Creating beautiful memories with dual monitors

• A lot of us have dual monitors for our computers
• Windows does not have a very good built-in multiple monitor management tool
• When we travel, we take lots of snapshots with our digital cameras but these don't do justice to some of the majestic sights
• Panoramic shots would be great but we don't all have appropriate lenses
• Mobile phones have built-in apps to help take panoramic shots but they cannot match a good camera for results on individual photos

So....

How can we take great high resolution panoramic snapshots and then make them a desktop image spanning 2 monitors?

Step 1.

Take panoramic shots with your camera overlapping successive frames while keeping the camera level and without changing the settings as you swivel left to right to capture the vista.  A suggestion I have is to try and set up the camera to enable the tallest structure in the panorama to be captured.  You don't want to change the field of view in the middle of the panorama.  In addition, wait till there are no moving people in the field of view.  Otherwise you will capture the same person in two or more frames if s/he moved while you were taking the shots or get "chopped off" as in the photo below.

At Chichen Itza

Cropped image

You will also need to do some centering, straightening and cropping of the stitched image. With some efforts you can convert the above image to look like this:

Step 2.

Download the pics to your computer and use Hugin [http://hugin.sourceforge.net/] to stitch these together.  I posted about this earlier.  Lifehacker has a great post on this. Hugin is a free utility with great features.  It has a bit of a learning curve but well worth the efforts.

Step 3.

Use Display Fusion [http://www.displayfusion.com/] to load the panorama you created in step 2 and span it across 2 monitors. Display Fusion is a free download (though there is a premium version with more features).  (Macs apparently have this functionality built-in and don't need this tool).

So there you go, 2 free apps to make your vacation memories stay alive on your dual monitors.  All you have to do is remember to take overlapping photos with your camera while keeping the camera settings constant.  The rest you can do when you get home!

Here are some other panoramic shots:

Backyard

Soccer fields

Providing health care In The Wild! Technology on a shoestring budget.

Students in our medical school have since 2009 "adopted" a village in rural Peru.  They go there for a month at a time accompanied by faculty members to provide various health services.

While there are many challenges, technology is a big help.

One key challenge was to learn about the population and document this and pass it on to the next group of students using an Electronic Medical Records system.  This would help them plan on bringing appropriate supplies e.g. eye glasses, education material etc.

Solution:
OpenMRS:  This is an excellent, robust open source electronic medical records system that was developed out of a partnership (Regenstrief Institute @ Indiana University and Partners in Health).  This is available here.
It lets you create custom fields, forms and reports.  We wanted to capture the data at the point of care at the clinic where we would work.  This would save the time of entering data from paper forms to the database and hopefully decrease errors.
  One problem we have in rural Peru is a reliable power supply.  So we decided to create an ad-hoc wireless network using a laptop as a Server or host and tablet computers as the data entry devices.  The plan is to take some extra extended batteries for the laptop so it can run constantly for about 8-10 hours and the tablets should last for at least 6-8 hours if we don't use them for anything else.  We would charge everything overnight at the hotel be set for the next day at the clinic.

iPad (on right) connected to Laptop (Hosting ad-hoc network)

Another challenge is language - the folks there speak Spanish.

Solution:
The students and faculty are getting a crash course in Spanish from some of the students who are quite fluent in this.  Luckily there is a free medical Spanish app

Another challenge is checking the visual acuity so we can give the correct eye glasses.  We have an ophthalmologist in the group who is training all the students.  But getting them to learn refraction using retinoscopy may not be feasible.

Solution:
Just saw this amazing video of a $2 device that can be attached to a smartphone that lets you measure the refractive error in a few seconds.  Am hoping to get in touch with the genius inventor to see if we can get one or two of these devices to help the cause.

It is quite amazing how we are getting to a point where the portable devices are going to be able to change the world - a model where the health care provider goes to the patient rather than the other way around!  This may seem like something we need in rural and underserved areas in third world countries but why can't we use this right here in the US?  Is it because of our financial models or the legal system?

Media, Social Media and Medical Research - Do we need to police the hype cycle?

By now everyone knows the story of "Sitting for prolonged periods makes your bum bigger".  The news was flashed all over the WWW and Social Media. A Google search reveals over 2 million results for this search phrase since October 17the when this study came out.  The news media was splashed with images like this.  In addition, it was spread by Twitter and Facebook.

From The Telegraph (http://www.telegraph.co.uk/health/healthnews/8935097/Sitting-down-makes-your-bum-bigger.html)

You can get an abstract of the study here but the full article is behind a pay wall.  The key point is that this study was done in a lab by artificially putting a stretching force on cells.  The research is important to understand how mechanical forces can affect differentiation of fat cells and the pathways that can impact this.

The problem is how this basic science experiment has been extrapolated to a clinical outcome without sufficient evidence and distributed so widely.  Sure sitting for long periods is probably not good for you as some studies have shown. So probably no harm done.  Unfortunately this is happening all the time for all kinds of studies.  In the age of 24 hour news cycles, live blogs and various measures of your social influence, the media tend to sensationalize news to get a wider distribution rather than analyze and report it responsibly.  We know about many such stories that were incorrectly reported and then had to be retracted but not before they had spread all over the Web.  This is not going to change in the foreseeable future.

The social media do not have a good rating systems for who provides authentic balanced information.  People tend to be rated based on # of followers, # of shares/retweets/mentions thus again perpetuating the need for sensationalizing the news.

As personalized news filters (Zite, Currents, Flipboard) and Social Media becomes the predominant manner in which we get our news, we need to develop a rating system for sources that are authentic, balanced and diligent about going to and analyzing the primary sources. This is even more important as patients search for information on their conditions and become more involved in their own health.  There are a number of respected web sites for health related information but they may not be able to updated quickly enough.  Also the user would have to go to that site to get the information.

