Co-Evolution of Man and Machine: Neuroprosthetics in the 21st Century

NEUROPROSTHETICS IN 21ST CENTURY

Promise of Neuroprosthesis

Develop communications pathways between the brain and external devices to restore lost sensory, motor, or other internal
neural function.                         

Use the device to bypass injury or aid  in rehabilitation

Direct contact with body’s command and control systems

Seamless, intertwining of electronics, mechanics and materials.

Biomimicry : Closely replicates physiological function.      

              Figure 1

 

THE 21ST CENTURY BIONIC HUMAN

Figure 2

TRANSLATING THOUGHTS INTO ACTIONS  : THE NEURAL CODE

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Figure 3

 

THE NEUROPROSTHESIS DESIGN

Neural Information Processing , Adaptive Signal Processing , Feedback Control  

 

Figure 4

 

THE NEUROPROSTHESIS DECODING THEORY

Supervised and Unsupervised learning have been the key players in BMI design.

 

Figure 5

THE NEXT GENERATION BRAIN - MACHINE INTERACTION

Intelligent behavior arises from the actions of an individual  seeking to maximize received  reward in a complex and changing world.

Figure 6

Perception-Action Cycle:  Adaptive, continuous process of using sensory information to guide a series of goal-directed actions.

THE NEW FRAMEWORK

Co-Adaptive BMI involves TWO intelligent  agents involved in a continuous dialogue!!!

Figure 7

Figure 8

 

THE INFORMATION IS TAKEN FROM

Co-Evolution of Man and Machine: Neuroprosthetics in the 21st  Century

Justin C. Sanchez, Ph.D.

Assistant Professor

Neuroprosthetics Research Group (NRG)

University of Florida

http://nrg.mbi.ufl.edu 

jcs77@ufl.edu

Biogas Generator : A Renewable Energy Project Kit

Build Your Own Biogas Generator : By The Pembina Institute

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BRAIN SENSE - The Preface

BRAIN SENSE - By Faith Hickman Brynie

It makes a very good reading...

The Preface : Falling in Love with Science

I don’t recall when I first fell in love with science, but I remember the day when I said, “’Til death do us part.” I was counting raspberry bushes. They grew wild around the abandoned strip mines of Appalachia. As an ecology student at West Virginia University in Morgantown, I clambering around an old mine’s precarious slopes with twenty other eager undergraduates. We shot line transects and counted the bushes, orienting our test sites by the compass, while measuring roped-off segments ten-meters square for careful counting and mapping. The day was hot and sticky. The prickly bushes tore our clothes and gouged our flesh. Black coal dust clogged our lungs. Sunburned and sweaty, we learned

that wrestling truth from reality was difficult . . . and fun!

Field science infatuated me that day, but my pledge of lifelong devotion to

the scientific process came a few days later, when we pooled data from several

teams. We made graphs of numbers of raspberry bushes, north and east, upslope

and down. The graphs sang to me. Their meaning popped off the page and danced

around my desk. In axes, points, clusters, and lines, the numbers of raspberry

bushes revealed the history of the mine. In the days long before ecology became

a household word, those bars, dots, lines, and curves mirrored the fifty-year history of the mine, disclosing how the site had been worked, when it had been

abandoned, where the acid mine drainage had polluted most, and how nature

had attempted—with wild raspberries—to bandage the land so it could heal from

within. The data painted a picture more beautiful to me than any art museum

masterpiece.

From that day on, I never questioned my choice of a career. It was science

for me, in some form, and I’ve tried quite a few. In the bacteriology labs at WestVirginia University, I grew on agar culture plates the acidophilic microorganisms that can survive in acid mine drainage when nothing else can. At Oak Ridge National Laboratories, I zapped protozoans with ultraviolet light to see if they would die. They did. At West Virginia University Medical Center, I worked under a grant from the U.S. Army, screening the effects of possible new malarial drugs on blood samples run through a labyrinth of tubes, reaction vessels, and colorimeters. (Computers do all that now.) In Colorado, I mixed reagents for thyroid tests in a medical lab. I stuck thermometers down prairie dog burrows in Rocky Mountain National Park, and I set up anemometers in mountain meadows.

Then I got into science teaching and educational reform because I wanted every

young person to fall in love with science just as I had. Writing curriculum and

designing educational materials led me into topics ranging from medical genetics

to land use planning.

In the early 1990s, I read a sentence that riveted my attention. The neuroscientist

Richard Restak wrote, “The [human] brain is the only organ in the known

universe that seeks to understand itself.”1 That sentence stopped me dead in my

tracks. Here was the science of science itself—an organ of tissue and blood attempting to understand its own functioning. To my mind, that was bigger than

malaria drugs, bigger than burrowing animals, bigger even than my raspberry

bushes. I couldn’t wait to find out what neuroscientists were doing with their

brains as they attempted to comprehend . . . their own brains! So I started digging

though the scientific literature and eventually I wrote a book called 101

Questions Your Brain Has Asked About Itself But Couldn’t Answer . . . Until Now.

