The New Patient-Doctor e-Relationship
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The New Patient-Doctor e-Relationship
How is the patient-physician relationship changing due to the internet, online social networks, and mobiles?
Curated by Camilo Erazo
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Mobile Health Tech: From Novel Startups to Global Industry

Mobile Health Tech: From Novel Startups to Global Industry | The New Patient-Doctor e-Relationship | Scoop.it
Last week's mHealth summit in Washington, D.C., gave tech leaders an opportunity to evaluate the field and its future.

(...) "Legislation has been an area of concern and confusion for many in the field. Digital health technologies, when used by physicians to administer healthcare, are subject to governmental regulation, but by whom, and in what manner, remains unclear. Many came to the conference hoping for greater clarity on this issue. Not coincidentally, the summit coincided with Silicon Valley Congressman Mike Honda's new bill to create an Office of Wireless Health at the FDA. Honda said that he seeks "consistent, reasonable, and predictable regulatory framework for wireless health issues." Conference presenter Joseph Kvedar, founder of the Center for Connected Health, felt optimistic that "the FDA and FCC have both been increasingly clear on how this space will be regulated, and that creates a path for innovation."

While regulation is of great concern for doctor-operated products, for the consumer-oriented market, so long as a product makes no explicit promises about diagnosis or treatment, the FDA does not need to be involved. This apparently slight distinction has a host of consequences for the markets in question.

For one, it's much easier to bring a consumer-oriented product to market than a physician-oriented one. As an example, an application tracking a diabetic person's blood sugars need not go through the FDA so long as it remains separate from actual clinical practice. Unfortunately, this creates a disincentive for developers who might have otherwise built the application to inform both physicians and patients. At the same time, it has fostered explosive growth among consumer-operated applications -- in many cases providing patients with data their doctors couldn't collect even if they wanted to.

Another corollary of this regulatory distinction is an increasing cultural divide. On the West Coast, specifically the Bay Area, consumer-oriented developers hold hackathons, and focus groups, and seek funding from angels, VCs, or even the crowd. Many of the physician-oriented tools, by contrast, are emerging from the East Coast, where developers have more often partnered with government and industry, especially pharma (Johnson and Johnson) and insurance companies. Both markets hope to improve health outcomes, increase data points, and lower costs, but the consumer-oriented culture speaks also of empowerment and access." (...)
Camilo Erazo's insight:

Very useful distinction between "doctor-operated" vs "consumer-oriented" (recognizing its artificial nature). Agree that consumer health apps will continue to rise while we keep wondering why we can't have that killer-app to communicate better between patients and physicians...

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Susannah Fox of Pew Research Center Talks About New Findings on Mobile Health Usage

Susannah Fox of Pew Research Center Talks About New Findings on Mobile Health Usage | The New Patient-Doctor e-Relationship | Scoop.it
Susannah Fox, associate director at the Pew Research Center's Internet & American Life Project, spoke with iHealthBeat about Pew's latest study on Internet use among U.S.


Latest research: http://www.pewinternet.org/Reports/2012/Mobile-Health.aspx

Pew's report found that the percentage of mobile phone owners who use their phone to look up health information has increased from 17% in 2010 to 31% this year. However, the report also found that the percentage of mobile phone owners who said they have a health-related application on their phone has remained steady at about 10% since 2010.

According to Fox, some of the most popular health-related apps include those focused on fitness, weight and nutrition

Read more: http://www.ihealthbeat.org/special-reports/2012/susannah-fox-of-pew-research-center-talks-about-new-findings-on-mobile-health-usage.aspx#ixzz2EqEvMM7r
Camilo Erazo's insight:

Interesting data point about lagging uptake of health apps; maybe this alone would decrease the supposedly billion-sized mHealth market.


Physicians will probably get marketed to prescribe health apps; this will (hopefully) prompt platforms that produce un-biased data on the quality and clinical relevance of apps. FDA efforts will probably fall short on this... Who're you gonna call?

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Open-Data Advocate Says Health Information Must Be Shared | New York Genome Center

Open-Data Advocate Says Health Information Must Be Shared | New York Genome Center | The New Patient-Doctor e-Relationship | Scoop.it
(...) "A leading and longtime advocate of open access to scientific data delivered a stern message to physicians recently: "You are not ready” for the flood of data that is coming, and you need to take the lead on setting privacy guidelines for that data before someone else does.

John Wilbanks, a self-proclaimed agitator and contrarian, warned that if privacy advocates drive policymaking on the use of health data, society and science will lose out.

In an era of “big data,” when personal health information can be derived from sources as diverse as credit card records and GPS, and when individuals can acquire a genome sequence without consulting a doctor, Wilbanks urged the medical research and entrepreneurial community to take the lead in integrating and applying these various data in useful ways. He also urged a rethinking of the paternalistic approach to protecting patients and study participants by withholding data from them."
Camilo Erazo's insight:

"You are not ready” for the flood of data that is coming," / No, we are not... but then again, who is?

