Tech tools such as FLIR, Butterfly IQ, and Olloclip phone adapters allow rheumatologists to remotely monitor patients using infrared thermal imaging, ultrasound, and nailfold capillaroscopy. Wearable biosensors can also passively monitor patients remotely. Virtual reality is being used to help with chronic pain management, drug dependence, anxiety, and rehabilitation. However, challenges include issues around privacy, payment models, applicability, internet access, maintenance, and ethics. The future of medicine will likely involve more machine-assisted diagnosis and treatment, but it is up to doctors to help shape how technology transforms healthcare.

2. techRHEUM
LISA TRABOCO, MD
PRA Annual Meeting
Davao, March 2019

3. u No financial arrangements with any of the
companies of the apps, sites and
hardware technology seen in this
presentation

4. Doc Emmett Brown
HOW MANY DEGREES OF SEPARATION?

5. 3.57DEGREES OF SEPARATION

6. Acknowledgements
#MedTwitterPH

7. Berci Mesko, MD, PhD
@Berci
The Medical Futurist Blog
Brennan Spiegel, MD
@BrennanSpiegel
Cedar Sinai VR/AR Research
Suleman Bhana, MD
@DrBhana
Rheum Journal Club
Paul Sufka, MD
@psufka
Rheum Journal Club
Acknowledgements
Leonard Calabrese
@LCalabreseDO
Cleveland Clinic
Marjorie Stiegler
@DrMStiegler
Author: The Social Prescription
Dana Corriel
@DrCorriel
@SoMeDocs Founder
Marie Ennis-O’Connor
@JBBC
Mayo Clinic Social Media Advisory Board
#MedTwitter

8. “
”
Any sufficiently advanced
technology is indistinguishable
from magic.”
(author of 2001: Space Odyssey)
ARTHUR C. CLARKE
Profiles of the Future: An Inquiry into the Limits of the Possible

10. Themedicalfuturist.com
Berci Mesko, MD, PhD
@Berci
The Medical Futurist

11. Past Present Future

12. Past Present Future
IOT

13. René Theophile-Hyacinthe Laennec
Wikipedia.com

16. Past Present Future

17. Past Present Future
- Professional / Clinic Workflows
- CME / Academic Medicine
- The Internet Rx

18. Data Studio
Macros:
EHRs:
Professional/
Clinic Workflows:
Workflows:
3$/year, 44$ standalone
Docs Slides Sheets Forms

19. CME / Academe
(Self-learning
&/or Teaching):
CREATE YOUR PERSONAL LEARNING NETWORK

20. “Flipped Classroom”
• The Flipped Learning Global Initiative". The Flipped Learning Global Initiative. Retrieved 2 August 2016.
“Adaptive Learning”
CME / Academe
(Self-learning
&/or Teaching):

21. images.rheumatology.org
esor.eular.org

22. www.healio.com/rheumatology
theultrasoundsite.co.uk
www.tripdatabase.com
www.pmmonline.org
(Pedia-Rheuma)
rheumatologymindmap.com
Dr Alex Papou (UK)
acr18.rheumnow.com
rheumnow.live

23. Past Present Future
- Professional / Clinic Workflows
- CME / Academic Medicine
- The Internet Rx

24. Navigating Health Websites
themedicalfuturist.com
WHO
WHAT
WHEN
WHERE
WHY
National Center for Complementary or Integrative Health
nccih.nih.gov
made it
is it saying
was it made
is the information coming from
did they make the site

25. ...BAKA SuspiciouS?
bit.ly/impormasyon101
For more information / (Tagalog) tutorial:
• BAKIT – bakit ginawa ang website? May produkto na binebenta?
• KAILAN – kailan ginawa? Ito ba ay napapanahon?
• ANO – ano ang sinasabi / ipinapangako? Mga pambihira o impossible ba?
• SINO – sino ang nagpapatakbo ng website? Mapagkakatiwalaan?
• SAAN – saan nanggagaling ang impormasyon? Sa mga (totoong)
scientists/researchers?

