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These are the slides from my talk at the 4th Annual Putting Patients First Conference in Mumbai.
If god were to manifest the world using technology, he would first create something like social media. Conceptually provide technology with the ability to understand the thoughts of a population
Further, anyone can setup an online site related to a treatment, a disease, a doctor, a drug , a concept or anything and see it grow into a popular site which in effect is simply the manifestation of a community which exists/ed but which no one ever knew of.
Personalized medicine is hoping to reach new heights thanks to the Cancer Moonshot, but won't get off the ground without a community-wide commitment to sharing big data.
The precision medicine community has long since recognized that sharing big data, including clinical records, genomic sequencing data, community-level health indicators, and research results, will be critical to making progress against cancer, neurodegenerative diseases, inherited conditions, and expensive chronic diseases like diabetes.
“Why is data sharing important? Because cancer is complex,” said Kenneth C. Anderson, MD, President-elect of the American Society of Hematology (ASH). Anderson specializes in multiple myeloma, a blood cancer with treatment options that hinge on the genetic variances of each and every patient.
“We’re learning so much about cancer, and applying these insights to drug development has been incredibly fruitful,” he continued. “Now we have treatments that are specifically targeted to patients’ genetic mutations. Not only are these treatments more effective — because they correct a specific mutation — they also minimize harmful side effects that we see with traditional total-body anticancer medicines.”
However, the continued development of these treatments cannot be sustained without a commitment to data sharing, he added.
Life sciences companies have too much information—manually collected, logged and stored to adhere to the highest quality standards. Information is forever coming from all different directions, including R&D, manufacturing, clinical trials and even patient care.
Digital analytics can funnel just the right information for risk management.
The idea of a "virtual doctor" project might sound rather futuristic.
Zambia has about 1,600 doctors for a population of 14 million, and two-thirds of these are working in towns and cities, while most of the country's population is in the countryside.
It means access to good quality health care is often difficult if not impossible.
For many communities, it is not practical to expect sick and frail people to walk or cycle for hours to hospital.
So families depend on rural health centres, which have health workers but no qualified doctors.
The virtual doctors project means that these isolated health centres can be supported by doctors thousands of miles away.
Health workers and clinical officers on the ground use an app on a smartphone or tablet computer to take notes on a patient's symptoms and photographs.
This information is sent to a volunteer doctor in the UK who helps with a diagnosis and recommends treatment. Cases are directed towards doctors with a relevant specialism, whether it is skin diseases or HIV and Aids-related problems.
The doctor in the UK will have a list of the drugs and equipment kept in the health centre in Zambia and can suggest treatment or further tests based on what is practical and available.
Virtual Doctors is now supporting 19 rural health centres, which typically deal with problems such as malaria, tuberculosis, HIV/Aids and pregnancy-related conditions.
The concept of a virtual doctor is not new, but it is one which will never get old.
At Plus91 we have been involved with multiple projects and pilots where simple tablet and smartphone based solutions are used by on-ground trained and sometimes untrained staff and advice, opinions, second opinions and in some cases virtual consultations are provided by remotely situated doctors and clinical staff. With time, the solutions eventually become more technologically advanced as the on ground staff get comfortable with such distributed protocols and the use of technology. This is an exciting solution as it helps provide much needed healthcare in small areas without qualified doctors. Who is to say this is not hi-tech ..for the millions who benefit from this, this is cutting edge.
Virtual doctor based solutions eventually evolve into distributed EMRs and local health centers become more involved.The Medixcel platform has a remote consultation as well as multi opinion module which was built out of this need and it has grown to be a platform of choice in many parts of Africa for being hi-tech yet simple.
Manufacturers are eager to lay the bricks and help pave the road to better, more personalized healthcare through integration of connected devices in the new Internet of Medical Things. Compared to other industries, healthcare has been "inherently conservative and slow" to embrace innovations such as the cloud and the Internet of Things -- but that's changing.
Innovative tech products and services are making it harder for healthcare providers to ignore the potential benefits of connected medical devices and the IoMT
By using fiber for broadband connections, eHealth services such as telehealth consultations are being delivered successfully with lasting results. This was shown by the Connected for Health project and its pilots in Denmark, Finland and Sweden.