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Myth and Reality of Doctors Getting Overwhelmed by Emails - Forbes

Myth and Reality of Doctors Getting Overwhelmed by Emails - Forbes | The New Patient-Doctor e-Relationship | Scoop.it

(...) "Physicians are understandably concerned about being overwhelmed by emails if they provide an option for secure messaging. As healthcare transforms, financial incentives have a big effect on the willingness to take on what many perceive to be “more unpaid work” (forgetting the fact that playing voicemail tag is also unpaid). Interestingly, the physicians who have given out their phone number or enabled secure email (without remuneration) haven’t found they are overwhelmed by any means. In the case of the groundbreaking Open Notes study, many of the doctors just heard crickets. For those who have proactively enabled email communications, they have experienced a number of benefits. See the section below on improvements in outcomes simply by having email. [Disclosure: One of the capabilities included in the patient relationship management system my company provides is secure email.]


Dr. Ted Epperly has been a family doctor for decades and describes his experience as follows:

I give them both my phone number and a way to contact me via email. In 32 years of being a family physician I have had this privilege abused less than 5 times. On the flip side it has led to many occasions where I have been able to expedite care and save countless number of office visits, ER visits and hospitalizations. That is patient-centered care and I personally feel better for it.” (...)


"It is clear that providers can impact how their patients use secure messaging. Providers who suggest that their patients follow up digitally will introduce it with messages that state, “After you’ve taken these new medicines for a couple of weeks, please send me a secure message and tell me how you are doing.” They also advertise their willingness and ability to engage with patients via secure messaging knowing they will have more digital encounters than their counterparts who mention it rarely or not at all.


As providers do more of their visits via secure messaging, however, systems will need to think about new models for compensating providers that acknowledge writing a thoughtful message to a patient does take time and needs to be balanced with other work. Some organizations, such as Group Health, expect over a quarter of their doctors’ time will be spent responding to email. The most important driver is reimbursing on outcomes. When that happens, email simply becomes a tool like any other organization (outside healthcare) to enhance communication with their clientele. (...)


"Email can be one way to address the problem that patients remember so little of what they are told in the provider’s office. Other options include providing a clinical summary to patients after the visit (as recommended by Meaningful Use measures) and providing documentation of a care plan online for patients to refer to later."


[CE: Keep in mind the disclosure before making the leap to secure email between patients and doctors...]




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Caregivers Turn to Internet for Health Care Information, Support

Caregivers Turn to Internet for Health Care Information, Support | The New Patient-Doctor e-Relationship | Scoop.it
Family caregivers outpace all other groups in their use of the Internet to seek health care information.


"The United States is becoming a nation of caregivers. Roughly 42 million people -- 30% of the U.S. adult population -- provide care to a spouse, parent or child.


Caregivers often are placed in the stressful position of having to make major health care decisions on behalf of a loved one or manage an aspect of care that requires knowledge that most people simply don't have.


So it's perhaps little surprise that a recent Pew Internet and American Life Project report found that family caregivers go online in search of health information at rates that far exceed other groups.


"Your first instinct, especially if it's a diagnosis you're not familiar with or a treatment protocol you don't understand is to go online and Google it and find out more," said MaryAnne Sterling, founder of Washington, D.C.-based Sterling Health IT Consulting. Sterling is also a long-time family caregiver.


According to the Pew report, eight in 10 caregivers have access to the Internet, with nearly nine in 10 of those caregivers using it to find health information on behalf of someone else.


Caregivers are more likely to report having gone online to search for information on behalf of another person, rather than for themselves. Sixty-seven percent of caregivers reported that their last search for online health information was on behalf of someone else, while 29% said their last online health search was for themselves. In comparison, 40% of non-caregivers who went online looking for health information did so on their own behalf." (...)


"There has historically been a lot of information on disease states and disease conditions and the medical elements [of caregiving]. It's been more recent that the marketplace has discovered there is a real need in the caregiving community in managing all of the overall tasks the caregiver has to do," John Schall, CEO of the National Family Caregivers Association, said." (...) 


"Some of the most daunting tasks caregivers take on, experts say, are those traditionally reserved for doctors and nurses.


Sterling said that family caregivers regularly perform medication administration, wound care, and they often work with IVs and catheters. "These are activities that family caregivers are ill-trained to perform and if done incorrectly can result in very poor outcomes for that patient. There is no magic bullet yet [or a place] where caregivers can go for this much more complex information."


Despite the technological advances, the complexity of their role still requires caregivers to seek out the human touch.


"My own professional belief is that the Internet is an excellent tool for seeking out information, but for actually making choices once you gather that information, nothing substitutes having someone to talk to who is knowledgeable and can guide you through that process," Feinberg said. (...)


Read more: http://www.ihealthbeat.org/features/2012/caregivers-turn-to-internet-for-health-care-information-support.aspx#ixzz2EVKjnI8Q


[CE: Useful perspective, especially for digital entrepreneurs wanting to provide real value through apps and the web to people in need of care.]

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Chronic Disease and Social Networks - HIMSS Blog

Chronic Disease and Social Networks - HIMSS Blog | The New Patient-Doctor e-Relationship | Scoop.it

by Jane Sarasohn-Kahn, MA (Econ.), MHSA, Member, HIMSS eConnecting with Consumers – Social Media Task Force Chronic.


(...) "A powerful force can be deployed to move the needle on health outcomes: patient involvement in their healthcare. One way to health-engage people in everyday life is via social media.


Social networking holds significant promise for engaging people in health and changing health behaviors. Two thirds-of people try to change their health behavior each year; 50% do not sustain those behavior changes, learned by the 2011 Edelman Health Barometer survey. When people connect to a social network of peers, though, commitment to behavior change is bolstered and supported, as the research of Christakis and his colleagues has found." (...)


