This document discusses the implications of mobile health and social media in clinical practice. It describes the three components of digital health as applications, devices, and infrastructure. Mobile technologies and social media have tremendous potential to improve care delivery, patient safety, information dissemination, and chronic disease management. The document outlines how physician communities on social media can facilitate knowledge sharing and discusses the growth of medical apps. It predicts that mobile health and social media will become integrated into everyday healthcare through digital tools and communities.

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.

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)

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

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.

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 TransformationalClaire Cain Miller, “The Virtual Visit May Expand Access to Doctors” (New York: NYTimes, Dec 20, 2009) B4.

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 .