Here I scoop the news coverage and relevant academic output related to new technologies, online social networks and other emerging trends that are changing the patient physician relationship.
I'm most interested in the way the information on this issue is presented in media available online and the possible effects of these communications in the perceptions people hold of doctors.
When a curated article is cropped, I indicate that there is more text with (...). Bold indicates what is most relevant. My own comments are preceded by "CE".
I look forward for your suggestions!
En esta página colecciono las noticias y producción académica relevante a las nuevas tecnologías, redes sociales online y otras tendencias emergentes que están cambiando la relación médico paciente.
Me interesa la forma en la que se presenta la información sobre este tema en medios de comunicación disponibles en Internet y los posibles efectos que estas comunicaciones tienen en la percepción de las personas respecto a sus doctores.
Cuando pongo solo una parte de un artículo, indico que hay más texto con (...). Las negritas indican lo más relevante. Mis comentarios aparecen como CE.
"This matters because a comment about a patient posted by a health care professional on their Facebook page may quickly lose its anonymity because of the size of their friend networks. This is especially true if “friends of friends” can access the posts.
A similar problem with confidentiality arises when health care professionals refer to patients on “open access” medical blogsor Twitter accounts.
Remarkably, a recent study found that 17% of medical blogs include sufficient information for patients to identify themselves or their physicians and the same study found that a small number of these blogs included recognisable photographic images of patients.
Another major area of concern relates to the maintenance of proper boundaries between professionals and patients (...)"
Patients are actively looking to engage their physicians online, but doctors aren't too keen on the idea. What's the big fuss?
(...) "Q: Privacy seems to be a big concern among physicians. Should doctors be friends with patients on Facebook?
Pho: The short answer is no. There is information on personal Facebook profiles that physicians may not necessarily want their patients to know about—pictures of their children, what they did on vacation, what they do after hours. Allowing patients access to a personal physician’s profile has the potential to blur the line between a professional doctor-patient relationship and one that brims on being too personal.
Instead, I advocate a “dual citizenship” method that separates a personal and professional online identity. It’s an approach that professional medical societies endorse, such as the Federation of State Medical Boards. Physicians can still maintain their personal profile on Facebook, but restrict access to it to close friends and family members.
Then they should have a separate Facebook Page for their practice that is open to the public. Doctors should maintain a professional demeanor on this page, and use it to connect with patients, share stories about the practice, and guide the public to reputable health information on the web. An increasing number of patients get health information on Facebook, so it’s important for physicians to have a presence there. A professional Facebook page is an ideal way to do so." (...)
One line in the final version has received a lot of attention on the twittersphere : "If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name."
Final 17If you identify yourself as a doctor in publicly accessible social media, you should also identifyyourself by name.Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely.
18 You should also be aware that content uploaded anonymously can, in many cases, be traced back to its point of origin." (...)
I continue to hear doubts echoing from my fellow medical students, residents, and attendings, particularly about the use of Twitter.
Why should medical professionals consider joining the Twitterverse?
The following are just a few reasons.
Stay up to date on news and literature. Doctors (and med students!) are busy and don’t always have time to seek out what’s happening in the world. Twitter conveniently brings news and research directly to your feed. (...)
"Share ideas and learn from others. Twitter is an open forum of conversation for the world. In my opinion, this is the most valuable use of Twitter.
I follow people who tweet about things that interest me, both medically related and not. As a medical student, I’ve used Twitter as a study tool , asking questions and gleaning knowledge from physicians, residents, and other students. I listen and converse in various tweet chats, such as the mobile health (#mhealth), healthcare social media (#hcsm), and medical education (#meded) chats. I hear patients share their stories and follow blogs." (...)
Help patients. This does not mean doctoring patients on the Internet, following my patients on Twitter, or anything of the sort. Patients are online, though, and many are on Twitter. As medical professionals, we can help disseminate accurate health information on the web. Twitter provides a great avenue for physicians to steer people to reputable websites for health information, dispel myths, share helpful articles, and educate people on medical issues." (...)
"It’s fun! Perhaps my favorite reason to tweet is that it’s fun! I love spending time on Twitter. I learn something new every day and read many hilarious or otherwise entertaining tweets along the way. I’ve connected with people I never thought I would, all with a myriad of ideas and opinions. The environment is so dynamic." (...)
The health care social media legal series continues here on Healthin30, and legal expert, David Harlow, Esq, Health Care Attorney and Consultant at The Harlow Group, LLC in Boston, answers a series of questions focusing on the legal aspects of...
It is the emerging social network that is the real value proposition in social media.
