Medical Futures Lab

Guest posting by Kylie Balotin

A recent lecture by Tim Caulfield about the influence of celebrities on public health made me think of how pervasive health advice from celebrities is in the media.  Let’s face it – we all want to know how celebrities maintain their figures and looks, and we are fascinated by the diets and health habits they follow. However, this can be detrimental to our health, especially since scientific studies have shown that these diets are not usually beneficial. We need to make changes in order to promote healthy living in our society. As I mentioned in an earlier blog, scientists need to become more engaged and share their studies to make sure that correct information reaches the public, but this is not the only change that needs to occur. The education system and media must also change in order to educate people on how to live healthily.

Caulfield suggested an education reform that would teach students how to be more critical about what they read, especially when it pertains to celebrities’ advice. I agree that it’s important to teach young students to look for important information in articles, but the holes in our education run much deeper. During middle school and high school, I was only required to take 2 health classes that usually focused on scare tactics to ensure that students won’t smoke, drink, or get an STD. The focus was not on how to eat well or maintain a lifestyle to improve one’s overall health. We have to reform our health education curriculum to focus on these topics in order to provide the information young people need in order to enable them to live a healthy life.

In addition to changing our health education curriculum, we need to redefine the purpose of media such as magazines. It’s fun to read about what celebrities are doing and how they are maintaining their figures, but we need to make sure correct information is given. The media has a responsibility, not only to entertain, but also to provide the public with legitimate information. This is especially true for media targeting young populations such as Seventeen magazine. I remember being interested in celebrities’ diets and workout regimens in this magazine and being so disappointed when they didn’t seem to work for me. This can be detrimental to young people’s self-confidence and discourage them from trying other methods that could actually improve their well-being. Magazines should follow a style similar to the blog Celebrity Diagnosis, which reports on celebrities’ health advice and gives medical facts with regard to their recommendations. This blog is able to keep topics entertaining without losing the scientific facts that readers need to know, which should be the goal of the media, in general.

We should improve how health advice is communicated in our society by reforming the health education system, redefining the purpose of the media when it comes to celebrity health advice, and encouraging scientists to speak out about their studies on health and diets, especially since information is becoming so easy to spread on the Internet. It is critical for people to learn how to scrutinize magazine and media articles to determine if the information provided is accurate and coming from knowledgeable sources. If correct information can be distributed through these areas, people will better equipped to make good decisions regarding their health.

*Hyperlink to: http://www.celebritydiagnosis.com/

Guest posting by Andrew Dumit

In my last blog post, I identified some of the problems with the top three electronic hospital record systems, which basically boiled down to antiquated design and procedure that doesn’t do justice to the modern age. In this blog post, I will be looking at the top three reasons Epic continues to dominate the market in the face of both a poor system and better alternatives.

The first reason Epic maintains its grasp on the market is that Epic has been riding towards the top on the back of taxpayers; specifically, $35 billion dollars in healthcare subsidies that go to hospitals for the purpose of purchasing EHRs. [1] Because Epic was in a dominant position before these subsidies were created, it was in a perfect position to capture even more of the market as hospitals followed the lead of other hospitals and bought into what was already popular.

The second reason Epic continues to dominate the market is that Epic maintains a “closed” system. That is, it’s extremely difficult to providers to transfer records between Epic and other EHR software. This means that inter-hospital transfer of patient records is a struggle if both hospitals aren’t using Epic. What this translates into is that when a hospital without an EHR system is shopping around for one it’s in their best interest to go with Epic because transferring records will be simple. One might think that the government would put standards in place to ensure that hospitals are able to transfer records with ease independent of their EHR vendor, but unfortunately, this isn’t the case. In fact, even Epic’s CEO acknowledges the downside of this system and jokes that “the good thing about standards is that you have so many to choose from.”[2]

The third, and possibly most important reason Epic has such a firm grasp on the industry is due to the conservative culture of medicine.  In a conversation I had with Dr. V (@Dr_V)[3], an insightful doctor who also sees Epic as an antiquated technology, he explained how “the conservative culture of medicine has tended hold back the advancement of technology in hospitals.” Unfortunately, both the tech people at the hospitals and the doctors are often against new technologies for fear they may not work, which could endanger lives. Because of this, hospitals’ progress towards new technology is usually stagnant. This leads to the current situation where even though better solutions may be out there, hospitals aren’t willing to try them.