"The Connected for Health project reached several remarkable results from its piloting and research activities", states Mrs. Marjatta Eväsoja, director of International Affairs and Culture in the Regional Council of Southern Ostrobothnia (Finland), which has been coordinating the project as Lead Partner.
In the project, four pilots were implemented in Finland, Sweden, and Denmark. They engaged real end users, patients, clients and professionals, mainly from sparsely populated areas that had built Fibre to the Home (FTTH) network infrastructure.Wound treatment and cost savings
The pilots achieved lasting results. "In Alavus, Finland, the best results were achieved in distance consultations for wound treatment, whereas in Hudiksvall, Sweden, the pilot's core task was to develop and test a social care alarm system (SCAIP) platform sending event messages between patient and carer. The tests showed that this platform brought the municipality considerate cost savings", tells Mr. Sami Perälä, the executive director of EPTEK.Patient empowerment
The fourth pilot was implemented in the Region of Southern Denmark, and the main conclusion was the fact that a well-functioning infrastructure ensures reliable eHealth solutions, which can contribute to increased patient empowerment.
Roughly 1 percent of searches on Google are symptom related. Starting this week, when consumers access Google’s mobile search for information about certain symptoms, they will quick, accurate facts on relevant related medical conditions up front on their smartphone or other mobile device.
Announced in a blog post by a product manager on Google’s search team, the goal of the new symptom search feature allows consumers to quickly explore and navigate health conditions related to symptoms.
Consumers can easily get basic answers on common a conditions, risk factors associated with the condition, self-treatment options and guidance on when to seek medical care.
For example, a symptom search — even one using common language free of medical terminology like “my tummy hurts” or “nose blocked” — will show a list of related conditions. For individual symptoms like “headache,” searchers will see overview information as well as have the ability to view self-treatment options and suggestions of when to seek help from a healthcare professional.
Although the Internet of Things in healthcare is not yet in widespread use throughout the industry, Indranil "Neal" Ganguly predicts that, in the next five years, there will be a massive increase in IoT for healthcare, "both on the clinical side as well as on the back end.
Ganguly explained how hospitals are using, or could use, IoT for healthcare in three areas:IoT for inventory management
Hospitals are not using IoT to track inventory in as widespread a manner as would be desirable, Ganguly said. He added that healthcare could learn a few lessons from retail.IoT for healthcare workflow optimization
Although the concept of RFID has been out there for 5 to 10 years, Ganguly said adoption of this technology hasn't taken hold as rapidly as he would like
IoT for medical device integration
Ganguly said that when it comes to IoT for medical device integration, the focus is more on the consumer end.
"People are looking at how to integrate things like the Fitbits and other fitness devices to bring patient provided data into the cycle of care delivery," Ganguly said.
IBM Watson Health is teaming with the American Diabetes Association to apply cognitive computing to the ADA's 66 years worth of research and data. The results will be used to help entrepreneurs, developers, healthcare providers, and patients learn more about diabetes, prevention, complications, and care
In 2012, according to the ADA, 29 million people were living with the disease, and another 86 million were diagnosed with a condition known as prediabetes.
To address the challenge, IBM Watson Health and the ADA are collaborating to apply Watson cognitive computing to the organization's massive library of information and data. Through this effort, IBM and ADA hope to empower entrepreneurs, developers, healthcare providers, and patients to gain knowledge that can improve outcomes and even prevent the condition's onset.
First, IBM's AI platform will ingest all the medical journals, medical text books, Pub Med, and other diabetes literature and resources available, including all the content from the ADA's Diabetes Information Center. Second, Watson will ingest the ADA's diabetes data sets.
Watson will be trained to understand the diabetes data to identify potential risk factors and create evidence-based insights that can be applied to health decisions.
IBM also is collaborating with the Health Maintenance Organization Maccabi Healthcare services to build a predictive machine learning model to help identify early risks for diabetic retinopathy, the top cause of blindness for those with diabetes.
Obtaining informed consent is one of the most important things that a surgeon does.
