Patients increasingly are using technology to share their health information with family or friends, and access to information is causing them to pay better attention to their care, according to a recent study.
Published this week in the Journal of Medical Internet Research, the research looked at patient use of OpenNotes, initially a one-year program that gave patients electronic access to medical notes written by their doctors.
Technological developments in the health care sector hold great promise for delivering a better standard of care in the United States. But just because you build it doesn’t mean they will come. Doctors, that is.
Andrew Spong's insight:
Healthcare professional reticence can have as much to do with concerns about patient safety as it can with personal skepticism.
Let's remember that the personalised medicine agenda extends to doctors, too. Many doctors do an outstanding job in terms of delivering exceptional care and supporting optimal patient outcomes without a battery of gizmos and gadgets.
Push through the legions of techno-zombies and wild-eyed advocates, and find the solution that works for you, in whatever combination of digital and analog forms, in tandem with your care team.
Some industry stakeholders from providers to investors to consumer device makers think something like Apple’s HealthKit could be the catalyst that finally brings the patient — and patient-generated data — into the healthcare ecosystem in a way that electronic medical records have persistently failed to do.
Andrew Spong's insight:
Whilst I think the general theme delineated here -- consumer-collated, interoperable, personalised health data redefining what the 'electronic health record' is, and toppling legacy providers -- is germane, from what we know of HealthKit so far it seems unlikely to be the sort of epoch-defining release that the article's title suggests.
However, if Google were to acquire a company like Withings and integrate its products into Android...
An app which enables healthcare professionals to share photos is to be rolled out across western Europe by the end of the year.
The app was designed to enable doctors to share pictures of their patients, both with each other and with medical students.
So far, more than 150,000 doctors have uploaded case photos with the patient's identity obscured.
Andrew Spong's insight:
Not having access to this platform (for very good reasons) I can't comment on its functionality.
There are pros and cons to any image sharing resource, but my first question is: what is Figure 1's business model?
As the app is free, and I don't see any premium subscription product, does this mean anonymised data about clinician interests and behaviours is being sold to third parties?
On the plus side, I like the fact that Figure 1 is in keeping with the emerging interest in clinicians in #FOAMed-like peer-sourced medical education rather than legacy CME, which is looking less and less relevant.
The observation Dr. Landy makes in this piece about existing clinical decision support tools being 'highly curated repositories of articles written and edited by experts' is a polite way of saying that clinicians are increasingly uncomfortable with anything resembling 'eminence based medicine' which is not open to critique or emendation.
On the negative side, any clinical image-sharing platform is going to run up against the limitations of its own functionality when users wish, for example, to consider aspects of the clinical implications of the image against the fuller history of a patient's EHR.
Perhaps Figure 1 is looking to present itself as a modular solution which could be acquired by and integrated into one of the leading EHR's? Who knows.
I have broader concerns about consent, anonymity, verification, and abuse, but these would of course apply to any similar tool as well. Some of the language in the FAQ accessible from Figure 1's Twitter URL isn't as robust as I personally would have liked it to be.
Part of Philips Hospital to Home’s suite of telehealth programs, eCareCoordinator and eCareCompanion, received USDA’s 510(k) clearance, are focused on patient care within the home and the first clinical applications to be available through the cloud-based digital health platform.
The application gives clinicians real-time access to both objective health data – like vital signs, blood pressure and weight — as well as subjective responses collected via health questionnaires and other communication with the care team about the patient’s status.
The mental health field is perhaps uniquely suited to transition from face-to-face meetings to online appointments. Despite hurdles related to insurance reimbursement and concerns about whether an interpersonal connection can survive in the virtual world, proponents say that online therapy is an effective solution to bring mental health care to those who might not otherwise get it.
Technology is shaping the future of healthcare, and while technology has brought a number of innovative healthcare solutions, some are worried about the growing impact and potential danger of unregulated health IT apps. Plenty of health and fitness apps in the Apple App Store and Google Play range from harmless to helpful, but doctors are worried about untested and unregulated apps that claim to replace medical devices or diagnose illnesses. Doctors are now asking the FDA to take notice and are warning the public to evaluate these apps with a critical eye.
Andrew Spong's insight:
This. Will. Never. Happen...
...for reasons of resourcing alone.
However, once they're settled their first class action against a health app, I can still see Apple and Google hiring massive clinical faculties to assure the quality of apps in house.
For health app makers, the era of low-to-no scrutiny will soon be over.
As a healthcare provider without diabetes, I will never fully understand what it is like to live with diabetes. I do however try my best to understand the day-to-day challenges as best as I can. I have tested my own blood sugars, worn all the insulin pumps and CGM devices, taken saline injections, etc.; I also engage in the DOC (diabetes online community).
To try to encourage other healthcare providers to gain better perspective on diabetes, I worked with members of the DOC to set-up a fakebetes challenge. Whitney, a new nursing graduate, and Kim Vlasnik both volunteered to be first to take this challenge, and were paired together.
In this fakebetes challenge, Kim text Whitney fake insulin doses, including a carb ratio and correction factor; and blood sugar readings from her own glucometer. Whitney was encouraged to check her own blood sugars and count carbohydrates, but take saline injections according to the blood sugars Kim had text text her. In this way there would be some blood sugar readings in different ranges to think about and respond to.
