Presentation at monthly CME activity of the Philippine Dermatology Society in cooperation with Skin & Cancer Foundation Inc. at the St. Luke's Medical Center Global, 20 April 2016

1. PUSHING
FRONTIERS OF
HEALTHCARE
DELIVERY
IRIS THIELE ISIP TAN MD, MSC
@endocrine_witch
Professor, UP College of Medicine
Chief, UP Medical Informatics Unit

2. QUANTIFIED
SELF
CARE
HACKING DEVICE
DIVIDE
Johnmar & Bhargava. ePatient 2015: 15 Surprising Trends Changing Healthcare

3. QUANTIFIED
SELF
CARE
HACKING DEVICE
DIVIDE
Johnmar & Bhargava. ePatient 2015: 15 Surprising Trends Changing Healthcare

4. THE RISE OF THE QUANTIFIED SELF
https://youtu.be/V08dWCtDyd8

5. — Lisette Hilton
IMAGINE WEARING ELECTRONICS POWERFUL
ENOUGH TO TRANSDERMALLY MEASURE THINGS
LIKE HYDRATION … THE TECHNOLOGY IS SO THIN,
BREATHABLE, SOFT AND MALLEABLE, THAT YOU
DON’T NOTICE IT ON YOUR SKIN. IT CAN BE ON
YOUR EYELID, ON YOUR LIPS, OVER HAIR.
IT SEAMLESSLY DOES ITS JOB WHILE YOU LIVE
YOUR LIFE WITHOUT CONSTRAINT.
”
“
Wearable technology meets dermatology
Dermatology Times 5 Jan 2015

6. Sci Adv. 2015 Oct 30;1(9):e1500701.
Ultrathin, soft, skin-conforming sensor technology that offers
advanced capabilities in continuous and precise blood flow mapping

8. NATURE COMMUNICATIONS | DOI: 10.1038/ncomms5779

9. TechCrunch
https://youtu.be/F5bZpd1pKJM
L’OREAL MY UV PATCH

10. QUANTIFIED
SELF
CARE
HACKING DEVICE
DIVIDE
Johnmar & Bhargava. ePatient 2015: 15 Surprising Trends Changing Healthcare

11. JAMA Dermatol. 2013;149(11):1300-1304
0
50
100
150
200
250
HCP PATIENT BOTH
n =229
51.1%
41%
7.9%

12. Brewer et al. JAMA Dermatol. 2013;149(11):1300-1304
10 MOST REVIEWED APPLICATIONS
a
renamed to SkinVision

13. ULTRAVIOLET ~ UV INDEX
By Robocat FREE

14. SPOT MOLE
By Cristian Munteanu FREE
First smartphone app to do automatic mole analysis using the device's
camera/gallery
Detect signs of melanoma using image processing and pattern recognition

15. SKINVISION
By SkinVision B.V.
In-app purchases
First CE certified
melanoma / skin cancer
app in the EU

16. — Brewer et al. JAMA Dermatol. 2013;149(11):1300-1304
These patient-oriented apps directed toward skin
cancer screening may promote self-surveillance.
However, patients and clinicians should maintain a
healthy sense of skepticism because studies
regarding the safety and accuracy of such apps are
limited.
”
“

17. Patients face a dizzying
array of healthcare apps
to choose from, with
little guidance on
quality or support
from their doctors.
“

18. Even if medical app may meet the definition of a medical
device, the FDA can choose to not enforce requirements
because risk to patients is low.
ENFORCEMENT DISCRETION

19. QUANTIFIED
SELF
CARE
HACKING DEVICE
DIVIDE
Johnmar & Bhargava. ePatient 2015: 15 Surprising Trends Changing Healthcare

20. Launched 24 July 2015
at National Science & Technology Week
High speed wifi up to 50 MB/day

22. The demand for medical dermatologists exceeds the current supply
Teledermatology may partially solve health-care disparities
J Am Acad Dermatol 2015;72:563-574

23. TELEDERMATOLOGY
Store-and-forward
May require repeat
consultation for incomplete
clinical histories
Most widely used
More efficient for
physicians practicing
across time zones
J Am Acad Dermatol 2015;72:563-574
Less opportunity for
patient education

24. TELEDERMATOLOGY
Real-time
May save time by clarifying
consultant’s questions
Requires significant
bandwidth
Less convenient for
physicians practicing
across time zones
J Am Acad Dermatol 2015;72:563-574
Greater opportunity
for patient education
Video images lower
quality/resolution
than still images

25. TELEDERMATOLOGY
Hybrid
Requires significant
bandwidth
Less convenient for
physicians practicing
across time zones
J Am Acad Dermatol 2015;72:563-574
May improve patient
satisfaction
compared to store-
and-forward alone
Time-saving aspects of
real time plus quality
of digital still images

26. J Am Acad Dermatol 2015;72:563-574
TELEDERMATOLOGY: PRACTICE MODELS
Teledermatologists make
recommendations from
afar; providers assume the
responsibility for adopting
recommendations
CONSULTATIVE
To prioritize patient care
and determine need for
in-person visits
TRIAGE
Direct communication
between dermatologists
and patients with skin
complaints
DIRECT CARE
Remote monitoring of chronic skin
conditions that would otherwise
warrant frequent clinic visits to assess
disease activity and optimize therapy
FOLLOW UP

27. Diagnostic & management decisions made by teledermatology are
reliable and accurate
Clinical outcomes are reportedly similar to those of standard care
J Am Acad Dermatol 2015;72:563-574
EVIDENCE SUPPORTING USE OF TELEDERMATOLOGY

28. Patients & providers report high satisfaction with tele dermatology
Patients are typically willing to pay for tele dermatology consults
J Am Acad Dermatol 2015;72:563-574
PARTICIPANT SATISFACTION

