Medical Futures Lab

Guest posting by Sharon Syau

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Guest posting by Bailey Flynn

Medicine sits at the crossroads of many subjects. One of the reasons I love the field so much is because of its interdisciplinary nature. Medicine requires science, business, math, history, communication, engineering, logic, and more. However, these requirements also mean that it is an exceedingly complex, even intimidating, field.

One recent article has to do with the intersection of medicine and data science. Data science, a relatively new field, is the study of data and how it can be applied to solve problems. It has been employed in banking, school admissions, politics, and even social media. However, it’s been somewhat late to the field of medicine. The New York Times article, “On the Case at Mount Sinai, It’s Dr. Data,” follows the career of Dr. Hammerbacher, who is now applying data science to medicine, only after a long career in business, start-ups, and social networking. Similar to the field itself, Hammerbacher took some time to begin in medicine, however, the contributions he is now making are invaluable.

Data science, applied appropriately, has the potential to visualize disease progressions, formulate more effective treatments, project patient outcomes, and much more. The practice of medicine accumulates a tremendous amount of data – from patient vitals to more complex imaging and beyond. The application of data science would put this data to use to improve future patient treatments and outcomes based on past cases. In class, we watched a brief clip of Hans Rosling’s TED talk, in which he displays data about health in the developing world. It is at the same time attention grabbing and incredibly informative – overall an effective combination of medicine and data.

Specifically, for my project, data science would be useful to reduce the average length of stay necessary for patients after liver transplant. Collecting and analyzing data from current patients would allow doctors to see where the process is least efficient. It would also illuminate what a standard post-transplant stay looks like, allowing doctors to estimate when patients should be discharged.

It is critical that other disciplines, including data science, collaborate to make medicine as effective as possible. Of course, data science cannot single-handedly fix the healthcare system. It is only in conjunction with willing healthcare providers that it becomes effective. Even Dr. Hammerbacher admits, “We’re not the most important people, but we can help.”

New York Times article:
http://www.nytimes.com/2015/03/08/technology/on-the-case-at-mount-sinai-its-dr-data.html?ref=health
Hans Rosling TED talk: http://www.ted.com/talks/hans_rosling_shows_the_best_stats_you_ve_ever_seen

Guest posting by Andrew Ta

We live in an era of connected technology, in which the proliferation of smartphones and mobile apps has revolutionized everything from the morning routine to entire industries. Yet, medicine and healthcare, in least in the United States, sit monolithic, too massive and overregulated to sway with novel tech. Having yet not undergone the same transformation as other professions, the field is ripe for innovation, and Apple’s recently announced ResearchKit might offer a step towards that.

Announced at Apple’s March 9th media event, ResearchKit is an open-source framework for iPhone apps designed to help researchers gather data for medical studies. With permission from the user, the iPhone can share data from the Health app, as well as access the device’s other measurement instruments like the accelerometer or gyroscope. Participants would be able to tap on a screen to test for Parkinson’s disease, make a tone to detect vocal variations, or walk to measure their gait and balance. Partners, such as Massachusetts General Hospital and Stanford Medicine, have used the framework to develop apps for studies on asthma, breast cancer, cardiovascular disease, diabetes, and Parkinson’s disease.

 The immediate benefits of ResearchKit are obvious; with the iPhone’s customer reach, researchers are able to gather data from millions of users.  The Health app comes pre-installed According to the Pew Internet Project, as of January, 2014, 58% of Americans have a smartphone. One age group, 18-29, has a smartphone ownership rate of 83%. Another source estimates smartphone users at nearly a fourth of the world population, increasing to a third by 2017. Imagine a world where anyone with a smartphone can enroll in clinical studies and submit their biometric data with the tap of a screen, and at no extra momentary cost; the sheer reach potential warrants attention.