The book was moderately successful, garnering a “Best Book” honor from the

American Association for the Advancement of Science in 1999. The book is now

in its second edition and continuing to make a contribution, I hope.

For me, however, one hundred and one questions formed only the tip of the

iceberg. The more questions I asked and the more I read and learned, the more

I wanted to know. I became fascinated with research on how the brain and senses

interact—thus this book’s title, Brain Sense. “Brain sense” is a field that many

tillers are plowing: the neurologists who study the interaction of peripheral and

central nervous system; the brain mappers who chart the regions of the brain that

handle specialized functions and the nerve networks that connect those regions;

the biochemists who probe the molecular receptors that initiate the impulses

of the chemical senses; the biophysicists who explore how light and sound waves

can sometimes translate themselves into sensory perceptions; the physicians and

surgeons who seek to treat the maladies that befall the senses and the brain; the

engineers and biomechanicists who try to understand how perception works so

they can construct devices ranging from prosthetics to virtual reality simulators;

the cognitive psychologists who want to understand how we learn; the behavioral

psychologists who hope to explain why we do the things we do; and the clinical

psychologists who strive to cure the intellectual, social, and emotional sequelae

of sensory perception gone awry.

The organization of this book follows traditional lines. There’s a part on each

of the five major senses: touch, smell, taste, vision, and hearing. The book begins

with touch because, in my opinion, it’s the least appreciated of all the senses

and perhaps the most vital. We explore the chemical senses next, because taste

and smell work in similar ways. Next come sight and sound, the senses that we

rely on the most and can trust the least.

In the individual chapters about each sense, I’ve tried to include some stories

about how ordinary people live when their sensory capacities are diminished

or lost. I’ve also included as much of the latest in scientific research as I could

jam onto each page. There is so much going on in brain-sense research, I can

scarcely scratch the surface here, but I hope that the studies I’ve chosen for inclusion impart some sense of the endless fascination of that work.

Throughout these chapters, you’ll notice two recurring themes. The first is

brain plasticity. Plasticity means that the brain changes throughout life. Once,

we thought of the adult brain as fixed and unchanging (except for the deterioration that comes with age), but research in the last two decades has shattered that notion. The brain is constantly rewiring itself, reshaping its own structure, recruiting new circuits to perform its work when old ones are damaged or lost.

It even re-creates memories each time it retrieves them. The implications of brain

plasticity for understanding our senses, our consciousness, and the essence of

what it means to be human are nothing short of staggering.

The second theme is what I’ve come to think of as a negotiable reality. We

believe in our senses, and we trust that they are providing us with objective, complete, and accurate data about the world around us. We are wrong. Our brains

construct our reality, molding every input to what we expect, what we imagine,

what we wish for. Our brains have minds of their own. They shape light waves

into expected images, sound waves into patterns ranging from noise to music.

Our sense of touch is malleable, variable, and refinable. We taste and smell what

we believe we will taste and smell. In precisely the same environment, you and

I will neither see, hear, taste, touch, nor smell the same things—nor will we draw

the same conclusions about the information our senses have collected. Our personal worlds are constructions built by our brains using the raw materials of the senses—raw materials that are greatly modified during the construction process.

That idea of a negotiable reality is the reason for the last part of this book,

“Beyond the Big Five,” which looks briefly at some of the other “senses” or sensory

experiences that don’t fit with the big five but are too intriguing to ignore,

such as the mingling of the senses known as synesthesia, the experience of déjà

vu, the phantom sensations and phantom pain often experienced by people who

have amputations, the possibilities and probabilities of extraordinary sensory perception, and the brain’s sense of time kept by a body clock far more precise than most of us realize.

I hope that people who know a lot about the brain and the senses will read

this book. I hope that people who know very little about those topics will read it,too.

For those readers who are interested in the brain and the senses but don’t

know much about the brain’s structure and function, I’ve included an appendix

at the end of the book, “The Brain and the Nervous System—A Primer,” which

provides a short course in neuroscience and explains many of the terms and concepts used in this book. It also includes diagrams showing the locations of many of the brain regions discussed in the book. Before long, you’ll know your occipital lobe from your parietal, and you’ll be well on your way to comprehending your own “brain sense.”

