Health | Medical Futures Lab

Mar 22 2014

Design, Electronic Medical Record, Health

“Healthbook” App for iOS 8

According to rumors, the newest version of the Apple OS system, iOS 8, will include an Apple-designed app called “Healthbook” that will be a “preinstalled app that can track data points including a user’s blood pressure, hydration, heart rate and potentially other statistics like glucose levels. It could also remind users to take medications at certain times during the day.” According to the description and concept art, Healthbook intends to be an all-in-one resource for all kinds of self-tracking, including dietary monitoring, fitness, filling prescription. It is not clear whether it intends to self-diagnose any diseases.

Concept images for the “Healthbook” iOS App, courtesy of MacRumors

iOS 8 is expected to be announced at Apple’s annual World Wide Developers Conference in June 2014. This means that Healthbook could become available as early as this fall. It is also predicted that the Healthbook App will also be integrated with the upcoming iWatch.

What will having a preinstalled application on such an widely accessible device like the iPhone mean for the healthcare movement, especially self-trackers? Although the app stores contains hundreds of thousands of health-related applications, will having an official Apple-designed healthcare mobile application increase a user’s proclivity to become an e-patient, self-tracker, or be more aware of their health? How will Healthbook take into consideration the major issues regarding self-tracking applications such as privacy and user control?

And what about Apple’s design strategy? What features or GUI aspects will differentiate it from other self-tracking applications in the App Store and on Android? Reports claim it will use a similar card-based design strategy similar to Passbook, another Apple-developed application that keeps all your forms of payment, such as credit cards, in one place and was meant to serve as a virtual wallet of sorts. Will having all your health data in one place be seen as efficient and beneficial, or dangerous in regards to privacy?

My guess? Healthbook will receive a lot of early hype and attention, especially as the release of iOS 8 draws closer, and upon official release many curious users and e-patients galore will use the application in its early stages. However, unless Healthbook provides some sort of dynamic, engaging experience beyond being a basic self-tracker application, users who are were not originally intrinsically motivated to monitor their health will become bored by it and eventually stop using it. As we have learned, most self-trackers are not those who are in need of medical attention, but those who already have an interest in maintaining their health, and unless Apple brings something new to the table with Healthbook, the average user will see Healthbook not as a life-saving tool, but a new toy or game, and will quickly become bored once it loses its novelty.

Here’s two suggestions for how Apple can distinguish Healthbook from its competitors and engage the interests of users who have not had previous interest in self-tracking their health lifestyles:

For the dietary/calorie tracker, add fun facts to inform and put their diet into perspective. For example, if after a run a user burns 200 calories, Healthbook can joke “You just burned off a bag of chips”.
Have a goal-setting feature that includes specific suggestions on how to achieve that goal. For example, if a user wanted to lose 10 pounds, Healthbook could not only suggest how many miles they should run a week, but also suggest dietary restrictions and specific workout routines the user can engage in to create a total body regime that will help reach the user’s goal.

Whether these features or something even better (as Apple’s forte is coming up with what the user needs before they even need it) will be included in the Healthbook application remains to be seen. I am personally very glad Apple is trying to create an accessible and beneficial device that could provide better awareness of personal health. Apple has reinvented the personal computer, music, cellphone, and tablet industries, and I hope it can achieve the same success in revolutionizing the mobile healthcare space.

Mar 17 2014

1 Comment

Communication, e-patient, Health, Humanity, Medicine, Technology

Can Telehealth and Integrative Medicine Coexist?

Telehealth advocates the use of electronic services to support patient care, education, and monitoring. Proponents of telehealth acclaim its potential to reduce healthcare costs and to increase patient satisfaction. Implementing telehealth, however, would require deconstructing the traditional healthcare encounter. Patients and physicians would have to redefine their expectations for one another, and some argue that telehealth belittles the patient-physician relationship.

Photo Credit: firsthealth.org

Nevertheless, there are clear advantages for telehealth. Telehealth can serve as a means of supporting traditional healthcare. When distance separates participants, patients can use electronics to directly contact their physicians. They can receive direct clinical service miles away from the doctor’s office via virtual visits. If the patient’s health records, medical images, and medication lists are already compiled online, such virtual visits can serve as a timely and efficient way to improve patient care.

