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Digital Health: Medicine at the Croosroads

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Grand Rounds Presentation University Medical Center at Princeton 2011

Grand Rounds Presentation University Medical Center at Princeton 2011

Published in: Health & Medicine, Business

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  • Jane Rust woke up early one day last year and discovered that her left eye was red, swollen and itchy. So she logged on to her family doctor’s Web site and typed a message describing her symptoms and asking what to do.By mid-morning, the 61-year-old homemaker received an online response from her doctor with a diagnosis—conjunctivitis, or pink eye, probably contracted from a child in her Sunday-school class—and a prescription to pick up at the pharmacy. “I didn’t have to disrupt my day,” says Ms. Rust, who lives in Readyville, Tenn. “It’s much more efficient.”
  • Transcript

    • 1. Medicine at the Crossroads: Implications of Mobile Health and Social Media in Clinical Practice
      Steven Peskin, MD, MBA, FACP
      EVP and Chief Medical Officer, MediMedia
      Assistant Clinical Professor, UMDNJ
    • 2. The Three Components of Digital Health
      Applications (clinical/institutional, consumer-focused, and content).
      Devices (mobile phones, sensors, medical devices, and others).
      Infrastructure (both wireless and supporting wire-line and network services).
      Triple Tree, “Wireless and Mobile Health Report and Survey” (Minneapolis: Triple Tree LLC, 2009).
    • 3. Digital Health: Tremendous Potential
      Improve clinical care delivery and patient-provider communication
      Maximize patient safety and convenience with patient monitoring and patient tracking
      More effective information dissemination and dialogue within all medical disciplines
      Enterprise-wide health information
      Bridging the gaps hospital-based/other institutional, ambulatory/ office, home, pharmacy, self care
      Collaborative approach to diagnosis and treatment
      Simplified chronic condition and lifestyle management
      Triple Tree, “Wireless and Mobile Health Report and Survey” (Minneapolis: Triple Tree LLC, 2009).
    • 4. Bridging the Gap
    • 5. Market Drivers for Connected Health
      Accenture, “How Technology Will Transform the Future of Chronic Care”
    • 6. Wireless Health Information Flow
    • 7. Emerging Wireless Health Markets
      Triple Tree, “Wireless and Mobile Health Report and Survey” (Minneapolis: Triple Tree LLC, 2009).
    • 8. Index
      Part 1
      Social Media and Physician Communities
      Part 2
      The App Revolution
      Part 3
      Into the Future
    • 9. Part 1: Social Media and Physician Communities
    • 10. The “Arc” of Communities
      Activity
      Time
    • 11. The “Anti-Arc”
      Jobs Board
      Reimbursement
      coding
      need
      Lab Results
      Scheduling
      Affordable
      EMR
      CME
      “The Danger Zone”
      Jobs Board
      Hotspots: Earn
      New Peer-reviewed data
      Content
      The “Early Days of Sermo”
      New pharma interactions
      Hotspots: Learn
      want
      Observational data
      recreational
      vocational
    • 12. Social Media and Physician Communities
      QuantiaMD:
      Founded in 2005, has 120,000+ members
      Education and collaboration platform for physicians and other clinicians accessible on computers, tablets, and SmartPhones
      Sermo:
      Founded in 2006, has 180,000 members
      Bills itself as “the world’s largest online community of physicians, where you can exchange medical insights with colleagues spanning more than 30 specialties across all 50 states”
      Medscape Physician Connect:
      Founded in 2008, has 200,000 members
      Invites clinical and non-clinical exchanges through video blogs and user polls
    • 13. Decision Support
      Epocrates
      Founded in 1998, has 300,000 members
      Not strictly a social professional network
      Features Immediate formulary checks and drug information, “point-of-care references,” discussion topics, and an electronic game on Facebook called “Diagnose the Disease.”
    • 14. Social Media and Physician Communities- Peace, War, or Harmony
      Ebay
      c 1996-2003
      SermoDashboard
      Threadless
      Facebook Beacon
      Friendster
      Sermo AskRx
      Client Posts
      Linked-In
      MySpace
      Business Model in Conflict
      Business Model in Harmony
      Neutral
    • 15. Social Community Benefits for Physicians
      Social Communities facilitate sharing of clinical insights and solutions to practical clinical problems in a way that promises to hone “best practices”
      Allows physicians to:
      Access dialogs on best practices
      Source and disseminate immediate market research
      Solicit useful feedback about preferred treatments, protocols, and practice patterns that yield best health and patient satisfaction
      Build business arrangements
      Steven Peskin, MD. “Can a Medical ‘Facebook’ Help You Plan Thrive? (Yardley: Managed Care, June 2009) 25.
    • 16. User Experience
    • 17. Part 2: The App Revolution: iPhone, Blackberry, and Google Android
    • 18. Point-of-Care Mobile Technology
      88% of Physicians report that their PDA/Smartphone is essential to their clinical practice
      87% of physicians who use a PDA/Smartphone said the PDA channel provides clinical information that is most influential on their prescribing and treatment decisions.
      Skyscape. “Effect of PDA-based Information On treatment Decisions” (MASS: Skyscape, March 2008). Mix of 594 primary care and specialty physicians.
    • 19. Point-of-Care Mobile Technology:
      88% of physicians report that “my PDA/Smartphone is essential to my clinical practice.
      • 92% of physicians agree that “clinical information on my PDA/S, Smartphone improves my knowledge and capabilities.
      Skyscape. “Effect of PDA-based Information On treatment Decisions” (MASS: Skyscape, March 2008).
    • 20. “There’s an App for That”
      • Apps for electronic medical records
      • 21. The software developer, Epic, just released a new suite of apps that feature PHR access for a PDA
      • 22. Apps for patient information delivery