From beginning to end, this book is many things. It’s part memoir because

it’s my opportunity to reminisce about some things I’ve learned from science and

from life. It’s part investigative reporting because I’ve delved into the work of some cutting-edge researchers who are designing clever experiments to gain answers to questions that we didn’t even know how to ask a decade ago. It’s part biography because I want you to know—as I have come to know—what real scientists are like as they work in real labs on real questions that have never before been answered. It’s part textbook because basic knowledge about how our senses work is important to everyone. It’s part history because we can’t appreciate where we’re going if we don’t value where we’ve been. It’s part newspaper because it contains some of the late-breaking stories that are making headlines on a daily basis. It’s part travel journal because I invite you to fly with me as I visit working neuroscientists in Washington, Minnesota, Michigan, and Massachusetts. It’s part

personality profiles because the scientists I met and talked with are intriguing

people, doing interesting work and living full and satisfying lives. I want readers

of this book to see scientists as I have seen them—not as geeky weirdos in lab

coats, but as warm, humorous, engaging human beings who thrive on the search

for knowledge as they toil among the “raspberry bushes” of their chosen research

specialty.

Most of all, this book is a tribute to courage and to some of the wonderful

people who shared their stories with me: the tour guide who faced death as her

ship sank in Antarctica; the hairdresser who lost her sense of smell to brain injury; the woman who had a mastectomy but continues to feel her breasts; the

young poet, born deaf, who had a cochlear implant; the synesthete who sees letters in colors; the electronic genius who engineers phone lines and ignores his

tinnitus; the teenager who was born without the sense of touch and the mother

who has loved him totally and unconditionally through all he has achieved.

Finally, this book is a love letter to science and scientists. I’ve been wedded

to science all my life, and my fascination with the questions, methods, and inferences of scientific research has never diminished. Science isn’t the only way

to see, to know, to understand, but it’s the one that won my heart. Come meet

the love of my life.

Tips to master the Web

Tips and Tricks - MASTER THE INTERNET

Save time as you shortcut your way through the Internet with these nifty, must-know tricks

1. Receipt notification

If you have a really important message and need to know if it’s been received, use a feature called Read Receipt in Outlook Express. This feature is available on most e-mail clients and requests the recipient to confirm that he has received the message by a return e-mail.

To do this while composing a mail in Outlook Express, click on Tools > Request Read Receipt in your message window. If you desire, you can have all your outgoing messages sent with the Read Receipt notification. For this, go to Tools > Options, click on the Receipts tab and tick ‘Request a read receipt for all sent messages’. Remember, the read receipt confirmation is dependent on the e-mail client the recipient is using and also whether he wants to send the confirmation.

2. Adding signatures to your e-mail

If you send a lot of mail each day, then a repetitive task like signing your name at the end of each mail can be quite tedious. It’s easier to create a signature and attach it automatically to every mail that’s sent. To do this in Outlook Express, go to Tools > Options > Signatures. Then go to New and add the contents of the signature in the Edit Text field. Also select the option of sending the signature automatically with all outgoing messages. In case you don’t want to send this with replies or forwards, enable the option, ‘Don’t add signatures to Replies and Forward’. For creative signatures, use the option to append a file that contains the signature you have created. If you happen to have multiple e-mail accounts, select the account with which you want to send the signature. To do this, go to Tools > Options > Signatures and click on the Advanced button near the Edit Signature tab. A new box will appear saying ‘Advanced Signature Settings’ where you can select the account with which the signature should be automatically added.

3. Auto-respond facility

Won’t be checking mail for some time? Activate a feature called ‘vacation reply’ (if you are using a Web-based service). Most e-mail services such as Indiatimes provide this feature which can be activated through the options menu. You can type a short message which will be sent to all who e-mail you while you are away. In Outlook Express, you can do this from Tools > Message Rules > Mail and clicking on the New Rule option. Select the ‘For all Messages’ options from the condition for your rule field and in the Action select Reply with a message. You will have to select a message that you have already created and saved.

4. Keep a copy of the message

If you are on a trip and want to access your e-mail from another machine, keep a copy of your messages on the server of your e-mail service provider. Go to Tools > Accounts and select the account (if you have multiple accounts), then go to Properties > Advanced. Check ‘Leave a copy on server’. This has one more advantage: if you’ve formatted your machine without taking a backup of your mail, you can retrieve the mail as a stored copy.

5. Disable MSN Messenger from auto-starting

Whenever one opens Outlook Express or Microsoft Outlook XP, MSN Messenger loads automatically. To disable it, go to Tools > Options in Outlook Express and uncheck ‘Automatically log on to MSN Messenger Service’. Then go to View > Layout and uncheck the option of Contacts. In Microsoft Outlook XP, go to Tools > Options > Other and uncheck ‘Enable MSN Messenger’. The over-eager Messenger won’t be so eager now!

6. Optimising your Inbox

A three-step process to ensure that your Inbox never looks cluttered.

1. Organising: Outlook Express allows you to create folders within which mail can be organised. To create a new folder in Outlook Express, go to File > Folder > New. This will display the directory tree of your Inbox. Just select the location (say Inbox) where you want to create a folder and enter the Folder Name. Or, you could use the shortcut [Ctrl] + [Shift] + [E] and enter the Folder Name. You can also drag and drop folders to change their location. Folders can be quite useful, especially if you have multiple accounts configured on the same identity or to sort out e-mail messages on the basis of sender, subject, etc.