Andrew Spong's insight:
I'd be really interested to hear what the DOC thought of this initiative.
I'm conflicted, to be honest. On the one hand, I very much admire the commitment of the healthcare professionals involved to immerse themselves as fully as possible in the experience of living with diabetes.
However, in the last instance that does not extend beyond the routines involved with optimal management.
Also, for fear of stating the obvious, it can never take the provider inside the body and mind of a person living with diabetes to afford them first-hand experience of the multi-factorial inconveniences, physical discomforts and pain, and mental challenges of the disease.
Most significantly, their pancreas is still working. PWD don't have the option to stop being diabetic.
If this sounds more anti than pro, I don't mean it to -- there is simply a weight of things to say regarding the former.
Perhaps for people with diabetes, the gestural demonstration of wanting to understand what living with the disease is like to the best of the RN's ability is what they may consider most important.
I'd like to hear more, so please share any responses to this study that you may have seen from the DOC. Thanks!
As things currently stands, tablet computers are more than a novelty but are not as yet a necessity. Tablets are useful for data retrieval during ward rounds but their use as a tool to engage patients in the care process remains limited. Individual health professionals or organisations contemplating the introduction of mHealth are advised to speak to their IT department prior to purchasing tablet computers to understand their local clinical information systems requirements (e.g., operating system compatibility) and any limitations associated with translating the systems to smaller devices. Such considerations are critical if tablet computers are to deliver on their full potential.
Without addressing issues such as access, effectiveness and health literacy, implementing health and health care strategies that depend on digital technologies run a significant risk of increasing health disparities
Philips and Radboud university medical center have announced the debut of a prototype to support patients with chronic obstructive pulmonary disease (COPD).
Management of COPD is challenging and often costly, as the progressive nature of the disease leads many patients to require complicated therapies and frequent hospital readmissions. At the same time, consumers are increasingly looking for new ways to take control of their personal health in order to live healthier and better lives.
"Unlike other wearable solutions recently introduced to the market, this prototype collects more than just wellness data from otherwise healthy people," said Jeroen Tas, CEO, Healthcare Informatics Solutions and Services, Philips. "We are demonstrating the power of harnessing both clinical and personal health information to better manage chronic disease patients across the health continuum, from healthy living, prevention, diagnosis, treatment, recovery and home care."
The wearable diagnostic prototype for COPD patients feeds data collected from patients at home to clinicians through the PhilipsHealthSuite Digital Platform to two clinical applications currently available on the cloud-based platform – eCareCompanion and eCareCoordinator. Once a COPD patient has left the hospital, a wearable diagnostic prototype collects data day and night – including physical activity/inactivity, respiratory indicator, heart rhythm and heart rate variability.
That data is then sent via the cloud to the Philips HealthSuite Digital Platform, where it is shared with the appropriate care providers via the eCareCoordinator application, presenting a more complete view of the patient's illness
Data accuracy is a concern: patient generated data has traditionally been self-reporting, which means it isn't always accurate or complete. The second issue is a concern about the accuracy of the devices used to record that data. Doctors and nurses trust certain device brands and sometimes discourage patients from selecting a device from another company, particularly new companies. Both of these can be serious concerns and are valid.
Another concern is that while there's a significant value to monitoring metrics for people with certain conditions, particularly chronic health problems like heart disease, diabetes, and COPD, tracking a huge range of metrics for people that are essentially healthy could load too much unneeded data into a person's health record. This seems to be a particular concern for primary care physicians, who are generally ranked as the most overworked doctors in the country.
Healthcare should consider social media as a way to better inform patients of procedure and treatment risks, and to streamline efficiencies across doctor-patient communications.
Although surgeons already are using the technology to communicate with one another, driving equity of care in the process, we're only just beginning to glimpse social media's potential as a meaningful communications channel linking patient and physician.
Taking a hint from on-demand car service Uber, several US companies have developed smartphone apps that bring physicians directly to patients—often for less that it would cost to receive treatment elsewhere.
1. A practical digital health fellowship for providers and post-graduates
2. True interoperability
3. More women in leadership positions
4. A more robust representation of people involved in healthcare
5. A Hippocratic oath for the digital age
Andrew Spong's insight:
All sound enough observations.
Would any of them have made your top five?
Right now, mine would include:
1. A primary focus on patient outcomes as the driver of innovation
2. A secondary focus on reducing the personal and economic burden of care
3. A strong emphasis on design and the promotion of user uptake, utilisation, and retention
4. Interoperability (my definition includes not just connected systems, but also integrated workflows, and assumes a commitment to promoting open, anonymised data)
5. Dialogue: by which I do not mean ceaseless pronouncements about the seductive distractions of novelty, but rather the nurturing of ongoing, iterative, analytic discussions between designers, healthcare systems, clinicians, and users regarding objectives and outcomes (as well as the UX and UI) at every stage of the developmental process -- before, during, and after initiation
When asked whether users would like to see a more direct connection between the CME they take and patient outcomes, eighty-one percent of HCPs surveyed responded affirmatively.
Seventy-eight percent of respondents said "yes" when asked whether CME delivered at the point of care (in the form of decision support) could lend valuable insights into the management of patients.
The survey also found that less than one percent of respondents currently consume CME through an EHR system, demonstrating a significant unmet need in the marketplace for new approaches to CME delivery.