We can leverage the features of various search tools that tag a search result with names of our contacts who have +1ed it.  The late  sidewiki was another such feature that could help.  Maybe this will all get sorted out in time, maybe we just need to be patient or maybe the move to have real names in Google Profiles is a move to make this happen?  Twitter in the meantime has stopped the Verified account for the public.  Still all it does is identify who you are, we need to know if something you post or retweet is verified information.  Will at some point, folks start giving +1 to the person than the news item?

Google Currents! Become a Mobile Publisher

Google came out with one of its most awesome products (after Gmail, Google docs, Google+, Google Reader....), well its a great product, OK!!

Screen Shot from my Android Tablet Showing "Currents"

I just created a Magazine from my Blog and it is now published on Google Currents!

If you want to see it, here are the steps:
1.  Download Google Currents App to your iOS or Android device.
2.  Sign in with your Google Account
3.  Go to the Library
4.  Search (at top of left column)
5.  Search for "Technology in (medical) Education
6.  Subscribe to the one with my image on it.
Or just open this link on your device browser
http://www.google.com/producer/editions/CAow3fnhAg/technology_in_medical_education

Enjoy!!
ORScan this code with your device
Well so why am I so excited?
I am thinking about all the applications of this tool

1.  Publishers (content creators) can now publish their content to various mobile formats for free using an RSS feed.
2.  You can create bundles of content e.g. Journal Publishers could create tabs for the magazine with links to Editorials, Perspectives, etc.
3.  The articles can share with Google+ or other services like Twitter and thus enable discussions and collaboration in the online space.

How is this different from Google Reader?
- The user interface is very nice
- More likely to attract a newbie physician to subscribe to this rather than to an RSS feed in Google Reader.
- The ability to create bundles of blog posts, photos (Flickr/Picasa Web) or Videos (YouTube Channels) can make for great stream of updated content that learners can view in one place.

Questions?
How intrusive will the advertisements be?  Lets wait and see.

Meaningful Use Core Measure # 13 - The Patient Generated Clinical Visit Summary

One of the Meaningful Core Measures is to provide a clinical summary of the office visit [PDF] to each patient.  This a well-intended measure as we know that patients will often retain only a part of all the information that they received at the office visit.  The summary needs to contain very important information about the visit and decisions made during the visit including patient instructions.

Patients when they leave the office often go out with a sheaf of papers and find it difficult to know which ones they really need to read.

I have been actually giving the patient the "task" of creating their own summary of the office visit.  Once we have gone through the history and exam and labs, I will engage them in a discussion on next steps.  Then I ask them to summarize the plans and action steps and write them down on a piece of paper.   They write down what they agree to do instead of what I would tell them to do.  They take this paper with them as a summary of the visit in addition to the EHR  generated printed after visit summary.

This activity can take a couple minutes but is incredibly powerful.  There is something about a patient's own handwritten plan that cannot be replicated by a physician generated print out.

This is a summary created by a hypothetical patient who was diagnosed with high blood pressure.

Patient Generated After Visit Summary

How different is it when a patient-physician discussion results in the patient writing down himself that he will cut back on the alcohol vs a physician telling him to cut back and then handing him a printed patient instruction?

This process has another advantage - it gives the physician an idea about the patient's literacy level.  This has to be addressed in a sensitive manner but is incredibly useful information that each physician should know but often does not.  This may also not be appropriate for patients with writing disability (Parkinson's or Rheumatoid).  In these cases you can ask a patient to tell you what to write down.

If you want you can take scan the handrwitten document with an app on your iphone or android and upload into the EHR (make sure your HIPAA police are OK with this.  One option is not to have any patient identifiers on the image like the one above)

Frictionless sharing does not work in EHRs

Mark Zuckerberg when introducing the latest updates for Facebook popularized the term frictionless sharing.  What it means is the user does not have to do anything specific to share something with friends on Facebook.  Thus if you are listening to some music on Spotify, your friends could see what you are listening to without your having to do anything.  You could opt out of this, but by default you are opted-in!

This is actually not a new concept.  Primary care providers have been exposed to this in the EHR for a while.  

Examples:

• One fine day, out of the blue, you get some results for liver function tests in your EHR inbox.  The test results are normal.  This is a young adult patient for whom you are listed as the PCP but you have not seen in several years.  You try to find out who ordered the tests and why the results were sent to you. After multiple clicks and 10 minutes of searching you find out that the person had a positive TB test and a normal Chest X-ray and was going to get started on Isoniazid (INH) by an infectious disease specialist.  The specialist thought she was doing the patient and me a courtesy by sharing this result with me.  I want to know what's going on with my patients but I think this process was too well lubricated.  We need some friction.  I want the specialist to put a short message to tell me the what and the why and just summarize that the liver tests were normal.  
• Another day you start getting a stream of lab results for one of your patients.  Some of them are quite abnormal.  You drop everything to attend to these.  You find out that the patient is admitted to the hospital and the results are being copied to you as a courtesy.  Great, I get to learn that my patient is hospitalized and what is going on.  Problem is it was not urgent, he was already being attended to and all I needed to know was a summary of reason of admission and who the attending physician was in the hospital so I could contact him/her to discuss.

Doctors realized quite quickly that frictionless sharing in EHR is not efficient and while useful, it could be done in a much better way.  Automatic sharing increase noise/signal ratio and in an EHR world where doctors are swamped with copied charts, patient messages, refill requests and test results, it just does not work. I am sure we will realize that this holds true for the social media world too!  Actually we are being warned already!