2. Filtering: Message Rules can automatically sort your mail into the appropriate folder as soon as it is downloaded. Specify the folders where you want the messages to be downloaded based on names in the From address, names in the To address, certain words in the Subject line or in the message body.

Go to Message > Create Rule From Message. Create a rule selecting the appropriate options offered, and the next time you download your mail, it will be sorted according to the rules created.

You can also sort your existing messages based on the message rules created. In Outlook Express, go to Tools > Message Rules and click on Mail. You will get a list of the message rules you have created. Click on ‘Apply Now...’, select the rules to apply, and click on Apply to filter your existing folder.

3. Grouping: Outlook Express allows you to group e-mail messages on the basis of the conversation carried. To enable this, go to View > Current View and click ‘Group Messages by Conversation’ (In Outlook, this option is available from View > Current View > Conversation Topic).

With this feature, all e-mail messages are sorted on the basis of the subject line and the messages that are a reply to that particular subject are grouped together. A ‘+’ sign next to a message indicates responses based on that subject.

7. Download Mail to your PC

If you use a Web-based e-mail service, such as those run by Yahoo! and MSN, download a copy of your mail directly to your browser. This is much quicker than using the bandwidth-hungry Web interface and also allows you to access your mail without having to be connected to the Internet. To do this first add a new account by going to Tools > Accounts > Add and select the Mail option. You will be prompted for personal details and account information.

Select the POP3 server option in the screen that asks you for your e-mail server information and enter the appropriate POP3 server address for incoming mail.

8. Browsing offline

Quite often you may want to refer to a page that you have visited at some point in time. While finding the link in your browser’s History is not too difficult, you can view the site without actually logging on to the Internet by going to File > Work Offline. Then just click on a link in your History folder to view the complete page from your hard disk.

9. PC-to-PC calls

Buddy Phone, Yahoo! and MSN Messenger allow users to make phone calls from one computer to another, provided both computers are online. If you would like to use this facility in MSN Messenger, select your friend’s name from the list and go to Actions > Start a voice conversation. This can also be done by right-clicking on the person’s name and selecting the option of ‘Start a Voice Conversation’. After the opposite person has accepted your request, you can start talking into the microphone.

10. Split files

Splitting files can increase download speeds tremendously in FlashGet. Usually, splitting the file in three or five segments is sufficient. However, if you are downloading a particularly large file which is available from several servers, you could get better speeds by increasing the number of segments being downloaded simultaneously.

The number of segments that you want the file in can be set in the option box that pops up when a download begins. Just set the option for the number of segments that you want the file to be split into.

e-healthcare

e-healthcare (U.S.A - in context )

By :

Hongwei Du College of Business and Economics California State University, Hayward Hayward, CA 94542

hdu@csuhayward.edu

Ben Bradford California State University, Hayward Hayward, CA 94542 ben@benbradford.com

Rostam Assadi-Shehni California State University, Hayward Hayward, CA 94542 rostam@cwnet.com

Vikram Gandhi California State University, Hayward Hayward, CA 94542

vgandhi@csuhayward.edu

WHAT IS E-HEALTHCARE?

According to University of La Trobe e-Healthcare is defined as “a way of delivering and achieving better health outcomes through effective and innovative use of health information.” The author then defines e-Healthcare as the means “to provide high quality health care to all health consumers.”

Providing e-healthcare for the consumers will in turn “increase home care by remotely monitoring chronically ill patients in their homes,” and it will also “reduce the need for hospital care for patients.” It is further developed that the use of e-healthcare for educational purposes “through the use of information technology reduce errors, wastes, and costs.”

Nevertheless, we developed our own definition of what e-healthcare is all about. After thorough research through the Internet, visiting many sites, and analyzing the information we gathered, we have a thorough understanding of this business means. We were amazed to see how the healthcare industry running to catch up with the rest of the crowed who are already tuned into what we call free E.

We found many sites that they provide free healthcare advices to their patients, consumers, or visitors on drugs, diseases, prevention programs, and some sites go as far as diagnosis of many illnesses and recommendations for treatments.

EFFECTIVENESS OF E-HEALTHCARE

Leonard Schaeffer, the former head of the Medicare and Medicaid programs, explained some of healthcare’s challenges at a conference recently: “Current rates of healthcare spending growth are clearly not sustainable, and those trends will be further aggravated by the aging of 78 million baby boomers who want to look good, to feel good, and to live forever” (Rovner, 2004).