(...) "... in the past few months three data sets have been published that should be taken as the definitive answer to the question: What is the value of social networks on healthcare and healthcare education? Here are some highlights to make the case:
Perception = reality: In our recent paper in JMIR, more than 60% of physicians using social media as an element of their lifelong learning felt that their social media engagement improved their professional productivity and improved the care they provide to their patients.
Location = innovation: In a separate paper in Academic Medicine, while traditional Train-the-Trainer courses caused faculty members to believe they are more innovative, in reality it is the shape and structure of a faculty member’s social graph that ultimately determined their degree of innovation.
Structure = healthcare quality: In a third paper in Medical Care, 1 standard deviation (SD) in the median number of connections per physician (network redundancy) was associated with a 17.8% increase in total spending, in addition to 17.4% more hospital days, and 23.8% more physician visits.
So there you have it – physicians think social media makes them better docs. In reality, it is their place within their social networks that help them innovate. And, the end result is that a better structured social network improves healthcare quality and decreases healthcare costs (by nearly 20%)." (...)
The New York Times calls Eric Topol “a Naderesque crusader against drugs he deems dangerous, as well as their makers.” He is recently the author of "The Creative Destruction of Medicine."
I'd like to ask for your thoughts on improving patient communication because you’ve written about this. We as patients can get so much information on the internet, it opens up amazing possibilities for the flow of communication. But it’s really hard to tell which information is high quality. So the internet has turned into this source of rampant confirmation bias. Do you think there’s a way to filter for quality information and turn this ease of access into a public health tool?
It’s a challenge it’s even a challenge among the biomedical research community and now you are extending it to everyone. In a way that was the main reason I did the book. I was trying to teach the public about this stuff. So I did a whole chapter about the predator and the prey, understanding medical evidence—you know in a lot of cases there isn’t evidence, it’s eminence-based medicine rather than evidence-based medicine—and the caveats regarding relative risk, and all the things I thought the public should know about. I’m trying to push precisely what you are asking forward and I think we need a lot more of that to have a fully informed public. We need to make more of a conscious effort.
Teaching the patients these research skills, how to assess information?
Yes, I talk about in the book if you are looking for a doctor, how do you find the top expert in the country? In case you have the resources to go. You go into Google Scholar, you put in the topic, you check out how many citations—you know I just walk readers through examples. Because there are tools out there that are not Yelp. For example, anyone can have access to Twitter and why not follow the person who is the guru or expert in the health condition you are interested in? There’s all sorts of ways to tap into the cognoscenti of medicine that are not being used today. But in addition we need to take an active role in making it happen."
Camilo Erazo's insight:
This is an example of a top medical expert encouraging patients to be more active in their search for quality medical information and specialists according to their needs.
Google search has become part of our medical check-up these days. If you browse WebMD, Google or various online forums for answers before a doctor visit, you're not alone.
It's tempting to see if we can find an answer to our health questions in an instant when a world of information is at our fingertips, rather than leaving work or home. Flawed and inaccurate as some of that information may be, there are also many useful sites and forums with advice from actual doctors.
Ojo con esto: ""We haven't turned the corner to where we can say social media have changed people's outcomes, but there are some really interesting projects out there that are changing that," he says. "I think we're within a couple years of having secure sites and capturing more details about patient circumstance."
When Google Health first went live in 2008, the service held a lot of promise for people looking for a reliable and convenient way of centralizing their health records, and then matching them up with other resources like drug information and doctor databases. But when, in 2011, Google decided to shutter the service after it didn’t pick up enough traction, that left a lot of people with a challenge: abandon ship or look for a new place to fight the e-health fight. They had a bit of time to decide: Google said that it would only delete all remaining records on the service on January 1, 2013.
The Quantified Self trend is a must-watch, since it may drive a large part of Consumer Health Informatics apps and services. A glimpse into a future or just a present version of a hyper-neurotic future minority?
"Un encuentro de ingenieros informáticos, empresas, personal sanitario, investigadores y representantes de las administraciones públicas sirvió ayer para poner las cosas en su sitio: España es uno de los países con más smartphones (25 millones) y tablets, pero sólo un 12 por ciento de los pacientes utilizan aplicaciones de telemedicina.
"Lanzado el porqué durante el Foro de Innovación celebrado en el Centro de Investigación Biomédica de Aragón (CIBA), de Zaragoza, los profesionales de la salud presentes en la sala respondieron enseguida: "Es que no son fáciles de utilizar". Y, además, quizá falte formación entre el personal sanitario." (...)
"También coincidieron muchos asistentes en algo que puede considerarse como conclusión del encuentro: los profesionales de la salud tienen que opinar en el desarrollo de aplicaciones biomédicas, porque no basta con lo que piensa el ingeniero. Según Magallón, "hay una verdadera brecha, también entre los profesionales de la sanidad y los gestores de los centros públicos, que son en definitiva los que marcan el camino de los servicios". De hecho, recordó que existen proyectos parados y muertos en los despachos de gerencia.
