Tag Archives: mobile health

Embracing Technology and Providing Care: The Role of Email and Texting in the Patient Encounter

As we become more connected as a society, it is inevitable that healthcare moves toward more of a virtual online presence as well.  Telemedicine and remote follow up is becoming more common.  I have previously blogged on the importance of the “personal” face to face office visit but at the same time, I embrace the digital revolution in healthcare.  Finding the proper balance is the key to successful integration of technology into the delivery of effective healthcare in today’s changing world.

Recently, an article in the Wall Street Journal addressed the controversies surrounding the use of email communication between doctor and patient.  This practice is fraught with significant legal, personal and professional issues.  Patients certainly deserve prompt answers to their questions and reasonable access to their providers–but should we as physicians be accessible via email 24 hours a day?  The WSJ piece profiles a few physicians and highlights the way in which each uses email to communicate with patients.  Based on recent national surveys, it appears that currently nearly 30% of physicians communicate via email to their patients.  Nearly 18% actually used text messaging to interact with patients.  Estimates suggest that only 5% of American patients included in the survey use email or text to communicate with their physicians or other healthcare providers.

So what are the advantages of email communication?  Physician proponents of electronic communication cite the ease of interaction and the avoidance of “phone tag”.  In addition, physicians who email say that it actually saves them time in the office visit because rather than having to deal with misinformation that patients have obtained via google searches about a particular condition, they are able to provide accurate medical answers when the patient wants them via virtual communication.  Moreover, these advocates also say that the “good will” and positive ratings that are afforded them by patients who are particularly pleased with email access helps them compete in crowded medical markets such as seen in Manhattan in New York City.

Others see electronic communication with patients as problematic.  Obviously there are significant issues with privacy, security and miscommunication of important medical instructions or advice.  In addition, there may be major legal implications when providing access via email or text.  For example, if you provide email and text access to your patients, are you responsible for responding immediately on a weekend or holiday?  If the patient suffers a major negative health event, are you responsible if you did not respond.  I am certain throngs of litigators are licking their chops at this new frontier of frivolous malpractice claims.  Certainly, allowing access during time at home with family and during weekends and holidays may even further reduce a physician’s “down time” and reduce the quality of time spent with family and friends.  With workloads increasing and time away becoming scarce, burnout rates are as high as ever and this type of 24-7 connectivity may lead to even quicker flame outs.  Other physicians cite concerns over reimbursement–time spent emailing and texting patients is unpaid.  With reimbursements falling yet again, providing free services just doesn’t make sense to many providers’ bottom line.

Technology such as email and text can be an incredibly powerful tool in medicine.  I communicate with colleagues and with consultants routinely in this manner.  Departmental business can be easily handled via email communications.  Although many patients certainly enjoy the convenience and speed of email and text access to their physicians, I am not sure the medical system is ready for this interaction at this time.  We must define parameters for these interaction and come up with professional guidelines.  We must ensure that patients remain safe and do not replace important office follow up visits with virtual communications.  In addition, a method for compensating physicians for the time spent in electronic communication must be defined and incorporated into current reimbursement policies.  The trial lawyers must be prevented from taking advantage of the numerous pitfalls associated with email and text communications.  For privacy reasons, we must ensure that messages are encrypted and for medical-legal reasons we must create a way for email and text communications to be downloaded into the electronic medical record in order to fully document all doctor patient interactions that occur.  The digital revolution in medicine has begun–it is going to change the way we do business–it is essential that we guide its development in ways that positively impact outcomes and improve quality of care.

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Tracking Health Indicators: The Role of mHealth Technologies in Improving Outcomes

Smartphones, tablets such as the iPad and other mobile technologies are becoming commonplace in the US today.  These devices are nimble, efficient and able to process large amounts of data while conveniently sized.  In a recent survey in 2012, it was found that nearly 95% of all Americans have mobile phones and 60% have smartphone devices.  The numbers are a bit higher in the younger age groups but the devices are prevalent even in the over 65 set.  Tablet computer sales are expected to overtake laptops in 2013–one estimate predicts that 240 million tablets and 204 million laptops will be purchased this year.  With technology at everyone’s fingertips, it is not surprising that more and more patients are using technology to track their medical conditions.

The New York Times recently reported on a survey published by the Pew Research Center on American’s health tracking behaviors.  Fortunately, as a society, it appears that we are becoming much more health conscious.  In the survey, Pew researchers found that 70% of all adults track some health indicator for themselves or a loved one.  However, much of the tracking is classified as informal and 49% say that they track “in [their] head”.  Of those who track health indicators, 35% use a paper journal and now 21% use technology such as a smartphone or tablet application.  As mentioned in the Pew report, this is the first survey conducted to examine health tracking behaviors in the US–Importantly, the survey found that 46% of those with tracking behaviors changed their approach to healthcare and have become much more engaged.  Specifically, the engagement prompted them to ask more questions of their physician and to often seek more that one opinion.

Mobile technology is a powerful tool.  Last year alone over 500 companies made healthcare related applications and there are now almost 15,000 applications for health indicator tracking on the market.  By tracking health indicators such as blood pressure, heart rate, daily weights and blood sugars (among others) patients can see the impact of interventions such as diet, exercise and drug therapy.  Seeing results in real time can be very motivating.  The ill effects of chronic diseases such as hypertension and obesity are not always readily apparent to patients until end organ damage occurs.  With tracking applications, the patient is able to see the day to day variation and is engaged in the control of his or her health indicators.  As I have mentioned in a previous blog, I believe that the time is near when physicians will begin prescribing mobile health tracking applications for their patients during routine office visits.  Healthcare in the US has to change in order to be successful.  No longer can patients passively sit back and accept the fact that physicians will be able to take care of all of their healthcare needs.  Now, more than ever, patient engagement and participation is key to success.  Under the new healthcare system, physicians will face increased pressure to see more patients in less time.  Documentation challenges with electronic medical records (EMR) and other paperwork will further diminish the time spent with patients.  Patient participation in health maintenance through health indicator tracking via mobile applications will prove to be a critically important part of our healthcare system.  I foresee a doctor’s visit where a patient can download their smartphone data directly into their EMR file in their physicians office.  This ability to sync data will not only save time but will improve accuracy of the record.  Ultimately, I expect that mobile applications will be able to transmit data messages to physician offices when certain health indicators have risen to dangerous levels.

Technology to improve the health of Americans is here.  How and when we incorporate these technologies into the healthcare system is still developing.  As with most things in medicine in the US, the FDA will most likely begin to play a larger role in the evaluation of health tracking applications.  Ultimately, I expect the same level of regulation that we see with new prescription drugs or medical devices.  (However, that could be  subject of a blog all its own).  For now, I encourage patients and physicians to consider using medical applications in their practices.   Certainly, tracking indicators can benefit patient outcomes–patient access to data increases awareness, increases engagement and will ultimately save healthcare dollars.

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