Indeed there are many challenges facing our health care system today like rising healthcare costs, safety and privacy issues, the aging of the baby boomer population, and many other challenging problems affecting the world’s most advanced healthcare system. The healthcare challenges that we are facing today are being combated by range of methods. One method, e-Healthcare, is a new technology that is being used mainly due to the advancement of the Internet. For example, the integration of the Internet into healthcare can speed the transmission of information, globally connect physicians to collaborate on services, such as telesurgery, and provide access to physicians and people that were once thought unattainable. E-Healthcare is providing significant opportunities for healthcare providers to deliver technologically effective healthcare services to their consumers and provide consumers with ways to access the information the consumers need.

From a Provider’s perspective e-Healthcare can be a suite of IT related tools that enable the provider to deliver higher quality and more effective services. One area of medicine where you will find e-Healthcare related products is in Radiology. Radiologists use IT related products to transfer images across physical boundaries so that they can read digital film anywhere in the country at any time by logging onto the Internet. These systems utilized by Radiologists are called PACS (Picture Archiving and Communication Systems) and when combined with a web-enabled front-end, image, it can be stored digitally in a central location ready to be accessed through the Internet.

McKesson Corporation, a healthcare services / information technology company, has recently upgraded their Horizon Imaging System, which is a PACS / Radiology Information System product, to include “a Web-based workflow system for managing the full range of radiological functions, including management of patients, films, clinical history, electronic signatures, claims preparation and management reporting” (McKesson Corporation, 2004). The Horizon Radiology system is an effective e-Healthcare tool because it allows a physician to have access to patient history, images and reports to help the Radiologist give a better interpretation of the films that he/she is examining. The most effective part of a PACS system is the ability to store data digitally and be able to access it at any time and in any place ultimately delivering productivity gains for Radiologists and their staff. "The result should be improved clinician productivity, better and faster access to information, and ultimately, faster diagnosis of patient conditions so that treatment can begin" (McKesson Corporation, 2004).

Radiologists also use a tool called CAD (Computer Aided Detection) in Mammography and other imaging related modalities such as CT (Computed Tomography), and MRI (Magnetic Resonance Imaging). In layman’s terms, CAD is a tool that a Radiologist activates that scans a digital image and points out certain abnormalities in an image that a Radiologist may or may not have detected by the human eye. Many times, this computer aided tool can be an effective tool to assist a Radiologist in making a diagnosis and can even prevent the staff from utilizing a second Radiologist to interpret the image. It has been reported that “CAD can help doctors find almost 20% more breast cancers than they would have without using the technology” (Yee, 2004).

CAD assistance for modalities such as mammography has made a significant impact on the effectiveness of a Radiologist. Breast cancer screening with mammography is a hot topic and CAD’s strength is the ability to detect small cancers in the early stages. A 2001 study conducted by Drs. Timothy Freer and Michael Ulissey utilized conventional mammography reading techniques as well as techniques utilizing CAD to diagnose over 13,000 women. It was reported that the physicians found almost 20% more cancers with CAD (Yee, 2004).

Some Radiologists expect the CAD systems to evolve and assist in the diagnosis process, appropriately termed – computer-aided diagnosis. Effective and highly paid Radiologists are those that can read images quickly and error-free. The higher the throughput for reading images, the more money the Radiologist will make. CAD can help the Radiologist be more effective and be speedy because half the work will already be done for them; in theory, what’s left is monitoring the system to make sure it has appropriately diagnosed the image scan (Yee, 2004).

It is foreseen in the future that CAD could be an effective diagnostic tool if poorer communities are unable to afford a Radiologist or at least a full-time Radiologist, although this issue is highly controversial but has promise. However, it is quite clear that CAD will not replace an experienced human-being like a radiologist that must undergo years of intense training to be able to interpret and diagnose imaging studies (Yee, 2004).

Virtual Colonoscopy & the Use of CAD

Virtual Colonoscopy is a fairly new e-Healthcare technology that is being utilized by gastroenterologists to detect cancerous polyps in the colon region. “In a regular colonoscopy, a gastroenterologist inserts a scope into the rectum, and a camera provides video images of the colon. The 3D scan creates a similar view, and even allows a radiologist to zoom back and forth through the image of the colon and take a second look -- something you cannot do with regular colonoscopy”(Parker-Pope, 2004).

Anyone that has ever had a regular colonoscopy understands the major discomfort that one must endure before and after a study has been performed.

A virtual colonoscopy reduces the discomfort but also provides a much clearer image of the colon, allowing the radiologist to make a more accurate assessment of the diagnosis. Virtual colonoscopy produces “huge datasets that have to be reviewed by doctors, often taking 20 to 30 minutes for each study”. With the introduction of CAD to assist the radiologist in examining the 3d images, the ability to identify certain concerns in an image will help the radiologist reduce the time necessary for the exam and potentially point out polyps that are difficult to diagnose (Parker-Pope, 2004).