"Ante la opinión generalizada de que los sanitarios generan datos a los que luego no pueden acceder, el jefe de Informática del Hospital Clínico de Zaragoza, Fernando Bergua, argumentó que "se han hecho muchas cosas con muy pocos recursos", tanto en historia clínica como en receta electrónica. "Las nuevas aplicaciones se están generando en los centros de salud. Toda la información está digitalizada y sirve de comunicación horizontal. Las pruebas diagnósticas son visibles en cualquier centro de Aragón. Y queremos poner en contacto también hospitales, e incluso laboratorios". (...)
Por tanto, la simbiosis informático-profesional de la salud parece ineludible. Así lo reconoció Nacho Barraqué, de la empresa de software Hiberus: "Se aprende con el contacto directo".
Entre el público del foro surgió la idea de si no estamos sobrevalorando las tecnologías y olvidándonos del apoyo humano, del respaldo del entorno y el afecto. Pero los expertos dejaron claro que las tecnologías pueden servir para escanear los problemas y definirlos, aunque luego su abordaje tenga que ser más humano".
Camilo Erazo's insight:
Importante el último comentario... es esperable un aluvión de críticas sobre la deshumanización de la medicina por la tecnología - sin considerar que quizás las TICs puedan (¿re?)humanizarla.
What health care will look like after the information technology revolution.
Camilo Erazo's insight:
"Who treats us, and where, will change as well. With an electronic backbone in place, one doesn’t need to see a doctor for every issue. There is little the primary care doctor does that can’t—and increasingly isn’t—being done by a nurse practitioner, perhaps at a clinic in a Walmart or CVS. Routine prescriptions for medication refills can be handled online, with an electronic doctor watching. Even high-end services can be spread widely, with specialized centers coördinating the treatment of patients far from its walls." (...)
"Information technology is going to change the game because it will affect how people view themselves, their illness, and the people who care for them. Amazon’s loyalty comes in no small part because it uses our past searches and the searches of people like us to predict what we will want. The customer is part of Amazon’s Memex. Health care will be less frustrating when the power shifts from sellers to buyers, and when patients are more in charge."
Body Trackers are the small devices that we wear on our bodies that track our every motion, providing a lot of data that could be beneficial for patient care.
Doctors always wonder what their patients actually do after being told to “lose weight” or “eat healthier.” Well, with devices like this and access by medical staff to their patients’ logs you can get a pretty detailed picture. The idea that their “doctor is watching” might be enough to motivate people to make permanent healthy changes.
The flip side is the information can be pretty overwhelming. Logging food can be a daunting task and people are notorious for under-reporting what they eat. A patient might get overwhelmed by all the charts and graphs and just throw their hands up and walk away.
What are the different types of Body Trackers:
Wrist: Fitbit, Jawbone UP, Nike Fuel all sit on the wrist as a bracelet and track every motion. Many also have the ability to track sleep and can let you know how much REM sleep you’ve gotten.
Wrist w/pulse: MyBasis has a tightly fitting watch that tracks heart rate patterns, motion, perspiration and skin temperature throughout the day for a more accurate picture of what your body is doing.
Waistband: FitBit is the king right now of the waistband crowd (although they just introduced a wrist version). Same basic tracking but it tucks insideyour waistband so you don’t have to advertise what you’re doing.
Armband and other areas: Devices like the BodyBugg sit on the upper arm instead of the wrist or waistband. There are also several devices just launched or in development phase which have sensors built into clothing.
These devices track sleep patterns and movement throughout the day and most of them also have a robust meal diary so people can track calories in vs. calories out.
Sermo recently asked their physicians how they felt about body tracking systems.
Here are the results.
Question: Do you use or have you recommended a body/activity tracking system to patients?
Consumers have become accustomed to using smart phones for self-managing many aspects of their daily lives but still lack access to their own healthcare data.
Camilo Erazo's insight:
"The time for giving patients access to their electronic medical records has come."
"Currently, only one in five U.S. doctors allow patients to have online access to their medical summary or patient chart—the most basic form of a patient’s record. Most resistance stems from two concerns. The first is the concern that doctors will be inundated with questions from patients regarding their health, while the second is a concern that if given the opportunity, patients will change valuable information in their record.
Some health systems have proven that the benefits of allowing patients to have access to their records can actually outweigh the risks. According to a recent Robert Wood Johnson Foundation study, when given the opportunity to review their medical notes, the majority of patients at three health systems reported a better understanding of their health conditions, felt more in-control of their care and had an improved doctor-patient relationship. Furthermore, patients did not create additional risk or an excessive burden. In fact, patients became a helpful part of the record-keeping process, and furthermore, increased their understanding of their own conditions and improved adherence to care protocols. Their outlook improved when they were engaged in the process." (...)