ResearchKit lowers the barrier of entry and increases the range of capabilities of sample collection, especially important for medical studies susceptible to low sample sizes and inconsistent data collection. By enabling both cross-sectional and longitudinal studies of wide berths of the population, as well as by encouraging collection of control data, and with combination of all the gamification and instant gratification of smartphone apps, ResearchKit succinctly tackles numerous tough issues.

An open-source platform, anyone can use the framework to design their own apps. Combined with Apple’s relatively simple design guidelines and development tools, truly health literate mobile apps may not be that far away. With health literacy at only 12% according to the Institute of Medicine, such apps can help bridge the digital divide and pave the path for better care, better health, and lower cost, all the aims of such technology, according to Berwick.

The end user also shares in the benefits. With the possibility of increased engagement and case management tracking (via additional, third-party products for more specialized data collection), it’s another (likely, more fun) medium through which patients can be empowered through control and access to their data, previously left unrecorded.

Admits all the praise and possibilities, ResearchKit is not without its own issues, many of them shared with other novel technologies that previously attempted to breach the healthcare market. Privacy rights, data protection, and right to know are all such possible areas of infringement or overreach. Apple says the app allows users to customize exactly what data is shared, but just how much is lip service? With regards to study design, how limited is the data set? It would tend towards the rich, toward those who could afford iPhones, toward those who actively use their phones.  However, these issues should merely inform, not delay or impede, progress and research of technologies such as ResearchKit, all in the hopes that these sorts of innovations and ideas can be encouraged and built upon in order to advance the human condition.

(Berwick, Nolan and Whittington; eMarketer; Jordan Broderick; Pew Reserach Center)

References

Berwick, D. M., T. W. Nolan, and J. Whittington. “The Triple Aim: Care, Health, and Cost.” Health Aff (Millwood) 27.3 (2008): 759-69. Print.

eMarketer. “Smartphone Users Worldwide Will Total 1.75 Billion in 2014.”  (2014).  <http://www.emarketer.com/Article/Smartphone-Users-Worldwide-Will-Total-175-Billion-2014/1010536>.

Jordan Broderick, Theresa Devine, Ellen Langhans, Andrew J. Lemerise, Silje Lier, Linda Harris. “Designing Health Literate Mobile Apps.” Institute of Medicine of the National Academies  (2014).  <http://www.iom.edu/Global/Perspectives/2014/HealthLiterateApps.aspx>.

Pew Reserach Center. “Mobile Technology Fact Sheet.”  (2015).  <http://www.pewinternet.org/fact-sheets/mobile-technology-fact-sheet/>.

Guest posting by Sonali Mahendran

There are several resources available to improve patient health and knowledge. Recently, ORCAS, a health app intervention developer, created a method of mobile intervention for patients with nonspecific lower back pain. This app tracks the user’s pain levels and provides a pain-management program. This app works with Fitbit to record the patient’s activities, accounting for the patient’s occupation—whether the user sits, stands, drives, lifts for extended periods of time as part of his work. With insurance company Cigna, ORCAS tested the app with employed adults in a four-month study. One group of participants used the FitBack app, another received six links to online NLBP resources via email, and the third, the control group, returned only for periodic checkups. According to the study, after the four months, the FitBack users performed better than both the control group and the alternative therapy group with regard to physical, behavioral, and occupational outcome measures; control group members were 1.7 times more likely to report current back pain than FitBack users, and alternative therapy recipients were 1.6 times more likely to report current back pain than FitBack users. The rates of current back pain were 21% for FitBack users, 41% for alternative therapy recipients, and 41% for the control group after the final assessment. Moreover, FitBack users demonstrated higher satisfaction. It is important to note that the FitBack intervention was neither supported by professional caregivers nor integrated with a health care plan, which may provide even stronger evidence for FitBack’s positive effects on NLBS patients.

Another study suggested that interactive, personalized web content may improve patient health and overall knowledge. The intervention group received a web-based interactive health communication application (IHCA), which provided decision, social, and behavioral change support. On the other hand, the control group received the same content, but in the form of a content tree without any personalization.  This study showed that, among 561 participants who had either type 2 diabetes or chronic back pain, the intervention group used the tool for an average of 51.2 minutes, while the control group used their tool for an average of 37.6 minutes. Participants in the intervention group were more knowledgeable about their condition and showed better emotional wellbeing.