"Social media use has grown in the past several years, particularly among chronically ill people. Social network site users who are chronically ill are more likely to gather health information from the sites compared with people who have no chronic conditions, 20% versus 12%. Susannah Fox, who led the social networking in health survey for the Pew Internet & American Life project, calls this peer-to-peer health care. Note that caregivers, too, engage in social networking in health, where a peer can be a parent of a sick child or an adult child of an aging parent." (...)


"But patients, and particularly those managing chronic conditions, are driving the use of social networking in health. Some patients seek social networking in health on general platforms like Facebook and Twitter. More advanced patients seeking deeper relationships online find support, solutions and tools from health-focused social networks.


The pioneers of social networking and chronic disease were CureTogether and PatientsLikeMe. CureTogether was founded by Alexandra Carmichael and Daniel Reda in 2008 first focusing on three conditions. The network expanded to cover 637 diseases and partners with many research organizations and university teams to discover cures, together. Think of CureTogether as a community for patient-driven clinical trials for conditions eluding old-school research protocols." (...)


"Social networks in health are not a panacea for solving the complex challenge of chronic disease. Privacy continues to concern consumers when sharing clinical data that may be viewed “in public,” online. And, the evidence base on social networking in health must continue to be built to ensure best practices are adopted that most directly benefit patients and deliver value-for-money.


Patient engagement is hard. Social media exist organically in a larger context, where public policy, health plan benefit design, and personal preferences interplay and nudge people toward healthy behaviors.

One quite powerful nudge is coming in the form of accountable and value-based health care, which aligns incentives for providers, patients and health plans for patient-centered, outcomes-driven care. “No outcome, no income” is a powerful incentive for providers to focus on team-based care that puts patients not only at the center of the team, but as a valued member of the provider team, too.


Health is social. Social networks can and will play a growing role for patients that can empower them and their caregivers."


[CE: I love the idea of a social-media-driven systemic change in healthcare, with outcome based incentives and teamwork as central themes... Wishful thinking? Don't miss the thoughtful comments]

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Surveys: Many Clinicians Use Mobile Devices in Patient Care

Surveys: Many Clinicians Use Mobile Devices in Patient Care | The New Patient-Doctor e-Relationship | Scoop.it
A Healthcare Information and Management Systems Society survey finds that 45% of surveyed IT workers at health care organizations say clinicians use mobile devices at a patient's bedside.


(...) "The report found that about half of surveyed IT professionals believe that the use of mobile technology will significantly affect patient care. It also found that:

  • 45% of respondents said clinicians at their organization use mobile devices to collect data at a patient's bedside, up from 30% last year;
  • 38% said clinicians use mobile devices to read bar codes, up from 23% last year;
  • 34% said clinicians monitor data from mobile devices, up from 27% last year (Walsh, Clinical Innovation & Technology, 12/3); and
  • 27% said clinicians use the camera on their mobile device to capture patient data, up from 13% last year.

About 25% of respondents said that all patient data captured by clinicians' mobile devices are integrated with the patient's electronic health record (MobiHealthNews, 12/4).


Read more: http://www.ihealthbeat.org/articles/2012/12/4/surveys-many-clinicians-use-mobile-devices-in-patient-care.aspx#ixzz2E7EuBJ8v


[CE: Health Information Security Experts banging their heads on their desks in 3, 2, 1...]

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4 reasons to go virtual | Healthcare IT News

4 reasons to go virtual | Healthcare IT News | The New Patient-Doctor e-Relationship | Scoop.it

"First there was the migration to the cloud, now it's a push for virtualization. Gone (or soon to be gone) are the days where every nurse, doctor, and healthcare professional is chained to a desktop PC upon which they rely for access to their software and information.


(...)


Joe Brown, president of Accelera Solutions, shares four reasons for going virtual.


1. Personalized healthcare applications. Having a strong EMR is an important part of running a practice, but the burdens of cost and maintenance may be too much for smaller providers to bear. Brown says that, in an effort to make smaller doctors more "sticky" to their larger presence, hospitals are virtualizing their EMRs and hosting them on a private server for smaller practices to have access to. "They give them virtual use of their EHR system," says Brown. "These doctor groups work very seamlessly with the hospital system. They can order all kinds of things straight from the hospital through a very secure private cloud environment. In the past it would have been at past very cumbersome."


2. Patients outreach. Brown recalls a commercial he saw recently where a patient "made an appointment with a doctor, checked a prescription, viewed an X-ray, and said, 'I did this all from my smartphone.'" Brown sees this level of connectivity as a crucial element to healthcare, if a provider wants to stay competitive. "That's the way consumers want to interact with their providers.


Consumerization is driving healthcare systems to adopt the cloud faster than they'd like to," he says. Brown says that physicians aren't immune from this demand either, noting that "as doctors get younger in our generational shift, we're going to see the physician desire to interact with mobile devices more and more." (...)


[CE: So this might allow smaller practices to survive, or even spur a 'new wave' of independent physicians who are now able to work in a 'REAL' network with larger providers.]