      • 23. AirStrip Technologies: offers a suite of HIPAA compliant apps that collect all relevant patient information and sends it to your PDA (including: lab results, cardiology, temperature etc)
      • 24. From QuantiaCare: EatSmart with content from Hope Warshaw, RD, MMSc, CDE, BC-ADM
    • More Apps for Physicians
      • Apps for medical education and reference
      • 25. Krames Patient Education: iPatientED is a quick reference tool for physicians with 118 animations spanning 22 medical specialty areas, many with narrations in English and Spanish
      • 26. Modality: this company features 120 apps, 55 of which are focused on medical education
      • 27. MedCalc: a medical calculator with a wide array of medical formulas and scores. Includes information and bibliographic references for each formula
      • 28. ICD-9 Lite: Contains all 13,677 ICD-9-CM diagnosis codes for quick retrieval by disease classification in a drilldown format with no typing. Code to the highest level of specificity every time
    • Krames Patient Education: iPatientID
    • 29. Apps for Consumers
      : Use your iPhone to track doctors’ appointments, medication schedules and other health information.
      : Offers 30+ free trackers for BP, Cholesterol, Diabetes, and other health indicators along with charting and other tools.
      : A suite of apps that allow mobile access and mobile recording of personal health data for tracking and informational purposes.
    • 30. Online Care: Digital Diagnosis
      In 2009, 39% of doctors said they’d communicated with patients online, up from 16% five years earlier, according to health-information firm Manhattan Research, a unit of Decision Resources Inc.
      The most common digital doctor services are the simplest ones, like paying bills, sending lab results and scheduling appointments. But also can be used for diagnosing, and chronic condition tracking.
      Health insurers are beginning to pay doctors for treating patients virtually. Among companies that now cover digital visits are Aetna, Inc., Cigna Corp., and select BCBS plans in Florida, Hawaii, and North Carolina. WellPoint Inc. and Humana Inc. are trying it in parts of the country, and may expand their coverage.
      Methods include: interactive questionnaires, web video, live chat, and phone conversations.
      Anna Wilde Mathews, “The Doctor Will Text You Now” (New York: Wall Street Journal, July 9, 2009)
    • 31. Part 3: Into the Future
      Don Detmer MD, MA and President and CEO of American Medical Informatics Association
      “The health sector's most avoidable shortcomings can be linked to data, information, or knowledge that are inaccessible or demonstrate poor quality…the health sector has begun to unleash the transformational power of information and communications technology.”
      The federal government’s economic stimulus package is dedicating $19 billion to speeding the adoption of electronic health records, so demand for health informatics specialists is skyrocketing. “My rough estimate is that we need about 70,000 health informaticians.”
      “Significant value will be realized only when PHRs incorporate systems, tools, and other resources that leverage the data in the record and enable consumers to play a more active role in their health and health care. Some of these functionalities exist today; other applications are yet to be developed.”
      Don Detmer, “Building the National Health Information Infrastructure” (BMC Medical Informatics and Decision Making 2003 3:1 Christine Larson, “Fresh Starts-Connecting the Dots of Medicine and Data” (New York: NYTimes April, 2009) BU13. Don Detmer, “Integrated Personal Health Records: transformative tools for consumer –centric care” (BMC Medical Informatics and Decision Making 2008) 8:45.
    • 32. Online Care: Digital Diagnosis
      American Well’s “Virtual Visit”
      American Well has created an Online Care system that allows consumers to connect with physicians immediately, whenever they have a health need, from their homes or offices. American Well’s service is available to patients in Hawaii and Minnesota, through Blue Cross Blue Shield, and to some members of the military seeking mental health care, through TriWest Healthcare Alliance.
      • After American Well’s service began in Hawaii last year, lawmakers passed legislation that allowed doctors and patients to establish a relationship online.
      • 33. Online Care Personal Edition, allows consumers to see physicians on demand using video, text chat ,or telephone. Online Care Team Edition, allows providers to deliver coordinated care, using tools for provider-to-provider collaboration and the creation of online medical homes.
      • 34. It allows physicians increased flexibility and an opportunity for practice expansion.
      • 35. “By 2013, 25% of patient encounters in North America, Western Europe and Asia/Pacific that could be conducted virtually, will be.”Gartner article: Predicts 2009: Healthcare IT Moves From Transactional to Transformational
      Claire Cain Miller, “The Virtual Visit May Expand Access to Doctors” (New York: NYTimes, Dec 20, 2009) B4.
    • 36. The Apple iPad
      The iPad
      “You can browse the Web with it. It’s the best browsing experience you’ve ever had… a whole Web site in the palm of your hands.” –Steve Jobs at the January 27th unveiling
      Half an inch thin. Weighs 1.5 pounds. 9.7-inch IPS display
      • What can the iPad do for wireless health?
      • 37. Will facilitate a better-than-ever digital experience for easier video and Web site viewing
      • 38. Increase user friendliness of all wireless facets of the Health Market from community sites like Sermo and Quantia MD to improved usability of apps for electronic medical record, patient information, and medical education and reference.
      Brad Stone, (New York: NYTimes January 27).
    • 39. Into the Future (Cont’d)
      Mobile Health and Social Media will be a part of everyday health care
      Health care professionals will embrace digital tools/ communities for clinical performance improvement, time and $$$ savings/ revenue
      Increased availability, accuracy, searchability and dissemination of Information
      Image from the Jan 2010Consumer Electronics Showin Las Vegas. Note “digital health” in the center .