Additionally, telehealth allows the early detection of irregular or unfavorable body rhythms. For instance, early detection of irregular heart and brain rhythms could prevent potential heart attacks and seizures. In this respect, telehealth plays a role in preventive medicine and contributes to better health outcomes.

Schwamm (2014) gave an example that cellphone cameras could be used to photograph rashes and skin lesions. This would allow dermatologists to diagnose and treat their patients without having to physically meet. While this form of treatment is fast and efficient, it seems to be in stark contrast with integrative medicine.

Photo Credit: mc.vanderbilt.edu

Growing in favor since the 1990s, integrative medicine emphasizes a holistic approach to medicine with a focus on health and the physician-patient relationship. With this method of telehealth, the physician-patient relationship is almost nonexistent, and patients are reduced to their skin problems. Furthermore, diagnosis via photograph is hardly holistic; rashes and skin lesions may be signs of a multitude of health problems. It is unlikely that only the dermis is affected, and it would be erroneous to assume that the organ systems of the body work independently.

In Engel (1977)’s seminal article, he claimed the need for a new medical model—namely, the biopsychosocial model. This model posits that biological, psychological, and social factors all play a significant role in the context of disease and illness. Integrative medicine relies on this model because it focuses on the whole body. Therefore, it seems to be opponent to this localized method of diagnosis.

Photo Credit: theemotionmachine.com

While telehealth has its greatest benefits in early detection, it still has some outstanding limitations. In accordance with the biopsychosocial model, the physician also plays a role in helping the patient cope with stress and vulnerability. On a standardized stress scale, finding out that you are HIV+ scores a 99/100. Given current technological advances, it is possible to get tested for HIV without ever having to actually see a doctor; however, this is a questionable idea. Beyond biomedical treatment, the physician also provides intimate psychological and social support.

Currently, telehealth and integrative medicine can coexist; however, telehealth has its limitations. While it should complement and add value to existing medical care, it should not substitute healthcare completely.

Mar 06 2014

Communication, e-patient, Health, Medicine, Technology

There Are No Dumb Questions

“There are no dumb questions.” We’ve all heard this before, and as a result, we ask questions for all sorts of reasons. We ask questions because we want to know the answer or because we want to prompt someone else to get to the answer. We ask questions to impress our professors or classmates, to stand alone rhetorically, and to fill awkward silences. We ask questions constantly to other people, to anyone who’s listening, and even to ourselves (don’t pretend you don’t talk to yourself too).

So, why is it that we suddenly clam up in front of our doctors?

Many patients suffer from “white-coat silence,” or “a reluctance to vocalize questions to physicians.” At first this might sound ridiculous. Isn’t that your doctor’s job? To be the medical expert who answers your questions? Why wouldn’t you talk to him/her? While for many people this might seem obvious, for others, the doctor’s office is a strange, scary place where it’s a lot safer to just listen and let the doctor tell you what to do.

However, communication is key to successful patient-doctor interactions. In fact, a study found that the most powerful predictor of positive physician communication is good patient communication, which—surprise, surprise—includes the tendency of patients to ask questions. By asking a question, patients catalyze a cycle of patient-doctor communication in which they provide an opportunity for physicians to share information and give support. Not only does this increase a patient’s knowledge about their own health, but it also makes them feel more comfortable in the clinical setting, making for a better patient-doctor relationship.

So, why don’t patients talk to their doctors?

Intimidation, anxiety, and even impatience are just a few reasons. However, a study published in 2007 found that low health literacy is one of the most influential factors negatively affecting patient communication. Patients with low health literacy ask fewer questions, are less likely to use medical terminology, and ask less meaningful questions (e.g. “What is the name of that medicine?” rather than “Will I be in danger if I increase my dosage?”). Conversations with your doctor are much less beneficial if you don’t know what to say. With such a short amount of time per visit, low-literacy results in missed opportunities for patients to become more engaged and informed about their own health during their doctor’s appointment. Sometimes, patients who are aware of their low health literacy are too embarrassed to ask questions at all.

So, how is this being addressed?

