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Informed Pocket Guides for the iPhone

Informed Pocket Guide
I discovered Informed Pocket Guides almost two years ago and have been a huge fan ever since. The first product I got was the Emergency & Critical Care Pocket Guide. I believe the fact that I take extra care this little/big guide is always in my bag when I go to work, says it all. It is small, light and compact, yet it has all the necessary reference information you might need in medical emergencies. It is especially useful if you work in the field.
Informed Pocket Guide pages
Emergency & Critical Care Pocket Guide has almost 200 pages and covers the following topics:

  • Current ACLS Algorithms, Lab Values, Metrics, Notes
  • Emergency, ACLS Drugs & Top Prescription Drugs
  • IV Drips, Drug Infusions, Dosages
  • Poisons & Overdose / ‘Rave’ Drug
  • 12-Lead ECG Section & Acute MI
  • Medical Emergencies Section
  • Quick EMS Spanish Translations
  • Fibrinolytics for AMI & Stroke / CVA
  • Childbirth, Diabetic, Respiratory Distress
  • Pediatric Resuscitation, Drug Doses, Vitals
  • Trauma, Triage, MCI, Glasgow Coma Scales
  • Airway Management /RSI
  • Burn Charts, the ‘Rule of 9s’
  • Pulse Oximetry
  • Infectious Diseases

Well, ever since the first iPhone medical apps started appearing, I thought to myself… hmmm I would love to have my medical pocket guides on this great device. Obviously, it was just a matter of time when Informed would port them to this mobile platform, and yes they are here! The complete series of Informed Medical Pocket Guides are now available for the iPhone and iPod touch. Titles like the RN Pocket Guide™, EMS Field Guide® BLS & ALS edition, NIMS: Incident Command System Field Guide™, and of course the Emergency & Critical Care Pocket Guide™ are available for $9,99 USD via the iTunes store. In fact the Emergency & Critical Care Pocket Guide app has just recently been updated with many improvements, so now is the best time to present it to you.

Informed Pocket Guide and app
If we take a look at the content, the app is the same as the pocket guide. The basic difference is that on one side you have a physical pocket guide, and on the other an application for your iPhone. Now, bringing the guide to the iPhone has some advantages and some disadvantages. First of all, you no longer have to worry about forgetting the pocket guide. You have all the same information available on your mobile phone, which you carry everyday and everywhere you go. This all makes perfect sense, since the iPhone is by itself a great mobile phone for doctors and other medical workers. So having another great medical app running on it just makes it even more powerful. Furthermore, you can do things with the app which are impossible or difficult to do with the pocket guide. One such thing, and maybe the most important one, is finding information quickly. The pocket guide is not an encyclopedia, but still it has a lot of dense information on small pages, so finding exactly what you need can prove to be difficult. Sometimes I just know that I have seen a piece of information or a chart in the guide, but cannot find it unless I flip thru numerous pages. The app is the champion in this area. It is very easy to find information you need thanks to the great built in search function, but also other navigation features like the possibility to flick thru pages, go to a specific page, browse the table of contents and see thumbnails of pages. Other interesting features include bookmarks and notes which again are there to make the data you need and often use more accessible. On the down side, the iPhone screen is a little bit smaller that the pages of the pocket guide. Maybe this could be a problem for some, even though the resolution is high so you can simply zoom in and see all the details. Also, you might not like the idea of bringing your iPhone with you in the field out of the fear it might get damaged or other reasons. I also found that sometimes its touch screen does not work flawlessly if I wear protective gloves.

Here are some of the photos of the Emergency & Critical Care app and the pocket guide:

Both the pocket guide and the app have things going for them, so you will have to choose which one better suites your work flow and style. I like them both so much and cannot decide. It seams that the pocket guide will remain in my bag and the app on my iPhone. I am really looking forward to new updates of the app, and hope that in the future it will incorporate more interactive content, so it could maybe replace some of the other apps I have installed on my iPhone, like various medical calculators.