I’d argue that obtaining informed consent is one of the most important things that a surgeon does — akin to the last stitch of an aortic anastomosis, the life-saving jolt of electricity to jumpstart a fibrillating heart, or the first pass of a scalpel during an emergent laparotomy.
Informed consent defines 21st-century medicine, contrasting sharply to the days of paternalistic care. Informed consent, when done properly, puts decision making into the hands of our patients. It can serve as a checkpoint to discuss goals of care and what constitutes a meaningful life for a particular patient.
It’s time we teach our trainees how to obtain informed consent the proper way. We need to slow down, pull up a chair, and look people in the eyes. We need to truly know our patients — how they understand their diagnoses, how they interface with medicine, their socioeconomic status, and education level. We must address goals of care with clear “if-then” statements.
When I teach younger residents how to obtain informed consent I often harp on a concept I learned in my undergraduate psychology class called theory of mind. Theory of mind is defined as “being able to infer the full range of mental states (beliefs, desires, intentions, imagination, emotions, etc.) that cause action.” In my opinion, theory of mind is an integral part of the consenting process that allows us to reverse roles, to see the world how our patients see it.
Halfway through obtaining informed consent from my patient, my attending steps in. He snags a stool from the corner of the room. He sits directly in front of the sick man. He talks about what life will be like for him as a new amputee.
He emphasizes the importance of diabetes control and smoking cessation. We may do everything we can and the man still may die. Would he want to live if it meant he could never go home again? He conveys the gravity of the current situation in a way that is pitch perfect. This, I think to myself, is how it’s done.
For surgeon trainees, just like making our first cut, informed consent is a skill learned by example and should be done under the watchful eye of our mentors. It’s time to pay it forward. Next time you are the chief resident, the senior attending, or anywhere in between, take a trainee with you and teach him or her how to obtain informed consent the right way. Do away with the notions of “efficiency” and speed. Your patients and your pupils will be eternally grateful.
If you are in India and are interested in using a cloud based solution for informed consent which is in accordance with the supreme court guidelines, please leave a message in the comments.
We launched http://doctor.myconsent.in/ about 6 weeks back and it is in Private Beta at the moment.
A new survey shows 96% of mobile health application users and medical professionals believe mobile health apps "improve their quality of life."
Meanwhile, 86% of providers surveyed said mobile health apps will improve their knowledge of patients' medical conditions.
For the survey, researchers polled 1,000 mobile health app users and 500 medical professionals.
Overall, the survey found that 96% of surveyed mobile health users and medical professionals said that mobile health apps "improve their quality of life."
Among mobile health app users, the survey found:
Among surveyed health care professionals, the survey showed:
In a study it was concluded that Web-based questionnaires can be used to validly collect data on many chronic disorders, allergies, and blood pressure readings among pregnant women
The aim of the said study was to assess the validity of a Web-based questionnaire on chronic medical conditions, allergies, and blood pressure readings against obstetric records and data from general practitioners.
The background of the said study is that Self-reported medical history information is included in many studies. However, data on the validity of Web-based questionnaires assessing medical history is scarce. If proven to be valid, Web-based questionnaires may provide researchers with an efficient means to collect data on this parameter in large populations
Self-reported questionnaire data were compared with obstetric records for 519 pregnant women participating in the Dutch PRegnancy and Infant DEvelopment (PRIDE) Study from July 2011 through November 2012.
These women completed Web-based questionnaires around their first prenatal care visit and in gestational weeks 17 and 34. We calculated kappa statistics (κ) and the observed proportions of positive and negative agreement between the baseline questionnaire and obstetric records for chronic conditions and allergies.
In case of inconsistencies between these 2 data sources, medical records from the woman’s general practitioner were consulted as the reference standard. For systolic and diastolic blood pressure, intraclass correlation coefficients (ICCs) were calculated for multiple data points.
more at http://www.jmir.org/2015/6/e149/
Thanks to technology, Gary Sullivan enjoys a new kind of relationship with his doctor. If he wakes up with a routine health question, the 73-year-old retired engineer simply taps out a secure message into his doctor’s electronic health records system. His Kaiser Permanente physician will answer later that day, sparing Sullivan a visit to the clinic near his Littleton, Colo., home and giving his doctor time to see those with more urgent needs.