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Seeker Spotlight: Mom’s Medical Mystery (Part 2) | Perspectives on Innovation

Seeker Spotlight: Mom’s Medical Mystery (Part 2) | Perspectives on Innovation | The New Patient-Doctor e-Relationship | Scoop.it

Back in August 2012, we posted a very unique Brainstorm Challenge to crowdsource a diagnosis for a medical mystery...


"... We were overwhelmed with the Solver response, with 1,565 Solvers engaging in the Challenge. Fast forward to November, and Mom’s Medical Mystery returns, this time seeking design plans for analyzing the responses of the first Challenge. At the midpoint of this second Challenge (which closes on December 13, 2012), we spoke with Simon Turkalj to hear more about how the Mom’s Medical Mystery sequel is progressing.


Hello Mr. Turkalj – Thanks for joining us again. What were some of the most important ideas that you took away from the first Challenge you launched?


There is an old saying in medicine, “When you hear hoofbeats, think horses, not zebras.” It’s a reference to thinking about probabilities when you encounter evidence – horses are more common, and therefore more likely, than zebras.


This case has stumped specialists for more than two years now, so we did need to consider the unusual/unlikely causes, but without abandoning critical thinking. In this context, we had to learn how to balance our responses. We wanted to encourage out-of-the box thinking from the Solver community. We also wanted to involve our team of specialists in providing good technical responses to present a point/counterpoint (checking off the pros and cons of each theory) to deepen the Solver dialogue.


The depth and breadth of the responses was encouraging. While we didn’t reach our goal of a single definitive diagnosis, our first Challenge generated an incredibly rich dataset of detailed and interesting commentary. It also inspired our second “sequel” Challenge. We knew that the next step was to crunch the data we currently have, before heading off in new directions. (...)


CE: Breathtaking. Even for non-rare conditions such as this, some people might attempt to look for other sources of medical diagnosis, which rely on netowrked knowledge. 

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El acceso a historias clínicas y el aumento de los servicios médicos ...

El acceso a historias clínicas y el aumento de los servicios médicos ... | The New Patient-Doctor e-Relationship | Scoop.it
En un reciente artículo publicado por la revista JAMA (The Journal of the American Medical Association) se estudia la relación que existe en la posibilidad de acceso de los pacientes a la historia clínica con el uso de los ...

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Patients With Online Access To Doctors May Make More Office Visits : NPR

Patients With Online Access To Doctors May Make More Office Visits : NPR | The New Patient-Doctor e-Relationship | Scoop.it
Previous research has found that patients with online access to their doctors made fewer trips to the doctor's office. But a large, just-published study shows just the opposite: Patients who can email their physicians may schedule more visits.


(...) "Some patients hope that having online access to their doctors will mean they can cut down on how often they have to go to the doctor's office. But fresh research suggests that patients with online access actually schedule more office visits.


Dr. Ted Palen is an internist at Kaiser Permanente Colorado in Denver. He says it's pretty common for him to see a patient in his office and then think, "You know, we could've handled this by e-mail."


Palen, who's also a researcher, wanted to see if offering patients online access to their doctors would mean they'd need to come in to the office less often. Previous studies found around a 20 percent drop in patient visits once they had online access.


But Palen's much larger study, just published in the Journal of the American Medical Association, showed that patients with online access actually scheduled more visits.


"The finding really did surprise us, this association between online access and an increase in in-person services," Palen says.


Why the increase? Palen says it could be that patients who signed up for online access were sicker than those who didn't, although his study tried to control for that. It could be that doctors who aren't used to an online give-and-take with patients asked them to come in more often to clear things up.


Or it could be that the new online relationship between doctors and patients means that, together, they're catching important health indicators that were getting missed in the past, and patients are getting better care." (...)



"We have all sorts of individuals right now who actually think their health conditions are the doctor's problems and not theirs," Murphy says. "And I think that's what we're really trying to focus on, helping the patient see that when they get engaged in their care, and when they become part of the therapy plan, that they can actually have better outcomes."


There's no definitive research linking more online access to doctors to better patient outcomes. But many doctors are optimistic.


"It's a new form of medical care that offers the promise to be able to improve care," says Dr. Jeff Cain, president of the American Academy of Family Physicians.


Cain says doctors and patients are still learning what they can accomplish online together, and whether that means more or fewer office visits. The answer is important both for planning future health system capacity, and because most doctors still get paid based on the number of office visits, not for answering emails." (...)


CE: What happens next? Private healthcare providers pushing for patient-physician email at their health centers...


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Desarrollo de apps de salud: implicando al paciente en su propia seguridad

Comunicación ganadora del premio especial a la comunicación más innovadora en el XXX Congreso de la Sociedad Española de Calidad Asistencial.


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Recetas de información para la fiebre 2.0 / SINC

Recetas de información para la fiebre 2.0 / SINC | The New Patient-Doctor e-Relationship | Scoop.it

"Desde que internet es la principal fuente de información sobre salud, ya no basta con que el médico recete fármacos; también necesita páginas web de confianza para 'prescribir' a sus pacientes. Hasta hace unos años, la traducción de la estadounidense MedlinePlus era de las pocas webs de referencia en castellano. Ahora quienes padecen una enfermedad crónica, como diabetes y cardiopatías, cuentan con foros fiables donde compartir sus experiencias. Forumclínic, la Escuela de Pacientes y Kronikoen Sorea son buenos ejemplos".