From these studies, it is evident that patients will utilize resources as they become available. But what happens if usage of these resources tapers off? How do we maintain user engagement?

With regard to our team’s project, we can provide parents of children with congenital heart disease a large binder of information, an online course tailored to each family, or a virtual hospital library. However, patients must be willing to return to these resources as needed and prepare themselves for future discussions with the physician, surgeon, or any other hospital staff member. We can take the measures necessary for the families to receive sufficient information, but we need to keep the families motivated and remind them that they can return to these resources and use them efficiently to become more knowledgeable and, thus, engaged in their child’s care.

What motivates an individual to become involved in self-care? Do interactive resources have potential?  How might we facilitate that motivation and encourage individuals to become more knowledgeable and thus reap the benefits of deeper engagement in their own health care?

http://mobihealthnews.com/41086/study-interactive-tailored-web-content-may-improve-patient-health-knowledge/#more-41086
http://mobihealthnews.com/39725/cigna-helps-tests-efficacy-of-standalone-self-management-app-for-back-pain/

Guest posting by Sarah Bakhiet

A friend was recently raving about the medical television series “Grey’s Anatomy” and how it had saved her grade on an Immunology exam. The question that had earned her the two extra points needed for an A was on a fairly new practice in medicine called domino surgery, a concept she could only remember from an episode aired months prior to the exam but not from her notes. In her case, following Grey’s Anatomy for the past eleven seasons had finally provided her more than just drama-filled entertainment.

While popular medical shows such as Grey’s Anatomy, Scrubs, House, and ER are based on solving fascinating medical cases, viewers are attracted by the juicy story lines that aim to show doctors in a different light. With the millions of viewers that tune in each week to watch medical dramas, a question remains unanswered: in which ways do these shows shape the views and actions of patients regarding healthcare?

A persistent theme in our Medical Media Arts Lab has been the benefits of patient engagement in their own medical care. The role of technology and media in healthcare has been rapidly increasing, allowing patients to be more connected to their healthcare providers than ever before and to have access to vast amounts of medical information.  However, does fictional television play any role in promoting public health and producing patients that are interested in their own healthcare? One positive outcome of medical shows is that they portray the emotional challenges of being a physician. As a result, viewers are more likely to see doctors in a positive light, thus improving their satisfaction as patients themselves (Beck, 2014). Whether this could lead to patients who are more willing to seek healthcare and be involved with their physicians is yet to be determined.

In addition to improving viewer’s attitudes towards physicians, research has shown that health information may be remembered better when it is introduced through fictional media. A study published in the Human Communication Research journal found that college-age women were more likely to commit to using birth control regularly after watching a drama on teen pregnancy compared to women who simply watched a news report on teen pregnancy (O’Callaghan, 2010). By exposing viewers to positive health practices and increasing awareness on health risks in a memorable way, medical shows may have the power to promote public health to millions of people.

However, fictional medical series have been criticized for including medical inaccuracies and possibly dangerous treatments. For the sake of show ratings, medical shows are known to include life-threatening conditions much more often than less fatal conditions, such as diabetes or asthma. This creates a disproportional impression of the likelihood of developing dangerous medical conditions in real life. Although viewers are aware that shows are dramatized, they are still vulnerable to being influenced by inaccurate medical information that they are exposed to on a long-term basis. While medical shows have the potential to improve patient attitudes towards healthcare providers and to distribute valuable information on a large scale, the portrayal of faulty medical facts must first be removed in order to make a positive impact on viewers.

[1] http://www.theatlantic.com/health/archive/2014/08/healthcare-in-the-time-of-greys-anatomy/379087/
[2] http://content.time.com/time/health/article/0,8599,1978591-2,00.html