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Medicine's High-Tech Future Is Here

Patient-implantable microchips and bar-coded drugs just the beginning

WEDNESDAY, July 27, 2005 (HealthDay News) -- Picture this: A tiny microchip embedded in a patient's shoulder that contains data on their identity and where to access their medical record in case of emergency.

Or a high-tech in-hospital pill dispensary, where each pill rolls down a Willy Wonka-like assembly line and is stamped with a bar code that enables nurses throughout the hospital to match the right drug to the right patient.

These and other technological innovations are already here, and they're poised to revolutionize the practice of medicine in America.

Advocates -- including former Health and Human Services Secretary Tommy Thompson, who will soon have a medical chip implanted in his arm -- believe the technologies, if properly used, will make health care more efficient and safer.

"We all make mistakes -- doctors, nurses, pharmacists, and every other health care worker -- and these errors are inevitable so it's important that we set up systems to protect patients," said Dr. Alexi Wright, co-author with Dr. Ingrid Katz of a perspective piece in the July 28 issue of the New England Journal of Medicine. Wright and Katz are both residents at Brigham and Women's Hospital in Boston, which has introduced its own bar coding system.

They penned one of two journal perspective articles focused on the increasing role of high technology in the world of medicine.

The other article, by Dr. John Halamka, chief information officer of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, provided a first-person account of being "chipped" -- having a radio frequency identification (RFID) chip implanted into his upper right arm.

The chip, based on technology used for pets, is about the size of a grain of rice, approved by the U.S. Food and Drug Administration, and can be implanted with a relatively simple procedure using only local anesthetic.

Once implanted, the chip allows anyone with a reader to scan Halamka's arm, obtain his 16-digit medical identifier and then retrieve information such as his name and the name of his primary care physician from a secure Web site.

According to Halamka, the insertion procedure was virtually painless and the chip has withstood air travel and rock climbing. In fact, he was interviewing after completing a 20-mile hike on New Hampshire's Mt. Monadnock.

So far, about 1,000 people have had the chip implanted, he said.

Granted, the technology is expensive ($200 for the chip and $650 for a reader) and there are ethical issues around implanting the chip in people who can't provide informed consent (such as an Alzheimer's patient).

But most problems, at this point anyway, remain hypothetical. The biggest one may be privacy. As currently designed, the chips are not encrypted and so could be read by many radiofrequency readers.

"I have lost my anonymity, because any place I go anyone could, without my knowledge, register that I had been there," he said. "The technology to track books going out of the library, at the video store to track videos, that's all RFID technology on the same frequency."

Many stores already use microchips to track products and discourage theft. "In a sense, when I leave Wal-Mart, although my medical record is not a garden rake, Wal-Mart is actually picking up on me," Halamka said. The store is "not doing anything with it, but there is no federal legislation that would prevent a vendor from tying my presence to a purchase and then using that to advertise."

Back at Brigham and Women's in Boston, Wright and Katz liken the hospital's venture into bar coding to a futuristic factory spitting out specially packaged, bar-coded pills.

Like Halamka's chip, this technology is designed to improve patient safety, specifically through making sure medication is dispensed correctly.

A 1999 report from the Institute of Medicine found that 44,000 to 98,000 Americans die each year because of mistakes made by health care professionals. Most of the deaths appeared to be the result of medication errors. The report also concluded that the number of deaths attributable to medication error may have more than doubled between 1983 and 1993.

Katz and Wright cited another study that found that physicians made 39 percent of mistakes while nurses made 38 percent. The mistakes made by nurses, however, are more troubling because there are fewer safeguards.

"Most of the technology out there focuses on preventing physician error," Wright said. "Patients have had the least protection from [nurses'] mistakes because there are fewer people between them and the patient. A nurse delivering a medication rarely has to cross-verify that with anyone else, whereas a doctor who makes mistakes is caught by a pharmacist or nurse."

At Brigham and Women's, bar coding has already reduced drug errors by more than 50 percent, preventing about 20 adverse drug events each day, Wright and Katz reported. It also saves about $4,700 per adverse event.

Roughly five percent of U.S. hospitals currently use bar coding, Wright estimated.

The downside to bar coding is its astronomical cost: Brigham and Women's spent $10 million just in start-up costs for the system, Wright said, plus about $1 million per year to maintain the high-tech venture.

And there is also a possibility that different mistakes will be introduced, such as accidentally entering orders for the wrong patient when clicking the screen.

But the gain in terms of lives saved is probably well worth it, Wright said. "There's pretty tremendous documented benefit," he said.

Halamka said that, thankfully, he has not had the opportunity to use his chip for medical reasons. His body and its attendant hardware are, however, used in training at the hospital.

But he may yet have such an unwelcome opportunity. Starting at 5 a.m. Thursday, he will be climbing the 1,500-foot vertical face of New Hampshire's Mt. Cannon. "If I were to be hurt in any way, there's not a whole lot that people would find on my body that would identify me," Halamka said.

Unless they happened to have a chip reader.

More information

For more on medical errors, head to the Food and Drug Administration.

SOURCES: Alexi Wright, M.D., resident, Brigham and Women's Hospital, Boston, Ma.; John Halamka, M.D., chief information officer, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Ma.; July 28 New England Journal of Medicine;Photo of medical identifier chip courtesy of New England Journal of Medicine, July 28, 2005
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