Once you took medical questions directly to your doctor, who advised, tested and treated you. Today, not only are we turning to the Internet for everyday medical information, we’re also generating our own health data: using a smartphone, for example, to investigate a child’s ear pain or monitor blood pressure. We’re learning from our peers online how to cope and find new treatments. Our doctors can keep our records electronically, accessible to us through a patient portal. Some of us can make video visits with doctors, who can offer diagnoses and treatment plans via computer or smartphone.
With all these advances, a traditional paternalism in medicine is changing, too.
Online records, video consultations , text messaging based Q and A's and smartphone apps for medicine have now started gaining acceptance and are transforming the traditional clinic appointments and visits. This disruption in the patient provider workflow is to everyone's advantage.
For Yale New Haven Health System (YNHHS), a well-connected health IT infrastructure with a focus on communication and patient engagement tools has helped clinicians deliver a high quality patient experience.
YNHHS’s focus on patient engagement tools, ranging from real-time surveys and telemedicine to patient portals and educational materials, has helped to reduce barriers to care access, improve satisfaction, and facilitate communication.
Real-time surveys reward quality interactions
One tool the health system uses is called Humm, a real-time patient satisfaction feedback survey deployed through a bedside tablet. Humm helps the care team gather data on room cleanliness, noise levels, and patient interactions with nurses and provider care teams.
Using population health to improve care access
Beyond understanding the patient and his or her needs at the point of care, Yale New Haven Health System is also dedicated to driving patient engagement to achieve population health management goals.
Faulty genes are major triggers and drivers of cancer, and the more knowledge we have about them individually, the better we can predict, track, and treat the disease in a way that is specific to individual patients' particular genetic promoters. To do this, researchers need models that are as realistic as possible.Cell and animal models help, but they do not meet the need at the tissue level. Now, using tissue engineering techniques, researchers have created a human colon model that allows them to identify and track the genes that drive colorectal cancer from initial abnormal mass to invasive tumor.
A survey conducted by Nielsen on behalf of the Council of Accountable Physician Practices (CAPP) finds that, at most, 52 percent of primary care physicians have recommended that their patients use an mHealth app or device to track their health. Yet only 4 percent to 5 percent of consumers surveyed say their PCP has made such a recommendation
This means that either physicians are making the effort but their patients are ignoring the advice, or patients are looking for that guidance but it isn’t coming from their doctors.
the survey reached a familiar conclusion in how each generation perceives mHealth and telehealth.
It found that consumers rarely use video visits (only 5 percent total), but those age 34 and younger are twice as likely to use and want them than those age 65 and older.
The same discrepancy was seen in the use of text reminders for medication and health measurements and online scheduling tools.
More than 60% of smartphone users used their mobile device to search for information about a health condition, according to Pew Research Center. The analysts at eMarketer have forecast that pharma digital ad spending will rise to $2.55 billion by 2019.
The growth in mobile investment within the industry is real. For example, half of Takeda’s Web traffic last year came from smartphones and tablets, which is why the drug maker is optimizing mobile for both patients and physicians in its marketing campaigns.
The real opportunities don’t lie in simply providing informational material — the app version of brochureware — but in finding simple ways to improve adherence and outcomes, When mHealth apps are paired with traditional treatments, this becomes possible.
The industry needs to act on the opportunity to be in the pockets of its consumers
People don’t crave the latest fitness wearable. Their overwhelming preference is for simple applications that provide and organize information
Startups in the insurance industry are investing feverishly to roll out products and services that will appeal to consumers. Taking a cue from the technology and communications industries, many are pursuing disruptive technologies that promise to revolutionize the healthcare experience — whether digestive sensors or systems that allow doctors to examine and treat patients via video.
But here’s the thing: Consumers aren’t ready for a revolution. They have far simpler demands and desires, such as an easier way to schedule doctor visits or the ability to get follow-up notifications on a mobile phone.
As a result, insurers that want to make the most of their investments in new technologies should focus their resources on developing simple digital products and services that align with their identities, strategic goals, and existing capabilities.