(...) "En Forumclínic, los médicos tienen la obligación de entrar cada 48 horas a su grupo de discusión para hablar sobre la enfermedad y ofrecer sus conocimientos a la comunidad. “Tenemos la suerte de que se conectan cada día y, sobre todo, los fines de semana”, cuenta a SINC Míriam Cañas, editora adjunta y responsable de las comunidades de Forumclínic. En ningún caso visitan a los pacientes: “Somos una web de divulgación”, recuerda la responsable Imma Grau.


Las horas de trabajo virtual en el foro no forman parte de la jornada laboral de los médicos, que cobran un plus por participar en el proyecto. “Mi motivación inicial para moderar el foro de depresión fue luchar contra el estigma social de las enfermedades mentales”, confiesa a SINC el psiquiatra Juan Miguel Garrido. El aprendizaje personal es otro aliciente de su experiencia virtual: “Me di cuenta de que los pacientes echan en falta a un psiquiatra más humano”, cuenta.


Los espacios virtuales se autorregulan por la propia actividad de los foreros. El médico se limita a contestar el aluvión de mensajes que no cesa nunca, ni a las tres de la madrugada. Aunque América Latina no comparta huso horario con España, muchas personas aprovechan este servicio gratuito con información de calidad desde la otra punta del mundo." (...)


CE: El artículo da la impresión de que hay que 'obligar' a los médicos a participar en el mundo 2.0, por que claro, si no les pagan no lo van a hacer... aún así, hay muchos médicos que intentan compartir información online de calidad sin esperar retribución.


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CMS seeks comments on patient experience data

CMS seeks comments on patient experience data | The New Patient-Doctor e-Relationship | Scoop.it
"To drive the collection and availability of performance data on the fledgling Physician Compare consumer website, the Centers for Medicare & Medicaid Services (CMS) is seeking provider feedback about the use of patient experience measures.

In a request for comment scheduled for publication in the Dec. 7 Federal Register, CMS invites physicians to share their thoughts on the pros and cons of collecting such data.

CMS is required by the healthcare reform law to develop and implement a plan for publicly reporting physician performance data by Jan. 1, 2013. One of the provisions of the reform law mandates the inclusion of patient experience data on the CMS' Physician Compare website.

According to the request for comment, the Consumer Assessment of Healthcare Providers and Systems survey for Physician Quality Reporting, a tool used to gauge patient experience in physician practices, "will fulfill this requirement."

Physician Compare's predecessor, Hospital Compare, included metrics of patient experience such as patient-reported impressions of pain management, communication with nurses and hospital cleanliness using data from the Hospital Consumer Assessment of Healthcare Providers and Systems survey. Physician Compare will be populated by much of the data from CMS' Physician Quality Reporting System, a voluntary program launched in 2007 that provides physicians with incentive payments for reporting performance data"
Camilo Erazo's insight:

Looking forward to see which social media channels are used to 'funnel' the patient experience data into the Physician Compare website... ¿Privacy issues?

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Why IT is the core of the healthcare renaissance

Why IT is the core of the healthcare renaissance | The New Patient-Doctor e-Relationship | Scoop.it
Standard, unified medical records will significantly decrease the risk of providing unneeded or dangerous medical care.

"Warning! I am a practicing doctor who sees real patients using an electronic medical record (EMR). My sole agenda is to provide the best patient care. I have no financial stake in information technology (IT). However, unlike the editorial board at the Wall Street Journal, Mr. Stephen Soumerai of Harvard or Mr. Ross Koppel of the University of Pennsylvania, I have actually used digital patient records for over a decade and I have news for them; EMRs work." (...)

"The average doctor writes his notes on parchment and scribbles orders on contact paper. He wastes time writing prescriptions by hand that cannot be read and will produce unneeded drug interactions and side effects. The data on billions of health care events cannot be mined, monitored, analyzed or improved, because it is not digital. Millions of hours are wasted, billions of dollars vanish and tens of thousands die because of preventable medical complications, the result of massive variation in quality and safety. We are doomed because we cannot access or evaluate most medical care data; “If you can not measure it, you can not manage it.” (...)

"This is just the beginning. Although EMRs now provide assistance with basic medical care, such as scheduling flu shots, identifying drug interactions, and health screening reminders, future systems will use academic information to assist the doctor in making diagnoses and planning treatments. Seamless with the EMR will be computer augmentation to create differential diagnoses and recommend treatment alternatives. In oncology alone there are almost 50,000 articles published each year; Artificial intelligence integration with the clinical EMR will help every doctor penetrate that massive database on a continuous basis as it applies to individual patients." (...)
Camilo Erazo's insight:

And will those "individual patients" want their data so massively accesible?

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Where E.R. Doctors Work Entirely Via Skype

Where E.R. Doctors Work Entirely Via Skype | The New Patient-Doctor e-Relationship | Scoop.it
In South Dakota, long-distance doctoring is bringing health care to rural communities.

(...) "But when the call comes in the middle of the night, with the push of a button -- mounted right on the ER's wall -- the nurses on-duty are able to connect with ER doctors in Sioux Falls, who have been waiting, in their patient-less hospital, for their call.