29. Patients generate & send images of their skin lesions, enables rapid
communication with healthcare providers
Patients are reportedly satisfied with this convenient modality and
take images of sufficient quality for telediagnosis
J Am Acad Dermatol 2015;72:563-574
PATIENT-CENTERED TELEDERMATOLOGY

30. Patient consent, confidentiality and privacy are of
paramount importance and care should be taken to ensure
they are not sacrificed for the sake of ease and convenience.
“

31. REASONS WHY DERMATOLOGY REGISTRARS TAKE
CLINICAL PHOTOGRAPHS OF THEIR PATIENTS
n = 13
Kunde et al Australasian Journal of Dermatology 2013 doi: 10.1111/ajd.12063

32. HOW OFTEN THEY TEXT OR EMAIL PICTURES TO
COLLEAGUES FOR ADVICE OR OPINION
Kunde et al Australasian Journal of Dermatology 2013 doi: 10.1111/ajd.12063
n = 13

33. SITUATIONS FOR WHICH VERBAL CONSENT FOR
CLINICAL PHOTOGRAPHY WAS OBTAINED
Kunde et al Australasian Journal of Dermatology 2013 doi: 10.1111/ajd.12063
n = 13

34. — Karen Michelle Devon, MD
I WAS SURPRISED TO FIND AN IMAGE OF
MYSELF, WEARING SCRUBS, AND
HOLDING A THYROID GLAND.
”
“
Devon KM. JAMA 2013;309(18):1901-1902

35. Palacios-Gonzalez C. The ethics of clinical photography & social media.
Med Health Care & Philos DOI 10.1007/s11019-014-9580-y
USE OF CLINICAL PHOTOGRAPHY
PRIMARY
For patient care
SECONDARY
For research and
medical education

36. Clinical photography + social media
DOES NOT equal telemedicine.
Palacios-Gonzalez C. The ethics of clinical photography & social media.
Med Health Care & Philos DOI 10.1007/s11019-014-9580-y
Patients do not have adequate information
to give informed consent.
PRIMARY

37. Even if patients recant consent, nearly impossible
to retrieve or delete clinical images.
Palacios-Gonzalez C. The ethics of clinical photography & social media.
Med Health Care & Philos DOI 10.1007/s11019-014-9580-y
Moderate comments to avoid derogatory remarks
about clinical images or patients depicted.
SECONDARY

38. www.healthxph.net/manifesto
I will value the patient’s
dignity & privacy by not
taking selfies, groufies or
videos during encounters
with patients that include
patients’ body parts,
surgical specimens or that
show patients in the
background without their
consent.
#HEALTHXPH

39. www.healthxph.net/manifesto
I will refrain from posting
information online that
will compromise
patient confidentiality
and privacy.
#HEALTHXPH

40. J Am Acad Dermatol 2013;68:1030-3
Sarah liked Dr. W’s Facebook page.
She commented on a discount coupon for tattoo removal.
Sarah’s mother fears that “everyone will know” about Sarah’s tattoo.
The mother demands that the clinic inactivate the Facebook page
immediately.

41. DR. W SHOULD …
A. Make no changes to the Facebook site.
B. Institute a system for monitoring the site on a regular
basis to purge inappropriate posts.
C. Disable the site’s comment section to eliminate the
possibility of patient’s disclosing personal information.
D. Discontinue the requirement that patients “Like” the
Facebook page to receive discount coupons.
E. Discontinue the Facebook site.
Orenstein et al. E-professionalism at the dermatology office: New challenges to
confidentiality in the era of social networking. J Am Acad Dermatol 2013;68:1030-3

42. DR. W SHOULD …
A. Make no changes to the Facebook site.
Sarah has the right to post
protected health information
(PHI).
Exercise vigilance when
establishing a web forum
with foreseeable risk of
unintentional disclosure of PHI.
Orenstein et al. E-professionalism at the dermatology office: New challenges to
confidentiality in the era of social networking. J Am Acad Dermatol 2013;68:1030-3

43. DR. W SHOULD …
B. Institute a system for monitoring the site on a regular
basis to purge inappropriate posts.
Approach is labor-intensive and
imperfect
Instantaneous dissemination of
information on social networks
Impossible to remove
information from cached Web
pages
Orenstein et al. E-professionalism at the dermatology office: New challenges to
confidentiality in the era of social networking. J Am Acad Dermatol 2013;68:1030-3

44. DR. W SHOULD …
C. Disable the site’s comment section to eliminate the
possibility of patient’s disclosing personal information.
Limits potential for
patient education
Orenstein et al. E-professionalism at the dermatology office: New challenges to
confidentiality in the era of social networking. J Am Acad Dermatol 2013;68:1030-3

45. DR. W SHOULD …
D. Discontinue the requirement that patients “Like” the
Facebook page to receive discount coupons.
Prevent the MD’s direct complicity in
exposing the patient’s treatment for
a potentially stigmatizing condition
Upholds social justice
Orenstein et al. E-professionalism at the dermatology office: New challenges to
confidentiality in the era of social networking. J Am Acad Dermatol 2013;68:1030-3

46. DR. W SHOULD …
A. Make no changes to the Facebook site.
B. Institute a system for monitoring the site on a regular
basis to purge inappropriate posts.
C. Disable the site’s comment section to eliminate the
possibility of patient’s disclosing personal information.
D. Discontinue the requirement that patients “Like” the
Facebook page to receive discount coupons.
E. Discontinue the Facebook site.
J Am Acad Dermatol 2013;68:1030-3

47. #HCSMPH
Apr 21
PICC
bit.ly/hcsmsummit2016
IRIS THIELE ISIP TAN MD, MSC
Professor, UP College of Medicine
Chief, UP Medical Informatics Unit
@endocrine_witch