The idea that customers prefer simplicity may not come as a shock to those outside the healthcare industry. But it’s likely a revelation to those in the business, especially the insurers who have been investing heavily in telemedicine and other advanced features.
The survey revealed further insights into consumers’ preference for simplicity and a streamlined experience.
Some 97 percent of respondents said they would be willing to share personal health data and nonsensitive information if it would enhance their care, and only 3 percent ranked data privacy as the most important feature of a health plan.
About half of consumers want to involve both providers and insurers in their healthcare, and consumers are becoming increasingly comfortable with receiving wellness advice from health plans. That makes sense given the growth of so-called consumer-directed health plans, which put more responsibility for healthcare decisions and costs on consumers.
As Web-based social media are growing in popularity, the number of people who share their experiences or ask for support in health-related social media has also increased. A study found that 41% of e-patients have read someone else’s commentary or experience about health on a Web-based news group, website, or blog.
Another study reported that more than 60 million Americans read or contribute to Health 2.0 apps, in which they consider these apps as their first source when gathering data and opinions. About 40% of Americans doubt a professional opinion when it conflicted with what they form from Web-based health social media.
One of the key benefits of health-related Web-based social media reported by researchers is the increased access to information to various demographic groups, regardless of age, education, income, or location. However, previous work has mainly relied on user surveys to study the effect of the use of social media to health-related factors such as psychological distress. In addition, previous work does not reveal granular information on what disorders or other health topics are mostly discussed in the Internet by each demographic group, which would allow health care providers to create targeted and effective educational campaigns.
In this work, we conducted the first, to our best knowledge, large-scale data-driven comparative analysis of the content of health-related social media across various demographic dimensions—gender, age, ethnicity, location, and writing level. For each demographic group, we study the content of the posts across the following dimensions: sentiment, popular terms (keywords), and medical concepts (particularly disorders and drugs). Concepts refer to entries in the Unified Medical Language System (UMLS) vocabulary, whereas terms are just words from the posts’ text that may or may not belong to any UMLS concept.
We report results for 3 types of social media:
(1) general Web-Based Social Networks, namely Google+ and Twitter,
(2) drug review websites, and
(3) health Web forums.
The selection of social media types was based on their popularity and on our study of the literature on health-related social content.
The objective of this study was to identify which health topics are discussed in which social media by which demographic groups, to better guide educational outreach and research activities.
read the whole study at http://www.jmir.org/2016/6/e148/
A recently filed lawsuit alleging a faulty electronic health record system caused patient harm may be among the first in a wave of such cases, even though most experts say the latest EHR systems are better designed than older models.
One patient's blood pressure plummeted dangerously after he was allegedly discharged with the wrong medications. In another instance, a physician couldn't place a pharmacy order for a newborn to receive vitamin K, which is given to babies to prevent serious bleeding.
Virtual reality has been making headlines for its potential to transform the ways we interact with our environments.
Breakthrough technologies like the Oculus Rift headset have made for incredibly lifelike experiences, notably in gaming and other forms of digital entertainment.
Aside from its boom in the media sector, virtual reality has also emerged as an innovative tool in healthcare.
Both virtual and augmented reality technologies are popping up in healthcare settings such as operating rooms, or being streamed to consumers via telehealth communications. In many cases, virtual reality has enabled medical professionals to execute care more safely and effectively.
As virtual and augmented realities enter the mainstream, the technologies have become more accessible to the general consumer population.
With a $15 price tag, Google Cardboard allows users to stretch physical limits with a smartphone — no extensive scientific knowledge required. That same philosophy is being applied to virtual reality in the healthcare industry, empowering patients to take charge of their health.
Dr. Leslie Saxon, founder and executive director of the USC Center for Body Computing, is leading several initiatives to make virtual and mixed reality more patient friendly.
The center’s Virtual Care Clinic system features an app that connects patients to medical expertise similar to what they would receive at the doctor’s office. The app displays Saxon’s image, guiding users through different courses of medical care.
But patients using the app aren’t interacting with Saxon herself. Instead, they are following instructions issued by a virtual rendering of the doctor.
