A clever pill to swallow

 

It’s reminiscent of Fantastic Voyage, the sci-fi story (both a film and a novel) in which a team of scientists gets tiny and travels through a human body to fix a blood clot. But in real life there are these little pill/cameras that can take pics of what’s going on in the digestive system, from the inside instead of endoscopically, a relatively minimally invasive way of diagnosing intestinal ills. Instead of going under sedation and having the colon probed from that end, you swallow a largish “pill” and wear a special belt and harness for a few hours while the camera travels through your gut, snapping pics.

The latest development in this futuristic technology is Olympus’ Endocapsule, which visualizes the small intestine by the use of a pill-shaped camera and an antenna belt that gets a wireless video signal from the capsule and shows video of the photos on a handheld device that controls it. Improvements on the new Endocapsule include a lighter, smaller over-clothes harness that is said to be more comfortable than previous systems that required being placed directly on the skin. More developments include a 160-degree field of view, a twelve-hour battery life and a three-dimensional tracking function that shows the progress of the capsule either in real time or downloadable for later.

In 1868 German physician Dr. Adolph Kussmaul figured out how to illuminate the process of endoscopy when he examined an open-throated sword swallower, using a light source made of an alcohol and turpentine mixture. However, until 1970 barium x-rays were used much more, in part due to the unpleasant nature of having a scope pushing against the powerful gag reflex, although sometimes inflatable scopes helped with that.

Although Olympus introduced the world’s first gastrocamera in 1950, several other companies have jumped on board since then. Given Imaging, from Israel (now being bought by an Irish company), introduced the M2A, or PillCam, in 2001. And later the same year the Japanese did them one better with the NORIKA3 that turned digestive forces into power to fuel the capsule with an on-board generator. Three years later Given Imaging came back with a capsule that could see the esophagus, and a year after that a Japanese company RF Comp Ltd introduced Sayaka, with higher resolution images. But at that time the large intestine was still unexplored by camera capsules, with nothing yet FDA-approved, mostly because of the folded nature of the organ, which allows growths to hide unseen by the cameras. So the endoscope, with air to puff up and unfold the tube, was still the best bet. But since it got FDA approval earlier this year, Given Imaging’s PillCam Colon can go through the large intestine in about eight hours, taking photos at close to four frames a second, increasable to six — remotely — if it’s going too fast. While some other capsules are still powered by mini-generators, the Colon uses a battery, so it’s a little bigger than its predecessors. The MIRO from the Korean company Kist can also see the large intestine. And Japan has been working on “Mermaid” capsules that can “swim” into the intestinal folds by use of a flapping tail.

Conditions that might call for capsule endoscopy include symptoms like bleeding, chronic abdominal pain, or unexplained anemia or weight loss that can be the result of digestive disorders like inflammatory bowel diseases or benign or malignant tumors. Although benefits of these devices include less discomfort or need for sedation or surgery, as well as less radiation exposure, one risk is a potential loss of the capsule necessitating surgical removal.

The device is contraindicated in patients with pacemakers or other cardiac electronic devices, who have any structural abnormality in the intestine that would hinder the passage of the pill, and for people who are pregnant or have swallowing disorders. And if the traveling capsule finds anything suspicious — a growth or a polyp — it can’t just snip it out as during the traditional endoscopic procedure.

Interoperability

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Photo by Flickr user MeddyGarnet/used under Creative Commons license
Photo by Flickr user MeddyGarnet/used under Creative Commons license

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Information is like a genie in a bottle. It can be used for good purposes and for bad. It’s good to keep both in mind.

Healthcare has its share of charlatans, incompetents, poseurs and crooks. Does the availability of more accessible information empower these people or disable them? Surely both. But believers in the free market of ideas start with the assumption — call it false optimism if you will — that in the world of ideas good will drive out bad.

Fishkill-based MedAllies, founded in 2001, is in the business of implementing electronic health records (EHR) in order to facilitate physician office redesign, improve office practice efficiencies, and enhance population health. Its thinking has been influential in the ideas contained in the New York State Health Innovation Plan adopted by the state government last year.

Its CEO, Dr. A John Blair III, is also president of the 5000-member Taconic IPA, whose physician members have been at the forefront of transforming healthcare delivery in the Hudson Valley through meaningful use of health information technology and pay-for-performance incentives. MedAllies boasts of now including nearly 2500 healthcare organizations and 40,000 users in its Direct network. It connects to more than 6000 healthcare organizations and 200,000 users.

The company appears to be continuing its expansionary mode. “MedAllies is experiencing unprecedented growth, both internally and in terms of market share,” said Blair recently.

Blair’s a nationally recognized expert in the use of healthcare information. He realizes that information is a tool for change. Revolutionary healthcare transformation, he wrote last month, “required the use of health information technology as a tool, care coordination as a process, and realigned payments as an incentive.” That’s the present New York State plan in a nutshell.

Meaningful Use

American healthcare transformation has been a long slog, as its pioneers are fully aware. The perils of information misuse and abuse are very real. Security and the protection of privacy are real concerns, as any veteran of the health information technology field is well aware. In that regard, MedAllies has put great effort into protecting the users of its network.