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The Future of Diabetes Management: New Technologies and Social Networking

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Presentation at UCSF Diabetes Update CME course, Mar 2013, in San Francisco.

Published in: Health & Medicine
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The Future of Diabetes Management: New Technologies and Social Networking

  1. 1. The Future of DiabetesManagement: Social Networkingand New Technologies
  2. 2. 1. Yourfamily members are looking for health information online.2. Your family members are on social media.
  3. 3. 1. Yourfriends are looking for health information online.2. Your friends are on social media.
  4. 4. 1. Your patients are looking for health information online.2. Your patients are on social media.
  5. 5. Goals• Increase awareness of what is already happening• Share my vision for the future of diabetes management• Place social media and social networking within healthcare context• Show you why social networking and diabetes make good partners• Give you practical tips you can try tomorrow
  6. 6. 2012 IOM Report: Best Care at Lower CostSmith M, Saunders R, Stuckhardt L, McGinnis JM. Best Care at Lower Cost. National Academies Press; 2012.
  7. 7. IOM recommendations to reach a “Learning Healthcare System”• Digital capture of the care experience “… for real-time generation and application of knowledge for care improvement.”• Real-time access to knowledge “… continuously and reliably captures, curates, and delivers the best available evidence to guide, support, tailor, and improve clinical decision making…”• Engaged, empowered patients• Transparency• Care continuity
  8. 8. IOM recommendations to reach a “Learning Healthcare System”• Digital capture of the care experience• Real-time access to knowledge• Engaged, empowered patients “… anchored on patient needs and perspectives and promotes the inclusion of patients, families, and other caregivers…”• Transparency• Care continuity “… improved coordination and communication within and across organizations.”
  9. 9. IOM recommendations to reach a “Learning Healthcare System”• Digital capture of the care experience• Real-time access to knowledge• Engaged, empowered patients “… anchored on patient needs and perspectives and promotes the inclusion of patients, families, and other caregivers…”• Transparency• Care continuity “… improved coordination and communication within and across organizations.”
  10. 10. Why isn’t this sustainable for thefuture?Patient Clinician• Measurement burden • Office visits rushed• Too much time • Office visits infrequent• Hard to remember the past • Data often incomplete• Forget to bring logbook • Data may be inaccurate • No EHR integration • Cannot query the data
  11. 11. Diabetesmanagementtoday
  12. 12. Part 1:Digitalcaptureofdiabetesdata
  13. 13. Bergenstal R et al.: Recommendations for Standardizing Glucose Reporting and Analysis to Optimize ClinicalDecision Making in Diabetes: The Ambulatory Glucose Profile (AGP). Diabetes Technology & Therapeutics 2013 Feb
  14. 14. Part 1:Digitalcaptureofdiabetesdata
  15. 15. Reimbursement
  16. 16. Willingness to pay for online consultation with doctorHamblin J: If Symptoms Persist, Text Your Doctor [Internet]. The Atlantic 2013 Mar 6 [cited 2013 Mar 11]
  17. 17. Part 2: Real-time Data(“Push” Medicine) • iBGStar • Dexcom G5 • Telcare • Ginger.io • Glooko
  18. 18. The Teachable Moment
  19. 19. 9 Data Points 303 Data Points Per Day Per Day
  20. 20. 810 Data Points/ 27,270 Data Points/ 3 Months 3 Months
  21. 21. Part 1: Digitization of diabetes dataPart 2: Real-time (“Push”) diabetes dataPART 3: PATIENT ENGAGEMENTAND SOCIAL NETWORKING
  22. 22. Evolution of Social Health (from Dr. Bryan Vartabedian) Long • Patients depend on what the doctor tells them ago • Patients find information 1990’s • Patients find each other 2000’s • Information finds patients NowVartabedian B. Physicians, Risk and Opportunity in the Age of Social Media [Internet]. 33charts.com. 2011 [cited2013 Feb 14]. Available from: http://33charts.com/2011/12/physicians-risk-opportunity-social-media.html
  23. 23. What is Social Media? Social Networking? • Social media • One way • Transmit or disseminate information or content to a broad audience • Social Networking • Two way • Sharing information among a community or network of people • Conversations • Online Social Network: a website that allows users to create a profile, connect that profile to other users, and “view and traverse” the connections made throughout the systemBoyd DM, Ellison NB. Social Network Sites: Definition, History, and Scholarship. Journal of Computer-MediatedCommunication. 2007 Dec 17;13(1):210–30.
  24. 24. Patients go online for health information • 60% of all adults have looked online for health information • It is the third most popular activity on the internet • The most likely groups of people to do this are: • Caregivers • Those with a recent medical crisis • Those who have experienced a recent or significant change in their physical health • 34% of all adults have read about health in a blogFox S. The social life of health information, 2011. Pew Research Center. Washington, D.C.: Pew ResearchCenter; 2011 May.Hamblin J: If Symptoms Persist, Text Your Doctor [Internet]. The Atlantic 2013 Mar 6 [cited 2013 Mar 11]
