Tag Archives: Engagement

An Apple A Day—Changing Medicine Through Technology and Engagement

The practice of medicine and healthcare in general has become an electronic and increasingly mobile interaction. Patients are better informed, more engaged, more connected and have a much greater virtual presence. In fact, according to Pew Research data, the fastest growing demographic on Twitter are those who are in the 45-65 age bracket.   Nearly 50% of all seniors engage online on a daily basis through at least one social media platform and many of these interactions and online engagements occur via mobile devices. Almost 75% of all adults go online within hours of attending a visit with their physician in order to gather more information about their particular medical problem. For healthcare providers—and for patients—the internet and mobile technology presents us all with wonderful opportunities to interact, engage, support and ultimately improve outcomes.

New connected devices and medical applications for mobile devices are on growing exponentially.   The world responded favorably to the latest release of the iPhone 6 and the iOS8 operating system recently released by Apple. The new device has many interesting features but one in particular caught my eye early on. Apple has created a standard package for all iOS 8 devices that is called the Health Kit. This particular application allows a user to track calories, steps taken (similar to a pedometer), flights of stairs climbed and other customizable health related data points. These data can be organized into graphs and charts that allow users to track progress and adjust activity levels to achieve particular goals. More impressively, the device will allow other health related applications to organize data in the Health Kit as well. One of the biggest problems with medial applications in the past is that there has never been an easy place to organize, store, collect and view all of the data together. Moreover, this data is not easily shared with healthcare providers. The Health Kit and Apple may revolutionize this entire process of data collection, retrieval and sharing—Apple has partnered with a major electronic medical record service known as EPIC. Work is underway to allow the Health Kit data and applications to easily interact with the EPIC medical record. This would allow for easy downloads of health data during a face-to-face encounter with healthcare providers. Currently, most major hospitals and healthcare systems are moving to the EPIC platform. The data collected and downloaded at one location would subsequently be available to all providers in the system—portability of data allows for better care and less duplication of effort.

Much has been written about patient engagement and improved outcomes in the medical literature. I can think of no better way to improve engagement than through the use of real time health applications –these allow patients to receive real time feedback—both good and bad—and respond quickly in order to improve their overall health status. I think that this type of technology will only continue to grow. Apple plans to release the Apple Watch in early 2015. I expect that this will also be integrated with Health Kit and allow for the measurement of respiratory rate, heart rate, body temperature and other biologic measurements. As these tools continue to develop and applications grow, healthcare providers as well as patients must be receptive to their use. These technologies have the potential to allow clinicians to better assess patients between office visits and provide more directed and timely changes in therapy. Ultimately I believe these technologies will transform healthcare. As we continue to struggle with healthcare cost containment in the era of healthcare reform, the ability to shift care and routine interaction to mobile platforms may very well prove to be a critical piece of the puzzle.

This is an exciting time in medicine as well as in healthcare technology. Moving forward, I look to a day where biologic sensors collect data, relay data to mobile devices and then transmit information seamlessly to healthcare systems. The healthcare providers are alerted to any abnormalities and electronic responses are generated—those patients requiring timely in person visits can be identified and scheduled, while those that can be handled virtually can be managed quickly and effectively as well. Ultimately, our goal is to better manage disease and improve outcomes. I think that technologies such as the Health Kit and the Apple Watch are giant leaps forward and are just the beginning of a new age of virtual healthcare.

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Practicing Medicine in the Digital Age: Challenges & Opportunities of the Virtual Encounter

The digital age of medicine is upon us.  This past week at the opening Plenary session at the Annual Heart Rhythm Society Meetings, we heard Dr Eric Topol and others tell us that we must embrace social networking in order to engage patients and improve care.  The Affordable Care Act has now changed the landscape of medical practice in the US–we must do more to focus on preventative care and work harder to curtail costs.  More patients are insured and a primary care shortage is upon us (according to data from the AAFP).  In fact, it is estimated that we must create an additional 65 training spots in primary care every year for the next 10 years in order to keep up with the demand–this is assuming that the AAFP estimate of a 25% growth in workforce will be needed to meet the growing pool of insured Americans.  In addition, preventative services will require frequent follow up, patient engagement and support services.