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AirStrip CRITICAL CARE

The Apple Worldwide Developers Conference (WWDC) is taking place in San Francisco right now. On the first day Apple introduced the new iPhone 3G S. They also continued their tradition of presenting some interesting upcoming applications.

AirStrip Technologies has presented its new medical app called Critical Care. I really don’t have any comments at this moment other than WATCH THE VIDEO IT WILL BLOW YOUR MIND!

AirStrip CRITICAL CARE features include:

  • Virtual Views – Remote, virtual real-time monitoring of live cardiac rhythm strips and other waveform data such as pulse oximetry, end tidal CO2 and peak ventilator pressures.
  • Strip Zooming – The zoom feature maintains relative size of waveforms and the background grid allows for easy assessment and measurements.
  • Automated Caliper – The automated caliper measures designated intervals, both automatically and manually.
  • Strip Scrolling – The scroll function allows users to quickly scroll through stored waveform data, such as telemetry strips.
  • Patient Data Display – Tidal volume, airway pressure, flow and volume readings are also available in virtual real-time, directly from patient monitors.

AirStrip already has one interesting application available in iTunes store called AirStrip OB. This application, intended for obstetricians, delivers vital patient waveform data — including fetal heartbeat and maternal contraction patterns — in virtual real-time directly from the hospital labor and delivery unit to a doctor’s iPhone.

If you are interested you can watch the whole Apple WWDC 2009 Keynote Address.

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openECGproject

open ECG project
I am proud to present to you the openECGproject. Something I helped to start up and the thing that kept me away from my blog for almost two weeks.

The openECGproject is essentially an online community conceived around a simple, but challenging and worthy goal – to develop an open source hardware and software solution for electrocardiography. More precisely, to develop an open source, low cost, and clinically functional 12-lead PC-based ECG with interpretive software.

The idea was conceived to help those hospitals and doctors, mainly from the Third World, who cannot afford similar currently available and expensive commercial products. Development of a free alternative could, I believe, have a profound impact on health care not just in poor countries, but in others too.

The whole project is philanthropic and depends on the efforts of volunteers who want to make a difference. Anyone can help, so be sure to visit the site, promote it and recommend it to others.

Thank you for your support.

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Kraftwerk: Elektro Kardiogramm

Kraftwerk is an electronic music band from Germany. They are definitely one of the most influential and revolutionary bands of all time and they inspired artists from nearly all genre of modern music. In the early to late 1970s and the early 1980s the were really hot with their sound that combines driving, repetitive electronically-generated rhythms with catchy synthesizer-generated melodies in a minimalistic arrangement.

Listen to them as they perform live their song Elektro Kardiogramm.

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Science Museum London

If you happen to find yourself in London, be sure to visit the Science Museum. It is great for anybody who loves science in general, but also for those interested in medicine. There are a lot of things to see regarding medicine scattered around the vast spaces of this museum. On the ground floor you will find the exhibition entitled “Making the Modern World” which features many inventions that shaped our world as we know it. Among these exhibits there are a lot of medical devices like the first CT and MRI scanners or ECG machine. Further along, on the third floor there is the “Health Matters” exhibition, “Glimpses of Medical History” is on the fourth floor, and finally “The Science and Art of Medicine” exhibition is on the fifth floor. Museum of Science in London is open every day from 10:00 to 18:00 and it offers free admission to all visitors. It is located on Exhibition Road in South Kensington, and can be easily reached using the public transport.

Take a look at some photos from Science Museum in my gallery.

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Exclusive interview: Dr. R.A. Brest van Kempen, CEO of RS TechMedic

RutgerHere is a treat for all you medical gadget lovers. An exclusive interview with Dr. R.A. Brest van Kempen who just happens to be the CEO of RS TechMedic. His company has produced some amazing high tech medical devices over the years. One of their most revolutionary product on the market today is a telemedicine device called Dyna-Vision. Only for you, Dr. R.A. Brest van Kempen talks about his company’s products and shares news about the development of software which will enable you to monitor your patient in real time using your iPhone.

Could you tell me more about yourself, about your background?