Due to the tax breaks, Epic’s “closed” system, and the conservative hospital culture, Epic has a tight grip on a huge market. And, in the end, Epic has won the battle for dominance in that market and it’s going to take an incredibly effective new software to remove them from their throne.

Guest posting by Emile Gleeson

When being diagnosed with an STD, there are many thoughts that run through a patient’s mind: Am I going to be okay? How did this happen? Who infected me? How could I have stopped this from happening? Is this treatable? How will this affect my life?. However, one of the most important questions is often not on this list: Who else could I have affected between contracting the STD and being diagnosed?. Of course, the patient is not to blame for thinking mainly of themselves in a time of personal crisis such as this, but then someone else must be responsible for thinking of the others that could also be infected. Luckily, the United States Centers for Disease Control and Prevention has a very clear process set up for this. The image below is a flowchart from the CDC’s website of the process of identifying and STD testing/counseling past partners of those recently diagnosed with an STD.

Although this flowchart may seem extremely complicated at first glance, it is actually a very logical, straightforward process. Essentially, as many potentially-affected partners as possible are identified and tested, and then the process repeats if they receive a positive test result. Seems easy, right? But look a little closer and you will see that there are many places to simply dropoff the flowchart: if the patient claims that they haven’t had any partners, if the patient refuses to name their partners, if the patient dies before naming partners, if the patient moves out of jurisdiction before naming partners, the list goes on. In an ideal world, every patient diagnosed with an STD would reveal the names of anyone else they may have infected/been infected from so that they could all get tested as well, but in reality, this simply doesn’t happen, which leaves many at-risk people completley unaware of the fact that they may very likely have been exposed to an STD. These people are then unable to take the necessary precautions and can continue spreading the STD until they finally show enough symptoms to be diagnosed as well.

Although this flowchart may make it seem that the CDC already has this process of informing those potentially at-risk of STDs figured out, the truth is that they don’t. They’ve done an excellent job setting up this system so far, but it still has farther to go. Now that this process is in place, we need to find a way to get more diagnosed individuals to reveal ALL of their partners. Until this happens, this will still be an incomplete system and people will still be going about their daily lives completely unaware that they were exposed to an STD.

Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5709a1.htm

Guest posting by Jesal Shah

In the upcoming decade, the incessant development of the Internet and the numerous interconnected technologies, known as the Internet of Things, invoke images like the one below of a futuristic, advanced technology world commonly portrayed in movies.

Future City Too (Image credit: RobertDBrown)

 However, as is typical, the pristine, ultramodern spaces’ perfection often masks the marginalized people and issues at the fringe of society. With the great vision involved in “Internet of Things” also arises the challenge of the Digital Divide, the gap between those who have resources for and access to information technology as well as the knowledge/skills to effectively employ it compared to those who do not.¹

The growing importance of technology in all spheres of life, from education to healthcare, places the Digital Divide at the forefront of the social equity discussion. The role of technology can accentuate the unmitigated inequalities rampant domestically and globally, further enabling those who are well-off and disadvantaging those already underserved. While by all means a great leap for society, there are serious concerns as to how equally the benefits will be shared.

In the U.S., the foundation for this inequality will be the exclusivity and expense involved in securing a high-speed internet connection that all these “things” rely on. This issue is extremely prominent due to the limited number of players in the cable industry as well as the largely laissez-faire approach by the government.² For example, a study in 2010 by the Department of Commerce highlighted that only 43% of households below $25,000 reported wired internet at home in contrast to 93% for households above $100,000.³

While a difficult battle, there are preventive tactics that can weaken this divide going forward. The need to incorporate technology in public education systems was emphasized as a long-term, intergenerational solution.^1,5 Increased government regulation in the U.S. could help lift the U.S. from its twelfth position, in terms of wired internet connection compared to other OECD countries, by improving affordability and access.³ Incentivizing information-communication technologies that directly involve and focus on underserved population groups, such as the poor and the disabled, will facilitate adoption and thus, help reduce the divide.Moreover, mobile phones can be leveraged as the gateway to greater technology use and accessibility amongst the low-income youth.⁴ Addressing the digital divide is no doubt a tremendous battle, but an extremely necessary one to lessen the eventual inequality. There are critical choices, like those mentioned above, that need to be made to fully promote a digital revolution throughout society and all its members.