Patients are more connected than ever–most patients now go to the internet to prepare for office visits and come armed with lots of information.  Office visits are already now dominated by keyboards and EMRs–it only seems logical that the next step will be virtual access for physicians and patients.  With growing primary care shortages and an increasing pool of patients needed access to care, telemedicine is likely to play a much larger role in the future.  The concept of telemedicine is not new–remote areas and hospitals have been utilizing telemedicine consults in order to provide specialist support for primary care physicians with limited access.

This week, the Wall Street Journal’s Belinda Beck reported on the growing telemedicine business–doctors seeing patients via computer portals from nearly anywhere in the world.  Several web based companies are now regularly hosting virtual doctor visits online where physicians and patients interact via phone and internet.  Patients describe symptoms and discuss issues with their virtual doctor and are then prescribed therapy–all for a cost of only 40-50 dollars.  Most visits are completed within 15 minutes and no travel is required for either doctor or patient.  Advocates argue that for simple straightforward problems telemedicine visits are much more cost effective and also provide high quality efficient patient care.  Critics have voiced concerns over the quality of care, lack of doctor-patient relationship and the over-prescription of antibiotics.  Some argue that when a virtual visit occurs, diagnosis is made more difficult due to a lack of physical exam.  In addition, data obtained by the Wall Street Journal from Rand, indicate that virtual visits are more likely to result in the prescription of an antibiotic.

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(Graphic from JAMA Internal Medicine and Published in the WSJ)

As you may expect, guidelines from regulatory agencies and medical boards are currently in the works.  Virtual physicians will be held to the same standards as in person office visits and continuity of care is being encouraged by allowing patients to choose their virtual doctor rather than have the provider randomly assigned.  In addition, the Federation of State Medical Boards is now recommending that all virtual doctors are licensed in the state in which the patient that is treated resides.  However, this particular requirement for licensing does not really make good sense if the objective of telemedicine is to provide care to those with limited access to physicians.  Virtual medicine has the potential to meet significant primary care needs in remote, rural and underserved communities and may be an alternative to in person treatment of simple, straightforward medical problems.

As we continue to reform the US healthcare system, many challenges must be met and overcome.  Providing affordable, high quality, efficient care to a growing number of insured Americans is a significant task.  With the advent of digital medicine and advancements in mobile technologies, it is now possible to provide care to patients who may otherwise remain unserved.  Wearable sensors, mobile devices that can obtain real time electrocardiograms and other technologies in development make it possible to receive diagnostic data from remote locations.   In order to be successful, we must embrace change and utilize the digital tools that are now available to provide care to those who so badly need it.
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(Image source: Screen grab via YouTube TED talk by Dr Eric Topol)

Patient Engagement and Improving Outcomes: Tweeting for Success

Patient engagement is critical to success–particularly in treating chronic medical conditions such as heart disease, diabetes and asthma.  In this era of healthcare reform and cost-containment we must now, more than ever, rely on patient participation in their own care.  Studies have shown that when patients play an active role in the management of their disease, hospitalization rates and complications are minimized.  Examples of “engagement” include daily recording of blood pressure and heart rate, blood sugar logs, daily exercise logs, and the like.  Engagement requires that patients not only partner with their physicians during office visits but take individual responsibility for their own healthcare—showing up three times a year as a passive participant in the office visit is not nearly enough.