Avera Health Network is believed to have the only long-distance critical care center in the U.S., and possibly the world. Based at Avera Mckennan Hospital, the nonprofit provides a range of "telemedical" services that take advantage of technology -- including high-definition two-way video consulting -- to make it possible for experts to be available 24/7 in locations throughout South Dakota, North Dakota, Minnesota, Iowa, Wyoming, and Nebraska.

Their four main services -- eConsult, eICU Care, eEmergency, and ePharm -- are set up to provide resources and support to the 10 percent of America's doctors currently serving the 25 percent of the country's population that resides in rural areas. As the rural population ages -- the proportion of people over the age of 65 is about 72 percent higher in South Dakota than the rest of the U.S. and is expected to double by 2020 -- the need for easy access to high-quality care will only increase.

"If you think about, there's an awful lot of medicine that is just done through visualization of X-rays, looking at the chart, talking to the patient, making assessments, writing prescriptions," said Fred Slunecka, COO of Avera Health. "There's an amazing amount of care that can be done that way." The Avera team calls this "hands in pocket doctoring." Of course, physical hands are needed to carry out virtual orders, and real doctors and nurses are always on hand to provide that. But even IRL (in real life), crisis situations require someone at the head of the room, keeping tabs on everyone and calling the shots. In emergency situations, where every second counts, the long-distance physician is able to be in the room an average of 14 minutes sooner than the local doctor.

The doctors back at the hub spend their time monitoring ICU patients -- they have virtual access to 60 percent of the beds in South Dakota. Pharmacists are on-hand to review prescriptions, make sure doctors aren't missing any allergies or medical history, and keep them abreast of the newest recommendations and standards of care.

"The magic is being able to see into room," said Jay Weems, the executive director of eCare. "But the bigger magic, we think, is the people are on both ends -- in the rural community and in the hub -- that support each other and work together as team, as medicine is meant to be practiced."
Camilo Erazo's insight:

"As medicine is meant to be practiced" - I just love this type of examples where technology allows a team based approach to Medicine.

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Social media reminds docs in family practice that they are part of a bigger movement

Mike Sevilla, MD talks with Bryan Hodge, DO about Social Media at the 2012 Conference on Practice Improvement (#CPI12) organized by the Society of Teachers of Family Medicine and American Academy of Family Physicians


Via Andrew Spong
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“End of the doctors surgery? GP visits to be replaced by Skype consultations in bid to save NHS £3BN”

“End of the doctors surgery? GP visits to be replaced by Skype consultations in bid to save NHS £3BN” | The New Patient-Doctor e-Relationship | Scoop.it
This Daily Mail article by Adam Shergold with 379 comments (and counting) HatTip: TelecareAware highlights some of the challenges that big brands and politicians need to be wary of as they try to i...


(...) "I think there really is an argument for the government walking the walk BEFORE it expects vulnerable members of the public to test out this digital paperless future. I’m certain that confidence in all of these optimistic online health initiatives would be much higher if they were coming from a government that had already adopted them itself.


The reality is that if you watched Parliament proceedings in black and white you’d struggle to see anything different from 50 years ago, online voting is still not possible (in sharp contrast to Estonia where this has not only been possible since 2007 but it’s now possible to vote via SMS), etc.


“Many face-to-face appointments would be replaced by phone or weblink treatment“


"It’s funny how reaction to this takes on 2 completely different interpretations depending on who is saying it eg. everyone wants to hear their GP tell them they can call them and/or communicate with them online but when it’s a politician talking about this opportunity most patients are thinking about outsourced services, interactions with a frustrating call tree, talking to unqualified call handlers who are reading scripts, etc.


“Doctors would use a mobile app to access patient records“


"I imagine “could also” would work a lot better in this phrase. Many Doctors work best at a desk and we shouldn’t be trying to force fit the future where it’s not wanted/required." (...)


CE: This is a much more nuanced, thoughtful reading of the Daily Mail article on Skype and public health providers.

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A Survey Of Primary Care Doctors In Ten Countries Shows Progress In Use Of Health Information Technology

A Survey Of Primary Care Doctors In Ten Countries Shows Progress In Use Of Health Information Technology | The New Patient-Doctor e-Relationship | Scoop.it

Abstract


"Health reforms in high-income countries increasingly aim to redesign primary care to improve the health of the population and the quality of health care services, and to address rising costs. Primary care improvements aim to provide patients with better access to care and develop more-integrated care systems through better communication and teamwork across sites of care, supported by health information technology and feedback to physicians on their performance. Our international survey of primary care doctors in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Switzerland, the United Kingdom, and the United States found progress in the use of health information technology in health care practices, particularly in the United States. Yet a high percentage of primary care physicians in all ten countries reported that they did not routinely receive timely information from specialists or hospitals. Countries also varied notably in the extent to which physicians received information on their own performance. In terms of access, US doctors were the most likely to report that they spent substantial time grappling with insurance restrictions and that their patients often went without care because of costs. Signaling the need for reforms, the vast majority of US doctors surveyed said that the health care system needs fundamental change."

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Scanadu hopes its tricorder-like device and a smartphone will help people track their health and diagnose problems. | MIT Technology Review

Scanadu hopes its tricorder-like device and a smartphone will help people track their health and diagnose problems. | MIT Technology Review | The New Patient-Doctor e-Relationship | Scoop.it
Scanadu hopes its tricorder-like device and a smartphone will help people track their health and diagnose problems.


