The document discusses the three components of digital health: applications, devices, and infrastructure. It describes how digital health has the potential to improve clinical care, patient safety, information dissemination, and chronic condition management. The document then focuses on physician use of social media communities and mobile applications. It provides examples of popular physician social networks and describes how physicians use smartphones and apps to access medical references, education, and patient information at the point of care. The document also discusses emerging trends in online care delivery through digital diagnosis and communication with patients.

1. American College
of Physicians
Wired and Wireless Health
Steven Peskin, MD, MBA, FACP
6 February 2010

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. Wireless Health Information Flow

6. Emerging Wireless Health Market
Triple Tree, “Wireless and Mobile Health Report and Survey” (Minneapolis: Triple Tree LLC, 2009).

7. Index
 Part 1
 Social Media and Physician Communities
 Part 2
 The App Revolution
 Part 3
 Into the Future

8. Part 1: Social Media and Physician
Communities

9. The “Arc” of Communities
Activity
Time

10. The “Anti-Arc”
Reimbursement
Jobs Board
need coding
Scheduling Lab Results
CME Affordable
EMR
“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

11. Social Media and Physician
Communities
 QuantiaMD:
 Founded in 2005, has 70,000+ members
 Features interactive 8-12 minute video lectures from top medical experts
 Sermo:
 Founded in 2006, has 110,000 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 100,000 members
 Invites clinical and non-clinical exchanges through video blogs and user
polls
 Epocrates:
 Founded in 1998, has 200,000 members
 Not strictly a social professional network. It features Immediate formulary
checks and drug information, “point-of-care references,” discussion
topics, and an electronic game on Facebook called “Diagnose the
Disease.”

12. Social Media and Physician
Communities- Peace, War, or Harmony
Ebay
c 1996-2003
Facebook Beacon Sermo Dashboard Threadless
Friendster
Sermo
MySpace Linked-In Client Posts
AskRx
Business Model in Business Model in
Neutral
Conflict Harmony

13. 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.

14. Part 2: The App Revolution: iPhone,
Blackberry, and Google Android

15. Point-of-Care Mobile Technology
Most Influential on
 88% of Physicians report Prescribing
that their PDA/Smartphone PDA/Smartphone
is essential to their clinical Direct Mail
Journal Ad
practice Rep Visit
e-Detail
 87% of physicians said the Pharma brand web site
PDA channel provides 6% 3% 2% 1%
clinical information that is 2%
most influential on their
prescribing and treatment 87%
decisions.
Skyscape. “Effect of PDA-based Information On treatment Decisions” (MASS: Skyscape, March 2008).

16. Point-of-Care Mobile Technology:
 88% of physicians report that “my
PDA/Smartphone is essential to my clinical
practice. Strongly Agree 45%
Agree 43%
Disagree 6%
Strongly Disagree 5%
 92% of physicians agree that “clinical
information on my PDA/S, Smartphone
improves my knowledge and capabilities.
Strongly Agree 56%
Agree 36%
Disagree 1%
Strongly Disagree 7%
Skyscape. “Effect of PDA-based Information On treatment Decisions” (MASS: Skyscape, March 2008).

17. “There’s an App for That”
 Apps for electronic medical records
 The software developer, Epic, just released a new
suite of apps that feature PHR access for a PDA
 Apps for patient information
delivery
 AirStrip Technologies: offers a suite
of HIPPA compliant apps that collect
all relevant patient information and
sends it to your PDA (including: lab
results, cardiology, temperature etc)

18. More Apps for Physicians
 Apps for medical education and reference
 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
 Modality: this company features 120 apps, 55 of which are
focused on medical education
 MedCalc: a medical calculator with a wide
array of medical formulas and scores. Includes
information and bibliographic references for
each formula.
 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.

19. 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.

20. 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. and 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)

21. 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) 8:4

22. 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
 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
 It allows physicians increased flexibility and an opportunity for practice expansion
 “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.

23. 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?
 Will facilitate a better-than-ever digital experience for easier video
and Web site viewing
 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).

24. Into the Future (Cont’d)
 Wired and Wireless 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 2010
Consumer Electronics Show
in Las Vegas. Note “digital
health” in the center .