  25. 25. Patients use mobile • 85% of US adults have a cellphone… ½ are smartphones • One-third of cell phone owners have used their phone to look for health information (up from 17% a few years ago) • 52% of smartphone owners look for health information on their phones • One-fifth of smartphone owners have a health appFox S, Duggan M. Mobile Health 2012. Washington, D.C.: Pew Research Center; 2012 Nov pages 1–29.
  26. 26. Patients use social networking • 46% of all adults use social networking sites • The most likely people to use social networking for health: • Female • Young (under 45 years old) • Caucasian • College-educated • Sicker than the general population1. Idriss SZ et al. Arch Dermatol. 2009 Jan;145(1):46–51.2. Powell J et al. J. Med. Internet Res. 2011;13(1):e20.3. Fox S. The social life of health information, 2011. Pew Research Center. Washington, D.C.; 2011 May.
  27. 27. Offline social networking improves health outcomes • Lack of social ties leads to worse health outcomes • Peer support and support groups improve chronic illness outcomes • Behaviors spread and are shared through “weak ties”1. Johnson JD, Andrews JE. The evolving role of consumers. Clinical Research Informatics. Springer; 2012;:95–112.2. van Dam HA et al. Patient Educ Couns. 2005 Oct;59(1):1–12.3. Christakis NA, Fowler JH. N Engl J Med. 2007 Jul 26;357(4):370–9.
  28. 28. Types of Social Network Non-healthcare • Facebook online social networks • Twitter Healthcare • PatientsLikeMe specific online social networks • Everyday HealthDisease-specific • TuDiabetes online health communities • Glu
  29. 29. Why do patients like online social networks? • Perceived lack of judgment and anonymity • Finding similar people around the world:18% of Internet users have used the Internet to find patients like them (Fox, 2011) • Information sharing • Emotional support • Access to clinical trials • Self-tracking of health-related data • Ability to query a physician1. Idriss SZ et al. Arch Dermatol. 2009 Jan;145(1):46–51.2. Powell J et al. J. Med. Internet Res. 2011;13(1):e20.3. Griffiths F et al. Soc Sci Med. 2012 Sep 1.4. Swan M. Int J Environ Res Public Health. 2009 Feb;6(2):492–525.
  30. 30. Why diabetes and social makethe perfect partnersPART 4: CONNECTING PATIENTSAND CLINICIANS FOR TRUECONTINUITY OF CARE
  31. 31. Potential Benefits of “Push” Medicine Patients • Social network support • Reinforce treatment goals Clinicians • Reminders • Everything on the left side • Real-time feedback and • Real-time clinical data improved understanding of • Social media surveillance impact of certain behaviors • Decision support • Educational resources • Improved connections with • Real-time communication patients with clinician
  32. 32. Example: WellDoc Platform
  33. 33. Willingness to communicate with doctors primarily onlineHamblin J: If Symptoms Persist, Text Your Doctor [Internet]. The Atlantic 2013 Mar 6 [cited 2013 Mar 11]
  34. 34. Meet patients “where they are”Russell Herder, One in Five Millennials Follow a Healthcare Provider on Social Media
  35. 35. Why you need to participate• Learn what patients are saying• Obligation to prevent myths from spreading• Cultivate your own digital footprint• Contribute to better illness support networks• Strengthen doctor-patient relationship*** People still trust doctors for information morethan anybody else ***
  36. 36. What can you do tomorrow?• Google yourself (also Google Alerts)• Create a profile for yourself on LinkedIn• Ask your patients what they are using and doing online for health• Pick 5-10 blogs and start reading them• Read social media guidelines • AMA • UCSF Social Media Guidelines
  37. 37. What can you do tomorrow?• Join Twitter and start following people• Buy your “vanity” domain name• Write guest posts on a blog or start your own blog (easiest with Wordpress)• Create a YouTube channel and post video content• Experiment with looking at data that patients bring in• Go to a HealthCare Technology MeetUp
  38. 38. Tiptoe into Social Media• Permanent• Public• Professionalism: All rules about offline conduct still apply (ie HIPAA)• Positive
  39. 39. Barriers• Unclear reimbursement models and business models• Privacy and security• Too much data  Better analytics• FDA regulations• Proprietary interests of vendors and lack of interoperability• Medicolegal: Are clinicians responsible for every piece of information?• Data integrity: Can clinicians trust patient-generated data?• Need research validating efficacy
  40. 40. $15-20M/year fromNIH and NationalScience Foundationfor:• Digital Health Information Infrastructure• From Data to Knowledge to Decisions• Empowering Individuals• Sensors, Devices and Robotics
  41. 41. The recipe for the future ofdiabetes management1. Digital data2. Real-time data3. Social networking and engaged patients4. True continuity of care that connects patients, clinical data, and clinicians

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