(...) "Scanadu announced Thursday that it plans to start selling this first device—the Scout, which monitors heart rate, temperature, blood oxygenation, and other vital signs—by the end of 2013, as well as a disposable urine-analysis test that can swiftly detect pregnancy issues, urinary tract infections, and kidney problems, and a saliva analysis test that can detect upper respiratory problems like strep throat and the flu. The Scout will cost less than $150, De Brouwer says; he doesn’t put a price tag on the disposable tests but says they will be “very, very cheap.”


The Scout may appeal to the growing quantified-self community, which focuses on tracking everything from sleep to stress levels (see “The Measured Life”) and includes some well-known figures such as the mathematician and entrepreneur Stephen Wolfram (who is also a member of Scanadu’s board).


The inspiration behind Scanadu came from a long hospital stay. De Brouwer’s son received a traumatic brain injury in 2006 after falling out of a window, and De Brouwer and his wife spent much of that year in the hospital with him. De Brouwer, a tech entrepreneur and onetime personal computer magazine publisher, started learning about the functions of various medical machines surrounding him. (...)"


"The smartphone app—currently just for iPhone, though an Android version is in development—will keep a record of your vital signs and data from any Scanadu test you take.


But the company may face skepticism from doctors, as well as from consumers, who are used to consulting a medical professional about an illness.


Ki Chon, a professor and head of the biomedical engineering department at Worcester Polytechnic Institute who has built software that can derive vital signs using a smartphone’s built-in camera, says Scanadu’s device sounds useful, but only if the results are accurate.

Leslie Saxon, chief of the University of Southern California’s division of cardiovascular medicine and the executive director of the USC Center for Body Computing, says that to ensure accuracy, the product will need clinical testing. She’s enthusiastic about Scanadu’s possibilities, though, saying it could help patients take a more active role in the health-care process and improve treatment of undertreated problems like hypertension.


In hopes of stanching skepticism and making potential users feel comfortable with the idea of home diagnosis and self-tracking, Scanadu is seeking approval from the U.S. Food and Drug Administration. The company is also talking to several hospitals about setting up a clinical trial with its device." (...)


CE: It is hard for me to attempt to separate consumerisation of medicine from the type of empowerment that this type of 'gadgets' promise... The device could be presented as a personalised device that provides better communication with caretakers, but instead it is marketed as DIY medicine. Looking forward to read some replies from MDs to this emerging trend.

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Facebook-like EMR UI designs by @karmel meet Meaningful Use. Great Ideas

Facebook-like EMR UI designs by @karmel meet Meaningful Use. Great Ideas | The New Patient-Doctor e-Relationship | Scoop.it
Facebook-like EMR In 2008, Bob Watcher wrote an article called “Why the medical record needs to become more like Facebook” where lay down the idea of having the social network as the mirror for a new...


(...) "A Design Proposal


Users & Profiles

If a clinical solution would need to completely work like Facebook, every user (physician, nurse, etc.) would have their own user porfile. However, the analysis of having a EMR looking like Facebook timeline suggests that the profile page is planned to show only patient data. Why would we need to see a nurse profile, then?


Following this idea, the Home page would be reserved for (primary) users and the Profile pages for showing the electronic medical records of patients (secondary users).

A possible extension would be allowing the access to the EMRz by Patients, so they could also check their own EMR online by themselves. In this case, we could consider them as secondary users not as part of the network community, but just to contribute to their own medical history and keep a direct communication between them and they’re care providers.


Social network

Social activity will be generated by clinicians considering patient-centred documentation based on Profiles. As suggested before, there are two main social groups: the one created by clinical staff only, and the one where patients and clinicians would interact." (...)


CE: Super interesting: how social media platforms are influencing the design of Electronic Medical Records, and thus the channels through which doctors and patients communicate about the patient's health information.

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Google now includes medications directly in search results, including brand names and side effects

Google now includes medications directly in search results, including brand names and side effects | The New Patient-Doctor e-Relationship | Scoop.it

"Google on Friday announced a useful update to its search product: the addition of medications. If you search for a drug, the company will now display information about it on the right-hand side, including key facts such as drug class, related medications, brand names, side effects, pregnancy risk, what the drug may treat, and so on.

 

Google will also include a list of other drugs that users who searched for this drug ended up searching for. (...)


"Google says it is surfacing the data from the US FDA, the National Library of Medicine, and the Department of Veterans Affairs, among others. Nevertheless, Google warns: “We hope you find this useful, but remember that these results do not act as medical advice.” (...)


"While Google has included medication-specific features in its search product before, the addition of drugs to the Knowledge Graph is interesting because it means the company is okay with surfacing information about the touchy subject. Google has a strict policy when it comes to advertising for healthcare and medicines, so I’m sure it has taken special care to keep things strict when it comes to this new feature as well. That’s probably why it was launched separately, and so late after the Knowledge Graph first rolled out a few months ago."


CE: I wonder what drug marketers will have to say about this... Considering doctors are probably using Google to search for prescription medications, rival brands might attempt to outbid each other on those "other" drugs... Will doctors and their patients receive the same info when searching for drugs in Google? How will that affect communications among each other when discussing treatment options?