How does one prevent snooping of patient records through a hospital, regional or local clinical information system?
(...) "The Medical Post article describes a situation in which an Edmonton physician at the Misericordia Hospital accessed the medical records of three patients with whom she did not have a physician relationship. The access took place via a hospital computer after a colleague failed to log out of a computer terminal. The disciplinary action was brought against the physician by the College of Physicians and Surgeons of Alberta and it was found that she was aware of the inappropriate access as well as the fact that she would not leave a fingerprint trace of her access as she used another physician's login to access the records.
This is one of those potentially avoidable situations that is unfortunate for both the patients and the perpetrating physician. After the fact identification of privacy breaches are the norm in today's world, in large part because the mechanisms to identify inappropriate actions generally take place through either a complaints or post-event audit process. It is very difficult to avoid breaches such as this particular example which appears to have had a calculated element to it, although the physician in question did not 'disclose or make use of the information' in any way. In addition to the fine, the physician received a 60 day suspension and was also ordered to attend an ethics class." (...)
You will learn a lot from other people. Twitter is used extensively to share not only opinions and news but also links to blog articles, news reports, and academic articles.
You will stay right up-to-date with what’s new and happening in your areas of interest – from links to blogs and articles from key opinion leaders, to live tweets from important conferences, press-conferences and the health committee. You can access up-to-the-minute news and information wherever you are.
You will be able to share important views, news, information and links with other people and you can use Twitter to raise the profile of issues that are important to you.
You can use Twitter to network with other people in healthcare and best of all you can broaden your network with the opportunity to debate and converse with a diverse range of people from junior doctors, nurses, managers, patients, senior doctors, policy makers, CEOs, Directors, politicians etc. People you might not normally have easy access to.
You will have fun learning, sharing, discussing, debating and getting to know people. It’s just like any conference or event. You get to broaden your horizons by meeting new people, learning new things, and sharing, except you can access it at will from your smart phone, laptop or tablet. And you can do so while on the train, in a queue at the supermarket or sitting on the sofa at home."
Camilo Erazo's insight:
Novel recommendations and tips, fresh take on Twitter for MDs, useful review of prior guidelines.
Engaged patients – those who actively seek to know more about and manage their own health – are more likely than others to participate in preventive and healthy practices, self-manage their conditions and achieve better outcomes.
As you might imagine because of visibility, the internet and social media outlets in particular, are another enormous area for potential regulation.
(...) "However, when physicians become active on Facebook, there is potential for both positive and negative impact. In a survey in the Journal of General Internal Medicine, researchers found that nearly 85% of all medical students are involved in social media sites–this suggests that the next generation of physicians will become increasingly more active and engaged with each other and with patients via sites like Twitter and Facebook in the future. Another survey found that while more than 80% of physicians who are active on Twitter and Facebook are likely to engage and interact with one another, less than 8% interact with patients via social media. However, for those that do use Facebook and Twitter to interact with patients, there are significant legal and ethical questions that arise. In an extreme example discussed in the WSJ article, one physician actually returns calls when contacted via his Facebook account. I worry that universal and unrestricted access to healthcare providers may blur the line between one’s personal and professional lives. In order to provide the highest quality care, physicians and other healthcare providers must also have some downtime–everyone needs to recharge and relax. Moreover, once a provider sets a precedent for interacting via social media with active patients (and establishes a doctor-patient relationship) a legal obligation to continue to respond in the same manner may be created. Just how deep does the rabbit hole go?" (...)
Cirujanos, doctores, enfermeras, residentes y otros profesionales médicos utilizan de forma regular iPad en su trabajo. Esta practica ha inspirado una industria artesanal, innovación en la atención sanitaria y protección de la privacidad
Patient-centered care is an important aspect of high-quality care. Health informatics, particularly advances in technology, has the potential to facilitate, or detract from, patient-centered cancer care. Informatics can provide a mechanism for patients to provide their clinician(s) with critical information, and to share information with family, friends, and other patients. This information may enable patients to exert greater control over their own care. Clinicians may use information systems (e.g., electronic medical records) to coordinate care and share information with other clinicians. Patients and clinicians may use communication tools and information resources to interact with one another in new ways. Caution in using new information resources is warranted to avoid reliance on biased or inappropriate data, and clinicians may need to direct patients to appropriate information resources. Perhaps the greatest challenge for both patients and providers is identifying information that is high-quality and which enhances (and does not impede) their interactions.
"The key to harnessing the potential of informatics to promote patient-centered care is to use technology to direct both patients and clinicians to high-quality information, and to share this information with one another. " (...)
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