26. Internet Rx
u General Medicine:
u nlm.nih.gov/medlineplus
u mayoclinic.com
u Hopkinsrheumatology.org/rheumtv
u Creakyjoints.org
u Rheuminfo.com
u Arthritis.org/living-with-arthritis
u Selfmanagescleroderma.com/index.html
DON’T Reject, REDIRECT !
themedicalfuturist.com

27. Internet Rx
Jerico Gutierrez
@jericogutierrrz
DON’T Reject, REDIRECT !

29. Past Present Future
- Professional / Clinic Workflows
- CME / Academic Medicine
- The Internet Rx

30. Past Present Future
- What’s App in Rheuma?
- Patient Pocket Power?

31. MedCalX MedConvert MDCalc Sanford Guide MIMS
snp.io
Calculators, Guides
Evernote Dropbox
File Sharing
Handy Tools
References (non-pdf format)
Uptodate
GoToWebinar
CME Streaming
#healthxph 1/19/19
Harrisons
Kelleys
UP Med Webinars
Office Lens

32. Add data to Excel directly from a photo—
Using the Excel app, you can take a picture of a
printed data table on your Android device and
automatically convert the picture into a fully
editable table in Excel.
Koenigsbauer, et al; New to Microsoft 365 in February—advancing security and empowering a modern workplace; Retrieved March 2, 2019

33. Spark Post Spark Video
ClipsPixabay
Content Creation
Bryan Vartabedian, MD
@Doctor_V
33charts.com
“Doctors are the first to complain…but the last to create”
• Infographics
• Info-videos
• Memes
• Inspirational Quotes for
Mental Health / Physician
Burnout
• Images Acronyms for Med
Education

34. #PSMIDVax
#PULMOCHAT
for @DrEdselSalvana

35. PODCASTS
RHEUMinations
@AdamJBrownMD @clevelandclinic
RHEUMnow Dr John Cush
EBRheum Dr Mike Putnam
The Curbsiders
Dr Matthew Watto
Dr Stuart Brigham
Dr Paul Williams
Dr Tony Sidari
Plenary Session @VPrasadMDMPH
Bedside Rounds @AdamRodman
listennotes.com

36. • Etymology of Gout?
• If Podagra is gout of the
toe/foot, what about the
shoulder? The knee?
• Which drug/ s was not
originally designed to treat
gout?
• What anti-gout drug can
we get from this flower?

37. Past Present Future
- What’s App in Rheuma?
- Patient Pocket Power?

38. Mobile health apps available in Apple iTunes &
Google Play stores
Account for half of all downloads
165,000
• IMS Institute, Patient Adoption of mHealth: Use, Evidence & Remaining Barriers to Mainsteam Adoption, 2015
• themedicalfuturist.com
36

39. apps.beta.nhs.uk
Other libraries:
• healthdirect.gov.au/health-and-wellbeing-apps
• healthhub.sg/apps

40. Devan, Hemakumar & Farmery, Devin & Peebles, Lucy & Grainger, Rebecca. (2018). Evaluation of Self-Management Support Functions in Apps for People
with Persistent Pain:A Systematic Review (Preprint). 10.2196/preprints.13080.
Stoyanov SR, Hides L, Kavanagh
DJ, Zelenko O, Tjondronegoro D,
Mani M. Mobile app rating scale: a
new tool for assessing the quality of
health mobile apps. JMIR Mhealth
Uhealth. 2015;3(1):e27. Published
2015 Mar 11.
doi:10.2196/mhealth.3422
MARS (Mobile App Rating Scale)
• engagement
• functionality
• aesthetics
• information quality
• subjective quality
Grainger R, Townsley H, White B, Langlotz T, Taylor WJ. Apps for People With Rheumatoid Arthritis to Monitor Their Disease Activity:A Review ofApps for Best Practice
and Quality. JMIR Mhealth Uhealth.2017;5(2):e7.Published 2017 Feb 21.doi:10.2196/mhealth.6956
SuperBetter
PainScale-PainDiary
Curable
Arthritis Power