Telesurgery

An example of effective e-Healthcare technologies can be found in new telesurgery products that are helping doctors perform surgeries. One such hospital, Kapiolani Medical Center for Women Children, broadcast live surgeries for physicians to participate in from around the world. The surgical suites that cost in excess of $1.5 million will use high-bandwidth video conferencing tools to connect doctors that are outside the hospital (Sawada, 2004).

Another added benefit of this e-Healthcare product also allows patients to stay in Kapiolani as opposed to being transported abroad for costly operations. Not only will it be cheaper for the hospital and the patient, but it will reduce the duress associated with an emergency situation as well as provide the same level of care that the patient would have received abroad (Sawada, 2004).

Proliferation of Telesurgery

A new and very exciting e-Healthcare tool used in Radiology that is in its infancy is called Tele-immersion. Surgeons are faced with the fact that they must examine 2D images to perform a procedure on a patient that is obviously 3D. A Radiologist always examines 2D images but rarely can see the image translated in 3D. When a Surgeon is performing a procedure, he or she must rely on the Radiologist to translate the 2D image before the cutting takes place (Sandrick, 2004).

Dr. Jonathan Silverstein, a director of the Center for Clinical Information at the University of Chicago, has developed a tele-immersion system with a team of Radiologists that “superimposes anatomic images onto patients while they’re operating” (Sandrick, 2004). "Surgeons can get 3D views that show where vessels are in relation to a tumor. They can turn the views into different orientations to truly understand anatomic relationships, to see where a tumor is so they can reach out and get it," Silverstein said (Sandrick, 2004).

This new e-Healthcare tool is creating more effective communication between the Radiologists and Surgeons by allowing them to view their information in the same orientation at the same time. The system sends images to head-mounted displays that surgeons can see around and past.

It also allows for Radiologists to communicate with surgeons through an instant messaging type device and also the ability to push images to the surgeon to help in the procedure. The tool will also allow for Radiologists to draw circle or arrows on images to flag important items and to follow the entire surgery from the comfort of their office. In fact, it is the same type of communication if the Radiologist were to be in the operating room with the surgeon (Sandrick, 2004).

The Internet as an Effective E-Healthcare Information Tool

The proliferation of the Internet has allowed for patients to have access to more information regarding their health care. Everyone says these days that you have to be your own advocate when being given medical advice. Take for instance my mother, who recently came down with breast cancer; my mom was scared to death mainly because of the unknown. In a matter of 2 hours my mother’s fears had rescinded because she educated herself by accessing information on breast cancer on WebMD. What she found was a wealth of information on what breast cancer is, how it is defined, how it is treated, and the success and failure rates of current treatment methods. When she went in to see her medical oncologist she could fully understand the lingo, the treatment methods she was being told, and she was able to discuss with him how she wanted to be treated due to the knowledge she had gained.

Harris Interactive performed a study in March 2004 centering on Healthcare statistics on the Internet. The study concluded that 111 million adults have looked for health related information on the Internet. Also according to the study WebMD was a top choice for web surfers seeking information online (Greenspan, Robyn, 2004 - 1).

Not only do patients have more information on the Internet than ever, but doctors do as well. The Internet has allowed doctors the means to seek out and research information on diseases, treatments, and studies to help serve patients. The Boston Consulting Group and Harris Interactive found that “doctors who have adopted electronic medical records, electronic prescribing, online communication with patients and remote disease monitoring say such tools have boosted their efficiency and quality of care” (ClickZ Stats Staff, 2004).

E-Healthcare Shortcomings

Even though e-Healthcare is an effective tool that the public, healthcare providers and insurance companies are promoting in this new Internet age, the tool has a few shortcomings. A new term dubbed, Cyberchondria, is the name given to those who self-diagnose their healthcare problems by solely visiting the Internet (Greenspan, 2004 - 2). While the information on the Internet can be an effective source for gaining information regarding illnesses, treatments, and health services, the data can sometimes be faulty.

A survey by Harris Interactive cited a significant outbreak of Internet users who go online to look for information regarding healthcare (Greenspan, 2004 -2).

Although the information on the Internet can sometimes be faulty, generally the public believes that the information they gather on the Internet has improved their health services they receive. A survey conducted by the Pew Internet & American Life Project claimed that nearly 2,000 of their respondents felt that online resources can help them become well-informed patients regarding the health information and services they receive via the Internet (Greenspan, 2004 - 3).

Another major problem of e-Healthcare is the security implications that are associated with transferring sensitive and personal data through the Internet. It will be important that the e-Healthcare systems of today in the future accurately handle consumer’s privacy, ethics, and security. A report sponsored by the California HealthCare Foundation and the Internet Healthcare Coalition found that 6.3 of the 37 million users who do not currently use online health information, do not do so because of privacy and security concerns. The study also explores several measures like password encryption and other security measures that can be undertaken by website operators to have a positive impact on a users desire to share personal health information online (Pastore, 2004).

