Jane Rust woke up early one day last year and discovered that her left eye was red, swollen and itchy. So she logged on to her family doctor’s Web site and typed a message describing her symptoms and asking what to do.By mid-morning, the 61-year-old homemaker received an online response from her doctor with a diagnosis—conjunctivitis, or pink eye, probably contracted from a child in her Sunday-school class—and a prescription to pick up at the pharmacy. “I didn’t have to disrupt my day,” says Ms. Rust, who lives in Readyville, Tenn. “It’s much more efficient.”
Digital Health: Medicine at the Croosroads
Medicine at the Crossroads: Implications of Mobile Health and Social Media in Clinical Practice<br />Steven Peskin, MD, MBA, FACP<br />EVP and Chief Medical Officer, MediMedia<br />Assistant Clinical Professor, UMDNJ<br />
The Three Components of Digital Health<br />Applications (clinical/institutional, consumer-focused, and content).<br />Devices (mobile phones, sensors, medical devices, and others).<br /> Infrastructure (both wireless and supporting wire-line and network services). <br />Triple Tree, “Wireless and Mobile Health Report and Survey” (Minneapolis: Triple Tree LLC, 2009).<br />
Digital Health: Tremendous Potential<br />Improve clinical care delivery and patient-provider communication<br />Maximize patient safety and convenience with patient monitoring and patient tracking<br />More effective information dissemination and dialogue within all medical disciplines<br />Enterprise-wide health information<br />Bridging the gaps hospital-based/other institutional, ambulatory/ office, home, pharmacy, self care<br />Collaborative approach to diagnosis and treatment<br />Simplified chronic condition and lifestyle management<br />Triple Tree, “Wireless and Mobile Health Report and Survey” (Minneapolis: Triple Tree LLC, 2009).<br />
Social Media and Physician Communities<br />QuantiaMD:<br />Founded in 2005, has 120,000+ members<br />Education and collaboration platform for physicians and other clinicians accessible on computers, tablets, and SmartPhones<br />Sermo: <br />Founded in 2006, has 180,000 members<br />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”<br />Medscape Physician Connect: <br />Founded in 2008, has 200,000 members<br />Invites clinical and non-clinical exchanges through video blogs and user polls<br />
Decision Support<br />Epocrates<br />Founded in 1998, has 300,000 members<br />Not strictly a social professional network<br /> Features Immediate formulary checks and drug information, “point-of-care references,” discussion topics, and an electronic game on Facebook called “Diagnose the Disease.”<br />
Social Media and Physician Communities- Peace, War, or Harmony<br />Ebay<br />c 1996-2003<br />SermoDashboard<br />Threadless<br />Facebook Beacon<br />Friendster<br />Sermo AskRx<br />Client Posts<br />Linked-In<br />MySpace<br />Business Model in Conflict<br />Business Model in Harmony<br />Neutral<br />
Social Community Benefits for Physicians<br />Social Communities facilitate sharing of clinical insights and solutions to practical clinical problems in a way that promises to hone “best practices”<br />Allows physicians to:<br />Access dialogs on best practices<br />Source and disseminate immediate market research<br />Solicit useful feedback about preferred treatments, protocols, and practice patterns that yield best health and patient satisfaction<br />Build business arrangements<br />Steven Peskin, MD. “Can a Medical ‘Facebook’ Help You Plan Thrive? (Yardley: Managed Care, June 2009) 25.<br />
Part 2: The App Revolution: iPhone, Blackberry, and Google Android<br />
Point-of-Care Mobile Technology<br />88% of Physicians report that their PDA/Smartphone is essential to their clinical practice<br />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. <br />Skyscape. “Effect of PDA-based Information On treatment Decisions” (MASS: Skyscape, March 2008). Mix of 594 primary care and specialty physicians.<br />
Point-of-Care Mobile Technology:<br />88% of physicians report that “my PDA/Smartphone is essential to my clinical practice.<br /><ul><li>92% of physicians agree that “clinical information on my PDA/S, Smartphone improves my knowledge and capabilities.</li></ul>Skyscape. “Effect of PDA-based Information On treatment Decisions” (MASS: Skyscape, March 2008).<br />
“There’s an App for That”<br /><ul><li>Apps for electronic medical records
The software developer, Epic, just released a new suite of apps that feature PHR access for a PDA
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)
From QuantiaCare: EatSmart with content from Hope Warshaw, RD, MMSc, CDE, BC-ADM</li></li></ul><li>More Apps for Physicians<br /><ul><li>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</li></li></ul><li>Krames Patient Education: iPatientID<br />
Apps for Consumers<br />: Use your iPhone to track doctors’ appointments, medication schedules and other health information.<br />: Offers 30+ free trackers for BP, Cholesterol, Diabetes, and other health indicators along with charting and other tools.<br />: A suite of apps that allow mobile access and mobile recording of personal health data for tracking and informational purposes.<br />
Online Care: Digital Diagnosis<br />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. <br />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.<br />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.<br />Methods include: interactive questionnaires, web video, live chat, and phone conversations.<br />Anna Wilde Mathews, “The Doctor Will Text You Now” (New York: Wall Street Journal, July 9, 2009)<br />
Part 3: Into the Future<br />Don Detmer MD, MA and President and CEO of American Medical Informatics Association<br />“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.”<br />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.”<br />“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.”<br />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.<br />
Online Care: Digital Diagnosis<br />American Well’s “Virtual Visit”<br />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.<br /><ul><li>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</li></ul>Claire Cain Miller, “The Virtual Visit May Expand Access to Doctors” (New York: NYTimes, Dec 20, 2009) B4.<br />
The Apple iPad<br />The iPad<br />“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<br />Half an inch thin. Weighs 1.5 pounds. 9.7-inch IPS display <br /><ul><li>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. </li></ul>Brad Stone, (New York: NYTimes January 27).<br />
Into the Future (Cont’d)<br />Mobile Health and Social Media will be a part of everyday health care <br />Health care professionals will embrace digital tools/ communities for clinical performance improvement, time and $$$ savings/ revenue <br />Increased availability, accuracy, searchability and dissemination of Information<br />Image from the Jan 2010Consumer Electronics Showin Las Vegas. Note “digital health” in the center .<br />