Medical Futures Lab

Guest posting by Alisa Momin

The problem my group and I tackled this semester concerned physician communication of a diagnosis of congenital heart disease to the patient’s families. As part of our solution to directly improve communication (which would in turn improve the information retention for the families), we included a “feedback form” which would measure the retention of the families while also giving them a chance to rate their physician in how well he/she communicated the diagnosis to them. However, a concern that came up was whether it would seem insulting or insensitive to ask families to take this “exam” while they were still emotionally overwhelmed with the diagnosis. I’ve created an infographic about feedback forms and some suggestions in how to mitigate the concerns that were brought up.

Sources:
(Feedback form example) https://www.mercyhospital.org.nz/patient-information/patient-feedback/complaints
(Psychosocial assessment) http://www.wisegeekhealth.com/what-is-a-psychosocial-assessment.htm

Guest posting by Charles Ho

My group for the Medical Media course has developed a series of short videos that help summarize important things parents need to know to ensure their child can live a successful life with a newly transplanted liver. A quick YouTube search shows that other hospitals have also developed vidoes which cover similar material. These videos were narrated by healthcare professionals, such as a physician or nurse.

Our video is different in that we had a child’s caretaker (mother) provide the information and allow the caretaker to add her personal insights and experiences. These patient-centric advices can be helpful for new patients, particularly when managing everyday tasks that perhaps may not be part of a discussion with a physician. This re-iterates a common theme discussed in the Medical Media course about the importance of inter-patient conversations, such as support groups and message boards.

In the following infographic I created, I depict a few examples where input from another patient’s experience can help enrich a caretaker’s understanding of what it takes to provide safe care to their child.

Guest posting by David Lam

We live in an age where eHealth resources are growing in acceptability, accessibility, and usability. To capitalize on rising demand, more and more initiatives are being started to equip patients with the tools to take control of their own healthcare. In fact, the amount of options to choose from is almost overwhelming. When searching for ‘personal health records’ on the iPhone’s App Store, there are more than a hundred results! This article will explore the need for PHRs and factors to consider in choosing a personal health record software.

What is a PHR?
 Before we explore options for PHRs, we begin by clarifying the definition of a personal health record. PHRreviews [1] defines a personal health record as a “consolidated medical record of an individual, stored in electronic format.” Dissected, it has two key features: PHRs are a collection of medical information, and they are electronic. They allow its users to compile their medical records, insurance information, illness histories, and lab reports in one place. What makes them distinct from electric health records is that the PHR belongs to the patient rather than physicians and other medical caregivers.

Why do I need one?
 According to HealthIT.gov [2], a personal health record can improve quality of care by shifting the central hub of medical records from the primary care physician to the patient. You, the patient, have a greater incentive to maintain up-to-date information on your record, because ultimately it is your health at stake. Furthermore, personalized health records allow for improved patient self-efficacy, more organized health records, and greater storage and safety of health records [3].

Patient self-efficacy
A patient can take control of their health in a variety of ways. By actively tracking their health, patients gain a tool to interactively learn about and understand their conditions. Furthermore, many of today’s PHR software contain tools for users to set goals for their health and keep themselves accountable. Finally, patients are able to refer to their medical information, prescriptions, and lab tests at their own convenience without having to wait on a busy doctor’s office.

Organized health records
Medical providers are not as incentivized as a patient to keep their records organized, accurate, and secure. Therefore, it is up to the patient to ensure that their personal health records are up-to-date and accessible! PHR software allow for tracking of routine check-ups, can be transferred between medical providers and institutions without cumbersome red tape, and are accessible even when traveling.

Storage and safety
An electronic PHR has the benefit of security and the ability to be backed up. In the event of a natural disaster or tragic occurrence, a patient’s paper-based medical records run the risk of being lost with no opportunity for recovery. They can also be backed up to multiple locations, in the case that one system fails.

How do I choose a PHR?                             
Like any new technological phenomenon, the standards of PHR software are still evolving [4]. This section will give a basic overview of factors to consider in selecting a personal health record system.

Features
 Can you control the content of your PHR? This includes adding, deleting, and editing your medical history. Furthermore, you should be able to consensually share your records with medical providers [4].

Integration
The whole point of a personal health record is to allow you, the patient, to take control of your healthcare! If the software you choose is not user-friendly, it may impact your ability and motivation to continue participating in your health through PHRs.

Security and Reliability
 PHRs contain sensitive information that you may not want revealed to the rest of the world. Is your PHR software secure, and does the company have a trustworthy reputation? You would not want your information shared or sold without your permission [4]. Furthermore, you would also not enjoy an unreliable software that is inaccessible when you need it.

In Summary
 Do your research before selecting a PHR software. Depending on your choice, it can be an empowering tool or a burdensome task to maintain. Your PHR is all about you and your ability to navigate your own healthcare. Finding the perfect PHR can lead to a better healthcare experience!