41. Dr Iris Isip-Tan
@endocrine_witch
#Healthxph

42. Past Present Future
IOT

43. Tools
u FLIR
u Butterfly IQ
u Olloclip + Gosky Frame
u Wearable Tech
SULEMAN BHANA, MD
@DrBhana
TheRheumPodcast,
RheumJC, Tech Tools 2.0
BRENNAN SPIEGEL, MD
@BrennanSpiegel
BERTALAN MESKO, MD, PhD
@Berci
themedicalfuturist.com

44. FLIR
Chohnowksi. M; et al; Infrared thermal imaging in connective tissue disease; Reumatologia. 2017; 55(1):38-43
Lim, MJ, etc al; Digital thermography of the fingers and toes in Raynaud’s phenomenon. J Korean Med Sci 2014.Apr 29(4):502-6
$299 FLIR ONE
$399 FLIR ONE Pro
Venuturupalli, R.S, et al; Digital Medicine in Rheumatology: Challenges and Opportunites; Rheum Dis Clin N Am 45(2019) 113-126

45. Butterfly IQ
Around $ 2,000
www.butterflynetwork.com/clinical/msk

46. Olloclip + Gosky phone adapter mount
u Synovial Microscopy
u Nailfold Capillaroscopy
u Traditional image
capture equipment
($$$$$)
Venuturupalli, R.S, et al; Digital Medicine in Rheumatology: Challenges and Opportunites; Rheum Dis Clin N Am 45(2019) 113-126
Van Room, AM et al; Abnormal Nailfold Capillaroscopy is Common in Patients with CTD and Associated with Abnormal PFT: J Rheumatol. 2018 Dec 15
65 $
21x MACRO
Vs DermLite 495 $
25 $
Lens is specific to a certain iphone model
(lens for iphone 7 cannot be used for iphone x)

47. Wearable biosensors
u Can we take care of people remotely?
u the doctor’s office = an artificial environment
u Hawthorne effect = a form of reactivity whereby subjects
alter their behavior simply in response to knowing that they
are being studied
Brennan Spiegel, MD
@BrennanSpiegel
Wearable Biosensors and the Quantified Self Movement ;April 8, 2016

48. Oura
Ring
Wearable biosensors
”Passive monitoring” = powerful monitoring

49. Past Present Future
IOTIs the
Future
NOW?

50. VR / AR
Venuturupalli, R.S, et al; Digital Medicine in Rheumatology: Challenges and Opportunites; Rheum Dis Clin N Am 45(2019) 113-126
Torakeva, Julia; The Difference Between VR, AR, MR; Sofware Development Consultant on Quora; Feb 2, 2018
• Computer generated
• Displays
• Sensors
• User Input

51. Virtual Reality
Brennan Spiegel, MD
@BrennanSpiegel
Cedar Sinai
CAREN – Computer assisted rehabilitation environment system
University of South Florida
• Chronic Pain Management
• Drug (Opiod) dependence
• Anxiety
• Post traumatic stress disorder
• Rehabilitation
• Stroke
• Spinal Cord Injury
• Empathy-building
• Post partum depression
• Social interaction training
appliedvr.io/research-media
Venuturupalli, R.S, et al; Digital Medicine in Rheumatology: Challenges and Opportunites; Rheum Dis Clin N Am 45(2019) 113-126

53. 3d Brush
Free

54. 1250 PHP

55. Artificial Intelligence Bitcoin’s Blockchain
Internet of (Medical) Things
http://inspiren.com/#meetin
Techinsider.io
Futurelearn.com
13yo
Rishab
Jain

59. ?Portable densitometry
?Portable xray

60. Movie: Elysium (2013)
CHALLENGES?
• Privacy / security
• Payment / profit / funds
• Applicability / Usability
• Internet Access
• Maintenance
• Ethics
Doctor
Diagnostic &
Treatment
Machine

61. CHALLENGES?

62. I’m not sure why we feel the need to create the illusion that doctors
will always be just as they’ve always been.
This is medicine’s new reality.
It’s up to doctors to decide how they will participate in medicine’s
redefinition.
The best way to predict the future is to create it.
Bryan Vartabedian, MD
@Doctor_V
33charts.com
Apologizing for Technology, Sept 2017

63. あ
り
が
と
う
ご
ざ
い
ま
す
THANK YOU!