The Agency for Healthcare Research and Quality (AHRQ) released a toolkit for improving health literacy. One of the guidelines was to “Encourage Questions.” Patients with low health literacy can benefit more from their visits if they know what questions to ask. By empowering these patients to see the benefits of speaking up, they can slowly learn that there are no dumb questions and learn to effectively communicate with their doctors. Over time, this increased communication can lead to the gathering of more health information, improved health literacy, better communication, and ultimately better health outcomes.

So, what can we do about this?

AHRQ also published a question guide that can be utilized by all patients, as everyone can stand to benefit from communicating with their doctor. Any MMAL group involved in patient-doctor interactions should keep patient-initiated solutions as an important consideration. Patient involvement indicates to the doctor that the patient is interested and engaged in their own health. It also helps battle the ‘intimidation’ factor in white-coat silence by empowering patients and giving them some authority. In developing our media solutions, the ‘not-dumb’ question we should ask is “How will this help catalyze patient-doctor communication?” because active patients make for happy doctors, which leads to better patient care.

Judson, T. J., Detsky, A. S., & Press, M. J. (2013). Encouraging patients to ask questions: How to overcome “white-coat silence”. Journal of the American Medical Association, 309(22), 2325–2326

Street RL Jr, Gordon H, Haidet P. Physicians’ communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor? Soc Sci Med. 2007;65 (3):586–598.

Katz MG , Jacobson TA , Veledar E , Kripalani S . Patient literacy and question-asking behavior during the medical encounter: a mixed-methods analysis . J Gen Intern Med . 2007 Jun;22(6):782–786 Epub 2007 Apr 12.

Feb 28 2014

Communication, Health, Medicine, Technology

Walking a Mile in a Patient’s Shoes

This past week, I had an appointment with a specialist in the Medical Center. I arrived to my appointment a few minutes ahead of time only to walk into a waiting room crammed full of people. I have never in my life seen a waiting room that full! I hoped that all the people in the waiting room were families of the patients not actual patients as I waited for the nurse to call my name. My hope was not realized, and an hour later I finally was called back to an exam room.

source: www.greatcanadianjokebook.com

At this point, I was already extremely frustrated and I honestly wished I had canceled the appointment.

When the nurse checked my vital signs, I didn’t even bother to ask what my blood pressure was. When the doctor asked me if I had any other questions, I quickly replied “no.” I didn’t event make an effort to think of any of my concerns. All I wanted to do was to leave. I had quickly transformed into an unengaged patient, just like the patient my team is trying to help.

It made me wonder if new innovations in technology could streamline this process. The main source of my lack of engagement was due to my frustration that built up while I was in the waiting room. My appointment had been a check-up, and there was no reason why I physically had to be in the doctor’s office. Everything could have been done from my home through a platform like Skype (although more secure.) My vital signs could have been recorded by the various mobile applications available and then sent to my doctor. A new smartphone app allows you to record your heart rate using the flash on your camera, and you can buy blood pressure cuffs and readers that connect directly to your smartphone.

This new trend in healthcare is called telemedicine, which means providing healthcare at a distance. Using telemedicine, a patient can have a virtual appointment with their doctor through a webcam. Telemedicine could prove extremely useful for situations such as check-up appointments, where there is no need for a patient to physically be in the doctor’s office. It also might be valuable for psychiatric care or primary care in rural locations. Telemedicine could provide a way for patients to feel less frustrated at their doctor’s appointments. Patients would no longer have to waste time driving to and waiting at their doctor’s appointment. Their appointment would be in the comfort of their homes, which could lead patients to ask more questions and become further involved in their treatment plans. While telemedicine won’t work for every appointment, it is becoming a increasingly feasible and attractive option for several different facets of healthcare.

Feb 28 2014

Communication, Culture, e-patient, Health, Story, Technology

Self Help App for Anxiety

SAM App Review

Recommended by: http://it-is-a-3-patch-problem.tumblr.com/post/57732674295/thought-this-may-be-useful-for-a-few-people-on

Medical Futures Lab

Category Archives: Health

“Healthbook” App for iOS 8

Can Telehealth and Integrative Medicine Coexist?

There Are No Dumb Questions

Walking a Mile in a Patient’s Shoes

Self Help App for Anxiety

Follow Medical Futures Lab