Medical Futures Lab

Source: Wikipedia

In order to tackle the problem of low clinical trial accrual, my group has decided to work on designing the general solution of a Clinical Trials Navigator (CTN). While I am satisfied with this as a good general solution, there are other specific solutions that could be beneficial. Especially being a computer science major who loves to build software, I can’t help but toy with these other solutions. So just for fun, I will change gears and write a slightly more technical blog post that describes the architecture for a solution that I would like to implement in the future (when I have time!).

The idea is a service that sends patients email digests for new trials that are relevant to them. A digest contains a simple list of potential clinical trials that the patient might qualify for, and is interested in. The flow of the application is described below.

Basic Architecture

The use case for a user is that they register online for the digest service and choose the corresponding types of trials that they would be interested in. After this simple registration, the user does not have to initiate any more contact with the service. From the user’s perspective, digests with aggregated clinical trials information will come in at a fairly steady pace. This saves the patient from the headache of sifting through trials themselves.

But how does the user receive this neat packaged digest of relevant clinical trials? The solution I have thought up is simple:

1. The listing of all clinical trials on clinicaltrials.gov is freely available and is updated every day. The end goal is to detect new trials, so what we will do is index all current trials, and then check every day to see if there are non-indexed trials (which means they are new).

2. When new trials are added, we check against our database of registered users to check whether or not the trials would be relevant. If they would be, then we make a note to include the trial in the user’s next digest.

3. Once a digest has reached a tipping point (a point where any more trials would clutter the digest) or a time of inactivity (below the tipping point, but there are trials that are getting stale), then we send the user the email digest.

4. In the email the user has the option to unsubscribe themselves from the digest.

Although this solution does not help patients who are not already engaged patients, I hope that it might help those who are not against the idea of trials, but have not the energy, time, or knowledge to sift through trials online.

Many of the applications that are being developed as part of this class have run into the same dilemma: how can we have doctors communicate with patients in a HIPAA compliant and secure environment? There are secure doctor networks like Doximity, and in my last post I mentioned an idea for a secure patient doctor portal based on Doximity.

Well here’s another option. Cyber Dust.

Cyber Dust (http://cyberdust.com/) is a Mark Cuban backed startup that is described as “Whatsapp meets Snapchat”. The mobile application allows members to communicate with one another in a secure environment in which all messages are automatically and permanently erased after 30 seconds.

The impetus for this technology has absolutely nothing to do with medicine. Cuban talks about situations like Alex Rodriguez’s incriminating text messages that were part of the case leading to his history making MLB ban; private discussions he wanted to have with investors without worrying about the SEC prying; and confidential discussions between clients and lawyers.

With current text messaging however that just isn’t a reality; cyber dust allows individuals to communicate without leaving a digital footprint.

The common denominator here is that all of these conversations were supposed to be confidential, which is exactly what communication between doctors and patients is supposed to be. So then could Cyber Dust be modified in a way that facilitates secure patient doctor communication?

I see a lot of promise in the idea. But there is also a risk. Without a digital footprint it could be hard to hold doctors accountable.

I guess the real question for patients, doctors, Cyber Dust, and Mr. Cuban is do the benefits outweigh the risks? 

I recently had a conversation with my friend who is a first year medical student and I made a comment about his new iPad. He began to tell me that his medical school requires that every new student purchase an iPad, a policy that is becoming a norm at medical schools around the nation. While most hospitals don’t allow electronic medical records to be viewed on an iPad, there are many useful mobile applications for medical students or doctors to use when they are making rounds or studying. Here are three that are especially popular or newly created:

source: techvibes.com

• Epocrates- Probably the most popular and well-known app used by medical professionals. It allows medical professionals to look up most drugs, and view the correct dosage amounts for children and adults. It also allows shows side effects and harmful interactions with other drugs. It has been used to replace the physician’s desk reference book.
• Touch Surgery- This is a relatively new app designed to help surgeons in training to learn the steps of an operation. It was created to help make up for the hours of surgical residents being cut, which means less time in the operating room practicing needed skills. The app is also designed to improve patient safety and to give medical students and surgical residents a boost of confidence before trying the procedure on a patient. 
• Up To Date- This app has an abundance of reference information that physicians can look up when trying to make a treatment decision. It is often used to look up innovative treatment approaches that physicians report have been successful in the past, when normal treatment options aren’t working.

These new apps, especially Epocrates and Up To Date, have the potential to make medical training less about memorizing thousands of pieces information and instead place a larger emphasis on understanding. Instead of essentially having medical training turn physician’s into walking computers, physicians now have the ability to carry around unlimited information with them on a tablet.

The increasing use of mobile apps is inevitable in the future of medical care, so the question becomes to what extent should physicians rely on these applications. A trusting patient-physician relationship often stems from the belief that our doctor has much more knowledge about our condition then us, but perhaps this view is becoming outdated. As information is readily available online, it is reasonable to assume that a patient could be more informed about their condition then their doctor. Medical training needs to change to accommodate this shifting relationship, with a greater emphasis on understanding a patient’s needs and trying to incorporate them into a treatment plan. It needs to not only teach physicians information, but also how to find needed information. However, we must stay wary of becoming too dependent on these applications, and not focus our time looking at a screen instead of the patient.