I studied at the Catholic University of Leuven in Belgium and have been a “clinical perfusionist” in cardiovascular surgery for 10 years in 3 leading hospitals in Belgium and the Netherlands. I started my MBA study in 2006. In 1999 we founded RS TechMedic, a company developing medical technologies. I am responsible for marketing and sales, the operation of the company and the machine-to-man interfacing design of the products. With our dedicated hardware and software engineers we’ve developed 9 medical devices and clinical software so far and our latest development is focused on the fast growing telemedicine market.

Please shortly describe the history and milestones of your company, RS TechMedic?

We developed products for Terumo CardioVascular Systems, Maquet, Martil Instruments, and a number of other companies. These products were all high-tech developments and are on the market as we speak. The most advanced product was our automatic micro-air removal device for heart-lung machines. With this technology we are able to significantly reduce the postoperative cognitive dysfunction in heart surgery patients. Out of 160 companies, we were granted the Innovation Award 2002 for this product.

dyna-visionCurrently one of your major products is Dyna-Vision. Tell me a little bit more about it and the ways it differs from similar products on the market?

Dyna-Vision is developed with the latest available technologies. What we often see is that other companies are “upgrading’ existing products to be used for telemedicine. We are convinced that this is not the best solution. We created a wish list of physicians and their patients and developed a new technology based on these requirements. This is a different strategy and makes that we can offer the most recent technology.

We are a bit careful with making comparisons as Dyna-Vision as we really see Dyna-Vision as a new “type” of products and not as one of the existing ones. Our device gives you 3, 5 or 12 lead ECG, Heart Rate, Heart Rate Variability, RR-time, Plethysmogram and Oxygen Saturation.

Basically, the device creates a data file to be used in different software for analyses. Currently we certified 4 packages: Cardio, Monitoring, Health and Fitness and Research. This makes Dyna-Vision a multi-purpose device. Physicians can use Dyna-Vision for different indications optimizing there return-on-investment.

Dyna-Vision is the first and only device in the world with an integrated mobile phone. With this connection the recordings are transmitted to a remote server for analysis by a physician. This process is fully automated so there is no action required by the patient to transfer the data. A physician can download the recordings for analysis from anywhere at any time. Also, we offer the unique feature of real-time remote monitoring. For example, a patient has symptoms and contacts the physician who can simply login to the server to monitor the actual streaming parameters on a computer !



Dyna-Vision is supported by several software packages (Cardio, Health & Fitness, Research , Monitoring) aimed at different types of users. Which one is the most popular so far?

  • Cardio is far ahead of the others as cardiologists are very used to recording and analyzing ECG. That makes that we can offer our Dyna-Vision as the “next generation” holter recorder. The patients are connected to the device in their practice. When the patient leaves the practice, the ECG is continuously transmitted to the cardiologist. The patient can be monitored for longer periods of time and does not have to come back to the practice to “download” data from the device. With Dyna-Vision, the patient has more freedom and can be sure that the cardiologist can always analyze the ECG, also when the patient is at home.
  • Monitoring is closely related to Cardio and it is commonly used to monitor remote patients.
  • Health and Fitness is rapidly growing since the wellness sector is focusing more on preventive medicine lately to expand their offering to their clients. When our test shows underlying health problems they refer their client to a physician for further analysis.
  • Research is used by universities but it is a very specific market. This is a niche which does not grow fast.

If I choose to use Dyna-Vision in my medical practice how much security can I expect regarding my patients’ data?

Dyna-Vision “creates” a data file with the recorded parameters. This data file is encrypted before transmission and it does not contain the name of the patient. The files are transferred from the server to your PC Software after entering a security code. After download, the files are decrypted and attached to the correct patient record. Although it will probably never be possible to design an unbreakable security, we took great care of making our product as safe as possible.

You have announced that your company will be launching the first real-time streaming patient monitor on the iPhone platform. How did you come up with this idea? Did you receive any requests from your customers for such a monitor on iPhone?