Using a virtual human agent may seem like a detached method of doctor-patient communication, but Saxon believes it to be the exact opposite. With this kind of technology, she told Healthline, patients could get their questions answered in an environment free from judgment. They can access information on their own time and at their own pace.
Patient education used to be a cookie-cutter operation: Hire a spokesperson, plan an event and draft a static list of symptoms, then call it a day.
But in the wake of groundbreaking campaigns from AstraZeneca and Novartis, the industry may well have to raise its content-creation game—and cede considerable control to super-informed patients in the process.
Larry Dobrow reports on the two programs that have raised the
After an initial diagnosis, diabetes sufferers often experience a period of shock when they learn that everything has to change. Turkish mobile operator, Turkcell, and agency R/GA London have created an app to make adjusting to the necessary life changes much easier.
Instead of trying to persuade sufferers to adopt entirely new habits, tools and behaviors to monitor the condition, "healthmetre" deploys Instragram, a tool many people already use and taps into behaviors that people already have.
R/GA designed healthmetre to be a more human way to manage diabetes and help patients develop new, more healthy habits in a way that feels natural and thereby, helping them reach a level of consistency.
The idea is to make using the app as simple as possible, helping people stay motivated, complying with treatment and keeping the lines of communication with medical staff open.
Diabetes is an increasing problem across the world and Turkey has been particularly affected. The most recent statistics (2014) from the International Diabetes Federation show that Turkey has the highest rate of the illness in Europe, with an incidence of 14.7%, much higher than countries like, for example, the U.K. (5.4%) or mid-ranked Germany (7.9%).
The results of the 18-month trial are highly encouraging. Treatment compliance increased by 54%. Blood sugar levels decreased by 27% and complication forecasts decreased by 37%.
The worst part of a sniffle or a sore throat is wondering what it is you're coming down with
A new app, called HEALTHYDAY, comes from a division of Johnson & Johnson and uses sickness-searching algorithms to take the guesswork out of your hypochondria by warning you when the flu is overtaking your neighborhood or pollen is driving allergies sky-high. as a kind of subtle advertising for its products.
The basic health tips the app offers up don't outright tell you which medicines to buy — instead they are each "brought to you" by one of the company's over-the-counter brands, which include Zyrtec and Tylenol.
The app's algorithm syncs self-reported data from local doctor's offices, Google searches, social media mentions on Twitter and Facebook and user data from people who use the app, then funnels it down into easily digestible trends, blurbs and infographics, according to McNeil's VP of marketing Katie Devine.
In San Francisco, for example, the app warns of a particularly high risk of allergies and cold symptoms and a middling likelihood of the flu.
The team wants to expand the app's features with more ailments and information once it has a bigger user base.
The mobile health industry has been revolutionizing the way both doctors and patients approach medicine today. When it comes to addressing health issues, mobile health consumers are moving toward preventing disease and increasing fitness and wellness. Through fitness trackers and wearable devices, more patients are now focused on exercise and diet.
New technology developed by Howard Hughes Medical Institute (HHMI) researchers makes it possible to test for current and past infections with any known human virus by analyzing a single drop of a person's blood. The method, called VirScan, is an efficient alternative to existing diagnostics that test for specific viruses one at a time, according to the scientists.
With VirScan, researchers can run a single test to determine which viruses have infected an individual, rather than limiting their analysis to particular viruses.
That unbiased approach could uncover unexpected factors affecting individual patients' health, and also expands opportunities to analyze and compare viral infections in large populations. The analysis reportedly can be performed for about $25 per blood sample.
“We've developed a screening methodology to basically look back in time in people's sera and see what viruses they have experienced,” says Stephen J. Elledge, an HHMI investigator at Brigham and Women's Hospital who led an international team that developed VirScan. “Instead of testing for one individual virus at a time, which is labor intensive, we can assay all of these at once. It's one-stop shopping.”
VirScan works by screening the blood for antibodies against any of the 206 species of viruses known to infect humans. The immune system produces pathogen-specific antibodies when it encounters a virus for the first time, and it can continue to make those antibodies for years or decades after it clears an infection. That means VirScan not only identifies viral infections that the immune system is actively fighting, but also provides a history of an individual's past infections.