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.
Posted in Doctor Patient Relationships, Healthcare Reform, Optimizing Patient Care, Outcomes
Tagged apple, Engagement, EPIC, healhcare, healthcare applications, medicine, patient care, technology
For scientists and researchers who are developing new treatments for disease, Data is power. For patients, Data can mean empowerment. Devices that track health indicators are readily available. These devices can track heart rate, blood pressure, blood sugar and even respiratory rate and body temperature.
This week in the Wall Street Journal, the medical applications of the Fit Bit device are explored. The Fit Bit is a basic pedometer that tracks movement, steps taken, calories consumed and (in certain models) sleep habits. This device is commercially available for around 100 dollars and was initially embraced by serious athletes in order to improve performance. Now, according to researchers, these devices may be able to impact health outcomes–both inside and outside of the hospital or healthcare setting. These impacts may forever change how physicians and healthcare systems think about managing chronic disease.
As I have mentioned in previous blogs, I firmly believe that smartphone applications for medicine are going to be a part of mainstream medical practice in the coming years. Providers will prescribe apps just as they do pharmaceuticals. In the case of the Fit Bit device and others like it, data obtained from physiologic monitoring can be used to assess physical fitness and progress towards obtaining specific health goals. In several recent studies, researchers at Massachusetts General Hospital in Boston, have found that the Fit Bit users who have diabetes are more likely to have better control of their blood sugars and achieve weight loss related goals better than those who do not use the device. Many patients with type 2 diabetes can better control their blood sugars through reduction in BMI (body mass index) and the data provided from the Fit Bit device seems to have a positive correlation with weight loss in this particular patient sample. In the hospital setting, researchers at the Mayo clinic found that in post-operative cardiac surgery patients, the Fit Bit was able to identify patients that needed more physical therapy intervention–by tracking movement in the early post-operative days. It is likely that by identifying and intervening early in patients who are not progressing after surgery we will be able to prevent many common complications such as deep vein thrombosis (DVT), pneumonia and other morbidities associated with lack of activity after surgery.
At this point, the FDA has no immediate plan for regulation as long as they are not specifically created to treat a particular medical condition or disease process–however, I do expect regulators to act on all types of biomedical data collection devices within the next 5 years. According to the WSJ, the health monitoring device industry is projected to exceed 5 billion dollars in 2016–largely due to our focus on patient engagement and prevention. Concerns have been raised as to the security of data and as to the reliability of the data generated by these devices. As with most new medical innovations, there is still much work to be done. We must create secure servers where patient’s data can be safely deposited (and HIPAA compliant) and easily accessed by their healthcare providers in order to provide necessary changes to care. In addition, the patient must be able to access their own data in order to assess progress, adjust goals and optimize their lifestyle changes in order to produce better health outcomes. Additional concerns have been raised around the legal implications of a large repository of medical and physiologic data—are physicians responsible for every reading and every piece of data in the repository? Will there be frivolous lawsuits initiated by ambulance chasers (or Fit BIt chasers) in the future?
I contend that more data is better. Data provides me with the power to make better decisions for my patients. Data provides my patients with real, meaningful feedback. When we are sick, we often feel as though we have lost the ability to determine our own destiny and lose any semblance of control. Data allows patients with chronic illness to actually regain some sense of control—and achieve ownership of their disease with the power to invoke change.
As a child, I often watched science fiction movies and television shows wondering how much would become reality in my lifetime. From space travel in Buck Rogers and Star Trek to time travel in Back to the Future, I often imagined growing up in a world where the impossible became probable. Bionics and the repair of human tissues was captivating and the Six Million Dollar Man (and its spin-offs) became a hit series. (we never missed an episode on Friday nights in my house!) Now, much of what was thought to be science fiction is becoming a reality in today’s world. No other discipline has seen science fiction become reality and produce human impact as readily as the medicine and the treatment of human disease.
Medicine is becoming increasingly “electronic” and patients of all ages are more consistently “wired” through the use of the internet, mobile devices and mobile applications for health. Patients are able to track health status, blood pressure, blood glucose and other indicators via their smartphones. This ability to track and transmit data is important to streamlining care and improving the efficiency of the doctor patient interaction. Hospitalizations are prevented through early intervention when physicians and patients have access to data while the patient is still an outpatient. For example, many implantable cardioverter defibrillators (ICDs) and pacemakers have diagnostic sensors that can transmit important information to clinicians and allow for the outpatient adjustments of medication before the patient reaches the point where hospitalization is necessary for congestive heart failure and other cardiovascular diseases.