 [1] http://www.phrreviews.com/what-is-a-phr
[2] http://www.healthit.gov/patients-families/health-it-and-health-care-quality
[3] http://www.phrreviews.com/why-do-i-need-a-phr
[4] http://www.phrreviews.com/how-to-choose-a-phr
[5] http://www.healthit.gov/patients-families/blue-button/about-blue-button

Guest posting by Rachel Marren

On April 10, the Texas Medical Board voted in favor of measures that would limit telemedicine in the state of Texas. In order for a physician to use telemedicine to communicate with the patient, the physician must have either (1) previously examined the patient in person, or (2) made a face-to-face telemedical diagnosis in which a different medical professional was physically with the patient taking vital signs and performing a physical examination.

The medical community is very divided on the issue of telemedicine and its role in the future of healthcare. Significant points can be raised for and against each topic:

 Pros:

Increased Access to Healthcare

For a number of people, telemedicine would allow them to access quality healthcare when they otherwise would not be able to. People living in rural areas would be able to speak with a physician without having to drive hundreds of miles. Those who are housebound or afraid of doctors’ offices would be able to get treatment from their own homes. People whose jobs require frequent travel or otherwise don’t allow for a potentially lengthy daytime doctor’s visit would be able to obtain care 24/7 from wherever they are located. Additionally, telemedicine would allow for patients to choose a physician based on the quality of care he or she provides instead of simply proximity, and allow physicians in different locations to communicate with each other about an individual case.

Decreased Cost

A number of studies have indicated that telehealth technologies can decrease the cost of healthcare. Telemedicine can reduce the need for patients to come into the doctors’ office for basic check-ins or medication refills. It can also ultimately reduce hospitalizations for patients with chronic illnesses by allowing patients to update medical professionals on relevant signs and symptoms. A consultation from Teladoc, the largest telehealth provider in the country, costs the patient less than $40.

Reduced Spread of Infection

Doctors’ offices and hospitals are often hotbeds of infectious disease, with patients regularly infecting each other and their healthcare providers. Telemedicine would allow sick patients to receive care without spreading their infections to others or putting themselves at risk for additional infections.

 Cons:

Technical Challenges

Frequent issues with sound and image quality occur when using video chat software, which would be particularly problematic when trying to make a diagnosis. Additionally, underserved populations who would benefit the most from telehealth services are also the most likely to lack internet access or devices that allow for video chatting.

Loss of the Patient-Doctor Relationship

Most telehealth companies work by matching a patient in need with whatever physician is available, preventing patients from forming long-term relationships with their doctors. This means that doctors will be less familiar with their patients’ medical histories and also potentially feel less accountability for their patients’ well being.

Inability to Perform Tests

Having the doctor and patient isolated means that the physician will not be able to physically able to examine the patient, record vital signs, collect blood or urine for testing, or perform rapid tests for common conditions like Strep throat or Mononucleosis. This means that for many conditions, an accurate diagnosis cannot be made remotely.

There are clearly major potential benefits to implementing telehealth but significant concerns to be addressed. The Texas Medical Board’s latest rules about telemedicine are a step in the wrong direction, as they prohibit most practical applications of telemedical care instead of recognizing potential benefits and seeking to minimize drawbacks. Additionally, to my knowledge, there have been no significant, relevant data to support the Board’s decision.

The ruling by the Texas Medical Board reminds me of responses to the rise of Uber and other similar companies. Taxi companies and various government agencies tried (and, in some cases, are still trying) to fight their expansion. But Uber, which is often the better option for the consumer, is still growing rapidly in the transportation sector. Maybe telemedicine can combat these regulations and do the same for healthcare.

Sources:
http://www.nytimes.com/2015/04/11/us/texas-medical-panel-votes-to-limit-telemedicine-practices-in-state.html
http://www.tmb.state.tx.us/dl/DAD89645-F81F-CF51-6FF8-D0E20891625A
http://www.teladoc.com/
http://content.healthaffairs.org/content/33/2/194.full.html

Guest posting by Alisa Momin

Background: ¹A Harris Poll survey of 955 health providers (including hospitalists, primary care physicians, specialists, hospital administrators, managers, etc.) showed that 30% were dissatisfied with the technology used at their institutions to contact each other and patients. The technology currently used causes confusion in whom to contact in medical situations and how to contact them. Overall, the risks are considerably significant and much time is wasted on all ends. As a result, I decided to create an infographic aimed at making healthcare organizations aware of the problem and giving them a way to attack it in order to find the best solution for them.

Source:
¹http://mobihealthnews.com/42196/survey-30-percent-of-medical-professionals-dissatisfied-with-communication-tech/#more-42196