joint
Prosthetic
Arm/Hand
Prosthetics
Leg/Foot
Prosthetic
Cosmetic Prosthetics
Causes For Prosthetic Needs
Amputation of a limb is the main reason requiring a prosthetic. The most common cause of amputation is poor circulation caused by damage or narrowing of the arteries, called peripheral arterial disease. Aside from amputation other causes may include severe injury (from MVA, burn, etc.), cancerous tumor in the bone or muscle of the limb, serious infection, and frostbite.
Restoration of functionality is another common reason (joint replacement.)

Advantages of
Using A Prosthetic
Restores functionality of a limb by replacement of a worn out joint.
Replaces an amputated or decapitated limb or body part.
Provides comfort to someone who has suffered a trauma where, although the prosthetic is
not a necessity, it offers the user the opportunity to resume a normal life.
The Cost
of Prosthetics
The average cost of a leg prosthetic can range between $5,000 and $50,000 depending on the functionality and materials. The average cost of an arm prosthetic between $3,000 and $30,000. However, even the most expensive prosthetic limbs are built to withstand only three to five years of wear and tear. Making the lifetime total much higher.
This price is influenced by materials such as stronger, less dense alloys and plastics, carbon fiber and aesthetics.
Also, whether or not technology plays a role in the prosthetic.
Who Pays
These Costs?
(EHR)
Medicare
Medicaid
VA
Private Insurance
Private and Non-Profit Organizations
More Organizations Available for Children

Prosthetics in the
Past...
In the past, prosthetics were made of fiber, wood, iron, and bronze.
After the Civil War, a need for more practical and more easily available artificial limbs was a necessity. At this point, the US government started funding the production of artificial limbs.
In the past half century, artificial limbs started becoming more life-like and using lighter and more durable materials.
Now-a-days, prosthetics have made exponential improvements in functionality and durability. They now use materials such as carbon fiber and have highly improved attachment methods. The addition of microprocessors and other computer-aided designs further improve the use and functionality of prostheses.
They now have sensors which detect nerve impulse causing the prosthetic to function as a natural arm would.
Scientists are now working on prosthetics that may include sensory reception as well. This would allow the recipient to feel temperature and moisture changes to prevent accidental damage to the prosthetic as well as provide a "feel of normality" for the wearer.
Future...
Present...
Pharmacy Systems
Questions & Answers
1. What is the main reason someone might need a prosthetic?

2. What is the name of the Walgreens pharmacy system?

3. Why was the first Kidney transplant a success?

4. What are some of the benefits of Laproscopic Apendectomy vs Open Apendectomy?

5.What is the name of the robotic system at Walgreens?

6. Name an advantage to using Electronic Healthcare Records compared to paper Healthcare records?

7. What are the kind of conditions can be treated with Gamma Knife?

8. In order to receive incentive payments- providers must show they are meaningfully using their EHR technology. True or False?
Full transcript