This week in the Wall Street Journal, author Laura Landro explores the issues surrounding patient participation in management of chronic illnesses.  In her piece, Ms Landro uses chronic kidney disease as an example of how patient engagement and strict adherence to a physician’s recommendations can make a difference in outcomes.  Exercise, dietary changes and monitoring of blood pressure can make a significant impact on kidney disease and, in many cases, slow progressing to kidney failure for many years.  However, this type of intervention only works when the patient and physician are “partnered”.  With increasing workloads and more clerical demands, physicians are not able to reach out to patients as often as they would like between formal visits.  Through patient engagement, however, we have the potential to bridge the gap between visits.  As Ms Landro points out, one of the biggest challenges is in “getting the word out” to patients.  Most patients lack disease specific education and are not sure how to go about “at home” management.  Moreover, with increasing patient volumes and less time available to spend with each patient in the office, many physicians are not able to adequately educate patients during a quarterly office visit.

What is the solution?  How can we educate more patients effectively?

For me, the answer is simple.  Let’s use the tools we have that are easily accessible to most patients. Today, more than 60% of all Americans own a smartphone or other “connected” mobile device.  Most households have at least one computer.  While today’s children are “born” understanding and interacting with the computer and mobile world, older Americans are also becoming more tech savvy.  Social media and the virtual world lend itself perfectly to helping support patients as they engage in the co-management of their own diseases.  Virtual health coaching and support can be the way in which we support patients between “real time” office visits in the future.   Applications for smart phones such as Lift can be an essential part of engagement and ultimately may become part of routine patient care activities.

1. Twitter:  Twitter can be a great way to conduct “disease-specific” chats–engage patients virtually with regularly scheduled group events identified by a specific hashtag.  A physician or other healthcare provider can serve as a moderator for the chat.  This is a great forum for support groups, educational events and information exchange.  As a legal side note, this is NOT an acceptable forum to provide specific medical advice or patient care.  It is more about support, engagement and education.  For patients it is a wonderful way to “check in” and track their progress in a supportive non threatening environment.  For instance, a twitter chat amongst patients with kidney disease may involve an exchange of healthy recipes.  By connecting with others (and likely a healthcare professional who is moderating the chat) the patient is supported and remains engaged during the time between real live office visits.

2. Blogging:  Regular blogging can provide a wonderful resource for patients and their families.  Disease specific blogs may provide nutritional advice, exercise tips, and help disseminate important information about drugs and disease.  Blogging can help educate and inform patients–as Ms Landro correctly points out in the WSJ education is a major reason that patients sometimes fail to engage.  Thru regular posts (by physicians, nutritionists, exercise physiologists, etc) a broad range of topics can be covered and the patient is provided with the tools they will need to succeed.

3. Facebook posts:  Maintaining a “Disease-Specific” Facebook page for patients is another outlet for successfully educating patients and disseminating information between office visits.  These pages can be a great place to post pictures of interesting recipes or provide information on new therapies for a particular disease.  As with Twitter, clinicians must take care to provide information only and NOT use it as a platform for discussing privileged medical information or for providing treatment.

4. Prescribing Apps:  As I have discussed before in previous blogs, applications for mobile devices are likely to play a major role in disease management in the future.  There are already numerous applications available for tracking blood pressure or blood sugars.  These applications are a wonderful way to store data and share the data with physicians during a live quarterly visit to the clinic.  The physician is better able to track progress and the engaged patient is able to see real change.  In fact, Lift has developed an app that is specifically designed to help patients achieve health related goals and is in the midst of a large diet tracking and comparison project called the quantified diet.

Patient engagement is critical to the management of chronic diseases under our new healthcare system.  Physicians have less time to devote to patient care due to paperwork, documentation mandates and higher volumes.  In order to maintain a high level of care and clinical success, we must also rely on patients to take individual responsibility for their own healthcare issues.  In the past, engagement between visits has been difficult to accomplish due to the lack of resources available for communication and interaction with patients.  Now, with the proliferation of mobile technologies and the use of social media outlets patients can be engaged daily–if they will accept the responsibility of co-managing their own disease in concert with their physician.  With widespread engagement, I expect to see outcomes improve and patient lives changed for the better.  #Engage now!  (in 140 characters or less!)

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