The report also highlights that many users are not fond of the mixing of advertorial content and commercial sponsorships on sites where personal health information is being collected. Many users are concerned that insurers could access this personal health data to limit their insurance coverage or employers could limit job opportunities if this information were ever shared (Pastore, 2004).

THE EFFICIENCIES GAINED BY UTILIZING E-HEALTHCARE

This is being achieved through a collaborative program between healthcare providers, patients, and information technologist as we have described thus far. Also it is further developed by the instant access to comprehensive and standardized health records; the integration of hospital, community, insurance industry, pharmacy, government, home and educational health management systems; and the provision of computer based training programs to health professionals. All that means nothing without the right educational background to make this work; and this is where we come in, the information technologist.

Furthermore, although we would love to have each one of our colleagues at the disposal of a doctor’s office, insurance company, school, pharmacy, and so on so forth, we created the technologies for people to be free, for their convenience, to provide personal freedom and independence for people through the use of technologies so that they have more time to enjoy their lives, as it was intended by whomever or whatever who has created us.

How Will E-Healthcare Deliver Efficiencies in the Future?

Speaking of goods, we may want to look at some of advantages of this system and address some of the concerns raised by the healthcare community.

• Advantages and Concerns:

i. Increased efficiency: We have already discussed the bad doctors’ handwritings that have caused so many deaths already. This is a serious matter that often taken as a joke. However, even if we do manage to find the patient’s chart, most often doctors does not have all the pertinent data, such as patients’ medical history and background information when making their assessments.

However, with a system such as EMR, Electronic Medical Records which is the backbone of e-healthcare system, we do not have to wait or be present for obtaining our own medical records to be transferred to another healthcare provider so that someone else can use the information to make the right diagnosis when providing healthcare for us. The reduction of paper trails, time saved for both of us, the doctors and the patients, when going through the whole medical-life-story every time visiting a new doctor, are just bonuses of efficiently using our resources.

Memorial Herman Healthcare System describes a real life example where Dr. David Bauer indicates, “An area where we have been able to quantify benefit is dictation costs. Since implementing Logician, our dictations have dropped by 81%. And since the dictations that are being done are electronically placed in the Logician chart, we are also saving the labor costs previously associated with pulling paper charts and inserting dictated notes.” Please see for more information.

ii. Improved accuracy: The lab tests and digital scanning methods can be entered quickly, easily, and accurately into an EMR system which can dramatically reduce the probability of error. Because the content is electronic, there is never an issue with illegible or unreadable text.Example: The River Health System reports that they had “significant improvements in immunization and diagnosis rates.” Please see <http://www.medicalogic.com/emr/user_experience/riverside.html> for more information.

iii. Address Accuracy concerns: High accuracy is a prime formulation of an e-healthcare system. The system achieves this by properly documenting every aspect of a healthcare

can provide decision support at the point of care. It can be used to track patient follow-up activities, patient compliance, and patient progress. Furthermore, At Providence Healthcare System Dr. Le Blanc testifies that Logician software that is implemented by the e-health system saves the day for a patient when “the orders for patient’s cardiac workup were rescinded, the patient did not have to undergo an expensive and duplicative battery of tests, and she went for immediate surgery to repair her injury."

Please see <http://www.medicalogic.com/emr/user_experience/providence.html> for full story.

v. Better resource allocation: When visiting a clinic, we can see how small the patients’ rooms are. “The Valuable space used to manage and store paper records can be reallocated for exam rooms or offices.” Also, we always have to spend a few minutes of our valuable time for the nurse keep looking for our records, only to come back to tell us that she could not find our records because she is either looking under our last names when we actually go by our middle names, they file our charts under our middle names but we actually go by our last name, the file is still seating on doctors’ desks because the good old doctor needed to discuss our healthcare plan with our healthcare providers to know what drugs are covered what are not, or simply they have lost the chart. These are not if statements, all of which did happen to me, and I am sure I am not the only one. We would like to have less time spending on pulling our charts, if they can find them and read them, and spend more time providing quality healthcare for us. Also, only God knows how many trees they have to cut down to file so many charts stored on those hospitals and clinics. No more paper trails period. Lets have the prescriptions e-mailed to our local pharmacy to pick up in our way home. How long do we have to wait in our local pharmacies to have our prescriptions filled? If we were that healthy to wait up, standing for that long in a local pharmacy store, then it was not our bodies that needed to be examined, but our minds.