Well, when I demonstrate Dyna-Vision to cardiologists they always ask me if it is possible to receive ECG data on their mobile phone for a quick analysis. Until now we were a bit hesitating to develop such a tool as it seems more easy than it actually is. Besides that, there are a number of security issues you have to take care of and finally, the processor speed and screen resolution of the phones are still not really suitable for high-resolution multi-parameter monitoring. But, then the iPhone came with the high resolution screen and some very useful programming tools to graphically optimize the streaming data to make it technically possible.
Now we can offer a true telemedicine system for ambulant patients where patients can call their physician when they experience symptoms. The physician can immediately look at the streaming ECG.

In your opinion how did the iPhone influence the whole telemedicine field? Does it offer anything new regarding the mobile phones already on the market?

I must say that I found only a few interesting applications on the iPhone for medical use. The actual use has to grow I believe and this will take time. The main problem is that Apple made it difficult to distribute applications through the central appstore and this brings uncertainty to commercial developers. We had the same discussion within the company: do we develop an iPhone application with the risk of difficult distribution after development or even removal from the Appstore… or do we develop a “common” web application that we can freely distribute. This is a difficult decision but we choose the iPhone for the technical specifications. On the side, the added value of an iPhone to our own Dyna-Vision must not be forgotten. The graphical interface is fun to use and is relatively fast. The iPhone does offer new features that are not found in other phones yet, but other brands are coming up with new products that have somewhat similar specifications.

Explain some of the key features of the iPhone software for Dyna-Vision?

With the software the physician can login to the server and start a live data streaming session. After authentication, the data stream starts and the software automatically starts in monitoring mode. The user can change the layout of the screen and the colors of the graphs. The application is touch screen controller (obviously) and makes use of “flips” to graphically enhance the interface.

Will iPhone be able to communicate with Dyna-Vision unit only by GPRS or also via bluetooth?

Initially we will launch it with the GPRS connection. However, the next release by the end of this year will also support the Bluetooth connection.

When do you expect that iPhone version of your software will be available?

We are introducing the iPhone Telemedicine Application during the Medica in Dusseldorf, Germany to be held from 19-22 November 2008. Immediately after that it will be commercially available. However, it is only sold to licensed physicians who need to register with our company. We will authorize them in the system so that they are able to use the iPhone application.

Was it difficult for your software engineers to start developing for the iPhone platform using the tools from Apple?

The Software Development Kit from Apple needs some work so to say before you are able to use it to its full extend. On the other hand, if you have an experienced software engineer this is not a problem. Also, you do not have to take care of compatibility with other platforms as is the case when developing JAVA applications. So in the end, it is less difficult than developing for other platforms.

How do you comment on the likely ban of iPhone sales in the Netherlands? Will it in any way interfere with your plans?

Assuming that you are referring to the internal battery I do not worry about it. First of all, Apple is already discussing the new law with the government and it seems that there are three escapes that Apple can use to bypass the law.. The most important one is the use for medical purposes where the battery is an essential part for the correct functioning of the product. When it is easily removed, this creates issues with data storage and patient safety.
By law, medical devices have a waiver for this requirement and as we are selling it as a part of our medical device… probably we are okay. Nevertheless we are facing this challenge not only for the Netherlands as it is a European Law..

We will not only sell the iPhone Telemedicine Application in the Netherlands but all over Europe. As an example we just made an agreement with a telecom provider that has 35 million subscribers. Early next year we will expand to the USA and Asia. We have contracts with different telecom providers for monthly iPhone plans. We just have to wait and see how things will end up but my hopes are that Apple will work hard on solving the battery problem urgently…

Now that you have stepped into Mac arena, can we expect the Macintosh version of your Dyna-Vision software for desktop computers?

Of course it is already possible to use Dyna-Vision Software on Macintosh with a windows emulator but we are working on a OSX version. We have no release date scheduled but I estimate this will be ready Q1 in 2009.

There you have it! Something to look forward to, a new and revolutionary way to monitor your patients on the iPhone is coming soon. We will keep you updated.

A big thanks goes out to Dr. R.A. Brest van Kempen for this interview.

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