Resources:

1. http://www.pewinternet.org/2014/05/14/internet-of-things/
2. http://www.nytimes.com/2011/12/04/opinion/sunday/internet-access-and-the-new-divide.html?pagewanted=all
3. http://www.ntia.doc.gov/press-release/2011/new-commerce-department-report-shows-broadband-adoption-rises-digital-divide-pers
4. http://blogs.worldbank.org/publicsphere/addressing-digital-divide
5. http://www.rand.org/news/press/2014/03/03.html

Guest posting by Andrew Ta

There are countless issues in healthcare. They range from the external, like patient engagement, to the internal, e.g. electronic health records.  From policy, i.e. the affordable care act and debates over universal health insurance, to personal, with concerns over self-image and internal motivation to care about one’s health and wellbeing. That last one, I believe, is top among them, and is, relative to the other issues, low hanging fruit with multiple potential solution and angles from which it can be tackled. Attempts at fixing it will undoubtedly spill over and positively affect other healthcare challenges and thus, it is my belief that such endeavors should be undertaken, in whatever form possible and as soon as possible.

The first step in approaching any problem is to look at previous solutions and research on the issue– a literature review. Already, to many, the process stalls; Coulter (2012) claims that popular belief thinks there is a lack of “published evidence on the likely effectiveness of patient engagement strategies.” However, she is able to compose a short review that walks through many such strategies, explaining the potential benefits and drawbacks of each.

Coulter establishes three goals these strategies attempt to accomplish:

1. Increase patient health literacy by encouraging them to read, understand, and act on health information
2. Encourage shared decision making, in which the patient works together with clinicians to select appropriate treatment and management options
3. Enable quality improvement by having patients provide feedback on health care processes and outcomes

The first two, health literacy and shared decision making, work together to empower patients. It’s a necessary step, especially given that, according to Barry (2012), medical advances, while improved health outcomes, distanced patients from their physicians. This distance has created a healthcare environment where patients and their families are excluded from key decisions and discussions, and thus remain uninformed about how their problems are being managed, or how to navigate the numerous care options available to them thanks to modern medicine.

Strategies to deal with these two issues include avoidance of typical education programs since traditional didactic methods have found to be ineffective. Instead, patients must feel encouraged and motivate themselves to determine their own goals for behavior change, instead of simply relying on or complying with a professional’s agenda. Coulter notes the imperativeness of making progress towards these goals, emphasizing how inactive patients, by deferring to clinicians, continue to remain inactive in a sort of negative feedback loop.  Tools by which to encourage patients that have previously shown effectiveness include consultation prompt sheets and patient information material, printed and electronic, pre-operative and pre-discharge. Implementation such material is a low cost endeavor and does not require massive policy-level changes, and that material can be fine-tuned under the aforementioned third goal.

That third goal, of patients providing feedback, is key in the critique and revision process that can help in developing workable, effective strategies. Coulter states that although gathering such feedback is required, it is not sufficient; action must be taken on it. Such a model is described in the HIV treatment process by Mugavero (2012), who also provides frameworks and an engagement continuum, examples of how continuous feedback can clarify direction and help maintain continuous improvement.

A proposed feedback loop for identifying where to improve patient care engagement (Mugavero, 2012). TLC+ refers to testing, linkage to care, plus anti-retroviral therapy.

The continuum engagement in care, as established by the Health Resources and Services Administration (Mugavero, 2012).

Mugavero also discusses various model programs and systems use to improve patient engagement, although in relation to HIV. Some factors he lights in an ideal model include culturally appropriate services, a climate of acceptance for all individuals, and strong patient-provider relationship. He looks at case management intervention, in which newly diagnosed patients are linked up with case managers who can give them more personal attention, a navigation model, which pairs up peers with similar cultural and socio-economic background to help navigate the healthcare system, and an orientation model, where trained staff would meet individually with patients shortly after initial contact to identify and troubleshoot anticipated barriers to their care. The models he covers require much larger infrastructure, but that should not be an excuse from working towards what can be accomplished and reevaluating goals and progress measures as they come up.

With the host of suggested models and solutions out there, and with the amount of framework and research, it’s time to move into the realm of implementation.

References
Barry, M. J., and S. Edgman-Levitan. “Shared Decision Making–Pinnacle of Patient-Centered Care.” N Engl J Med 366.9 (2012): 780-1. Print.
Coulter, A. “Patient Engagement–What Works?” J Ambul Care Manage 35.2 (2012): 80-9. Print.
Mugavero, M. J., W. E. Norton, and M. S. Saag. “Health Care System and Policy Factors Influencing Engagement in Hiv Medical Care: Piecing Together the Fragments of a Fractured Health Care Delivery System.” Clin Infect Dis 52 Suppl 2 (2011): S238-46. Print.