Now, researchers are beginning to develop small, unobtrusive diagnostic tools that have the potential to not only transmit health status but also deliver therapy. In Monday’s Wall Street Journal, author Robert Lee Holtz reports on implants that are as thin as tattoos that are able to collect, process and respond to health data. Even more impressive is the fact that in early clinical trials, some of these sensors are able to deliver medications and therapies in response to the collected biologic information. The biophysics of personalized medicine is upon us–experiments are being conducted in laboratories all over the country in order to design miniature, accurate, responsive sensors that can easily integrate with the body and dissolve when no longer needed. In fact, as reported in the Journal, current experiments include using digital technology sensors on eyes for glaucoma, wrapping around hearts in need of a pacemaker and implants that control pain after surgery. These types of technologies, while potentially years away from routine human use, represent a major shift in the way in which doctors are able to care for patients. We are becoming increasingly web savvy–at all ages and in all demographics. As a society, we must accept more individual accountability and responsibility for our own healthcare in order to help contain costs. New developments such as implantable sensors and drug delivery systems may help doctors treat more diseases remotely and avoid costly hospitalizations. For patients, increased education, increased self awareness and the ability to receive real time feedback from therapies may improve their ability to make lifestyle adjustments and improve their own health status.
As I have said many times in my blogs, engaged patients enjoy improved outcomes. New technologies such as tiny implantable sensors and drug delivery systems will allow patients to connect like never before. I look forward to a future where devices are individualized and personalized for each patient’s particular disease process and needs. I believe that it will not only be important for physicians to be able to interact with the biologic data BUT also for patients to receive and interpret this information via a smartphone, computer, tablet or other mobile device in order to make adjustments and prevent complications or exacerbations of disease. Although we don’t have Steve Austin or the Six Million Dollar Man with us, we do have the technology to make all of us Better, Stronger and Healthier. The Age of Digital Medicine is here–we must embrace these new technologies and promote their development and deployment in the marketplace in order to improve the lives of our patients TODAY.
For many years, authors and movie studios have imagined a world where humans are replaced by mechanized overlords–think Terminator and Matrix. In medicine, as technology continues to evolve, computers and other diagnostic aids are readily available. Many offices and hospitals utilize tablet computers, iPads and other fancy tools when managing patients. Although he practice of medicine is closely coupled to complex technology and computers, it is at its roots a very personal and intimate interaction between two or more human beings. However, computers such as IBM’s Watson are now able to solve complex problems and synthesize data to provide medical diagnoses from inputted data. It is only natural that some scientists (and businessmen) want to replace doctors with machines.
This week in the New York Times, author Kate Hafner explores this very issue. As a medical student at Wake Forest University, a resident at the University of Virginia and then as a Fellow at Duke University, I can remember going to case conferences and marvelling at the diagnostic skills of senior faculty. Often, an unknown case would be presented to the institution’s best medical diagnostician by the Chief Residents. These medical “superstars” would have absolutely no preparation and would have only the hour of the conference to come up with a diagnosis. History, physical exam and routine laboratory data would be provided in a case presentation. The “superstar” would then be allowed to ask questions and order tests. If the test result was actually performed on the case the result would be provided. At the end of the hour, the diagnostic superstar would mesmerize the crowd with a summary of the findings, describe his thought process and provide his top three diagnoses. Without fail, he would then provide the correct diagnosis AND his reason for his decision. A hush would fall over the auditorium and the Chief Resident would announce that once again, Dr Superstar had made the right diagnosis. As physicians in training, we would leave INSPIRED to become better doctors.
Computers are able to process incredible amounts of information quite quickly. In the New York Times article, the author explores the value of intuition and gut instinct–certainly computers are able to process vast amounts of information very quickly and come up with viable diagnostic options. Humans are quite adept at recognizing patterns. Pattern recognition is essential to making accurate diagnoses. As Ms Hafner mentions in her article, the “superstar” diagnosticians must combine a good fund of knowledge with logic, pattern recognition and intuition. No computer is able to combine all of these factors. However, when a physician does this type of diagnostic work, it is done at human speed. Computers can quickly crunch numbers and work through pre- defined algorithms and provide a list of diagnostic possibilities in an instant. Computers require programmers. Doctors require medical school, residency, fellowship and most importantly EXPERIENCE.
Physicians are essential to the practice of medicine. Computers and computer algorithms can help to manage and catalogue vast amounts of medical information. Neither a physician nor a computer can practice medicine alone in a vacuum today. As medical science continues to rapidly develop computers are very useful resources. Creating algorithms for problems solving and diagnosis is important–not as a Dr Superstar replacement BUT as an adjunct to diagnosis. By its very nature, medicine is all about human contact and human interaction. There are many subtleties to complex diagnosis that can only be picked up on by TALKING to and EXAMINING the patient. As we move forward with healthcare reform and begin to make tough decisions about cost effectiveness and efficiency of care, we must keep in mind the importance of clinical diagnosis by a PHYSICIAN. The practice of medicine is certainly a science but it also remains an ART. Just ask Dr Superstar, in an hour, he will amaze you with the right answer…every single time.