Via Alex Butler, Olivier Delannoy, Lionel Reichardt / le Pharmageek, Dean Berg
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Study Ties Web-Based Doctor Visits to More Antibiotic Prescriptions

Study Ties Web-Based Doctor Visits to More Antibiotic Prescriptions | The New Patient-Doctor e-Relationship | Scoop.it
A study finds that doctors are less likely to order tests and more likely to prescribe antibiotics when they treat a patient through an online consultation.


(...) "Study Details
For the study, researchers examined more than 8,100 in-person and online patient visits to four primary care providers at the University of Pittsburgh Medical Center Health System between Jan. 1, 2010, and May 1, 2011.


The visits included:

  • 5,165 appointments for sinusitis, of which 465 were online consultations; and
  • 2,954 appointments for urinary tract infections, of which 99 were online consultations.

Study Findings
According to the study:

  • Physicians ordered a UTI-relevant test during 51% of in-office visits, but only 8% of online appointments;
  • Physicians ordered tests, X-rays or CT scans for sinusitis during 1.2% of in-office visits, but not for any online appointments;
  • Physicians prescribed antibiotics for patients with UTIs during 49% of in-person encounters, compared with 99% of online visits; and
  • Physicians prescribed antibiotics for patients with sinusitis during 94% of in-person encounters, compared with 99% of online visits.

Comments on Findings
The study authors wrote,


Read more: http://www.ihealthbeat.org/articles/2012/11/21/study-ties-webbased-doctor-visits-to-more-antibiotic-prescriptions.aspx#ixzz2CtF716Tj


CE: And yet the total $ costs might still be lower for the whole system; are patients who receive online appointments receiveng less safe treatment?

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The Evolving Rules of Social Media and Healthcare - by Joe Wagner

The Evolving Rules of Social Media and Healthcare - by Joe Wagner | The New Patient-Doctor e-Relationship | Scoop.it

"At a recent FDA/CDER-CHPA seminar on promoting over the counter medicines in a social media world, experts wrestled with the fact that consumers are increasingly turning to others like themselves or other online channels for health information, data, and first-hand experiences to help them make better medical decisions. Almost half of consumers are reading someone else's commentary or experience about health or medical issues on an online news group, website, or blog. They are turning to social channels and platforms because they want customer service, immediate answers to basic questions, guidance and someone to make sense out of the cacophony of medical information.

 

The challenge this poses for healthcare companies is how best to get involved in monitoring and correcting misconceptions or misinformation. There is great upside and promise of social health promotion and marketing including sharing experiences, driving better behaviors and spreading useful information. However, there are cautions to take into consideration when using social media to promote healthcare products and medicines including the risk of misinformation spreading and information being taken out of context.

 

Rules against misleading advertising also apply to social media. The FDA, FTC and leading legal experts on social media marketing all cautioned that the prohibition against deceptive and misleading advertising applies to social media marketing. Advertisers can’t make claims using third parties that they couldn’t legally make themselves. Consumers have the right to know when they are being advertised to.


Celebrity endorsements via social media must be disclosed. When it comes to using celebrities to endorse products, in conventional ads, it’s not necessary for an ad to disclose that a celebrity is being paid, because in that context payment would be understood. Outside of conventional ads however, for instance on talk shows and social networking sites, the relationship with the advertiser should be disclosed when a celebrity talks up a product because payment isn’t obvious in that context. In addition, companies using bloggers or consumer endorsers as part of their campaigns must have policies in place to monitor whether disclosures are being made.

 

Best practices for monitoring and reporting remain a priority. Social media is a new data source for both industry and regulators. It is more far reaching and in a less controlled environment than traditional sources such as phone, email and postal letter. There is increased case volume to monitor. Companies need to be vigilant when following up with a post on a company site, while being mindful of privacy concerns. Company privacy policies should also be consistent with adverse event reporting activities. (...)"


CE: How could this discussion bring light towards issues like Conlifcts of Interest arising due to un-ethical marketing to physicians? Will patiente empowerement bring a more critic view onto relationships doctors establish with pharma reps, either online or off-line?


Via Parag Vora, Lionel Reichardt / le Pharmageek
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The More Social You Are, the Healthier You Can Be - GE Healthcare News

The More Social You Are, the Healthier You Can Be - GE Healthcare News | The New Patient-Doctor e-Relationship | Scoop.it
Can online social networks encourage improved health behavior? GE Healthcare recently commissioned consumer research related to this topic and convened a global panel of experts to discuss it, as well.

 

(...) "The collective results show that engagement is notable but there’s work to do to convert conversations into changes in behavior.

 

The survey found out that 26 percent of U.S. online adults have discussed health information online—through social media, online communities, message boards or forums—in the past 12 months. It also found that a conservative 30 percent of those who had discussed health information online have changed a health behavior, such as a change in diet or fitness, as a result.

 

According to the survey, many online adults agreed that others knowing about their diet, health and fitness, and/or specific medical condition(s) is the top concern to discussing health information online (46 percent).


However, during the GE Healthcare virtual roundtable on social networking in health, held in October 2012, actively followed on Twitter, the panel of global experts stressed that accuracy of information should be even more top of mind for consumers (vs. privacy)." (...)


CE: One doesn't expect a full fledged explanation of the limitations of patient reported outcomes and surveys on coverage like this, but still... very skimpy on evidence. Interesting that experts consider accuracy of information as more relevant than privacy! Patent disconnection.


Via rob halkes, Lionel Reichardt / le Pharmageek
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