If interested to learn more, please see a detail description of calculations of a healthcare provider since the implementation of their new e-healthcare backbone at:

<http://www.medicalogic.com/emr/user_experience/capregion.html>

vi. Address Security Concerns: We have heard many stories about how certain individuals, when getting fired or simply unhappy on their jobs, tamper with confidential information that are strictly doctors-patients’ prerogative confidential information. “Unlike paper records, access to EMRs can be restricted, so staffs have access to records based on job function. Audit trails track record access and usage.” These are password-protected files that are only accessible to healthcare professionals on need to know basis. As far as the communication across the network is concerned, we can always create a VPN, virtual private network, between the places we feel they must use high secure line of communication, firewalls, the state of the art encryption technologies, and so much more that insures the safe keeping of the information, transmission, and access.

vii. Reduced malpractice costs: It is further developed that e-healthcare system reduces the cost associated with malpractice insurance, insurance fraud, and so much more that is a burden to our society in general. Improving documentations and a properly developed database system for an e-healthcare system insures accessibility, readability, availability, and just about any other positive adverb as we said before in the beginning. The subject of audit and trail could

system in its roper order, place, and in a timely fashion- that is as fast as a computer can save the information and retrieve the pertinent data. This makes it easy to access the data and cataloging the most frequently used information, and facilitates the communication between healthcare professionals who often make assumptions based on experience and not pertinent data, which is scarcely available at their disposal.

iv. Improved patient care: The system can support a preventive care directly, by providing many information on a multitude of health risk hazardous materials, side effects of drugs, either over the counter or prescription drugs, preventative measures for the consumers, daily intake of products on the market place, dietary plans and so much more. Also, E-healthcare system

have never been any easier when the search for a claim is just the mater of accessing the data over a secure channel. The software industry awaits to plumb the market with all kinds of programs which can facilitate the process of a claim accurately and efficiently.

viii. Regulatory compliance: For as far as the regulatory agencies are concerned, e-healthcare system could only facilitate the information they require doing their job in a timely fashion. The paper trails, waiting periods for mailed documents, lost, illegible documents, and so much more that are currently associated with the relationship and communication chandelles between these agencies could be totally eliminated by implementing the e-healthcare system

Trends in e-healthcare

As the idea of e-healthcare becomes a reality here are some of the trends that will define it years to come

A more informed user:

Over 100 million users in the United States alone have some form of Internet access either at their work or home and 70% of these users have researched a doctor or a medicine online. This has lead to insurance companies like PacifiCare offer it’s members online access to tools that help them identify which hospitals might be best for them for more than 30 different surgeries and Blue Cross of California also offers access to quality and medical outcome data for all hospitals in the state—to more than 3.7 million of its PPO and self-insured.

“Digital” Hospital:

A lot of traditional hospitals are moving towards e-healthcare, hospitals like the Indiana Heart Hospital have moved towards a paperless environment this helps them keep a central data for all their patients. Thus irrespective of location the patient is receiving treatment his or her records can be access by a doctor or nurse with a click of button.

eCleveland Clinic, a Ohio based clinic, provides consumers with access to an evaluation of their medical records, imaging scans, and lab results. The clinic nurses triage email requests as they would phone calls, and match patients to the right specialists on the team. Patients are registered at the clinic and have their own medical records. If necessary, a patient can talk to a nurse who facilitates the conversation with the physician. The integrated service works because the underlying process is the same as an in-person second opinion visit—it’s only delivered electronically.

Greater Accountability:

Hospitals are moving toward the use of technology to improve patient safety, decrease medical errors, and improve outcomes. Senator Ted Kennedy recently introduced a bill that would require most hospitals to use Computer Physician Order Entry (CPOE) systems. “The requirement to use technology to improve care is a critical trend that will cut through all departments,” says Mark Bard, President, Manhattan Research, Inc., New York. “The push toward improving safety and reducing errors will have far-reaching effects on everything from clinical records and pharmacy orders to bedside care and the emergency room.”

CONCLUSION

E-healthcare has sure come a long way. From being a pipe-dream in the early 90’s this is largely due to physicians and hospitals adopting technology, as evident from a survey reported by Healthhero in June of 2003 which indicates that over 85% of physicians have gone online as opposed to only 7% in 1996.

However many challenges still remain; E-healthcare in hospitals offering certain services like appointments and prescriptions online, for it to become pure e-healthcare i.e. where a person is diagnosed and treated online is bogged down due to many factors like:

a) Regulation: Current U.S. Law prohibits a doctor from practicing medicine in any state besides the one he or she is licensed in – this restricts the reach a online physician can have.

b) Infrastructure: Many users are still using 56k dialup access to get on the Internet and many e-healthcare sites heavily use voice and data that a high speed connection.

c) User attitude: Patients still prefer to visit a doctor in person and are apprehensive about getting advice online, however as more people adopt the technology attitudes can change over time.

In spite of these challenges e-healthcare remains a lucrative industry with some analyst predicting a $2.6 billion market by 2010 and a 25% growth rate after that.

E-healthcare will empower the consumer and he/she will be able to choose their insurance, doctor and treatment according to their liking and will not be restricted to their locality or neighborhood this will lead to greater efficiency and reduced costs for providers and end users and hopefully will provide a solution for 40 million or so Americans who are un-insured.

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