Technology | Medical Futures Lab

Mar 17 2014

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 15 2014

Communication, Culture, Technology

The Opportunity of a Lifetime

Since the advent of the internet the global economy has been evolving and adapting dramatically to keep up with increasing technological innovation in a shrinking world. A recent article published in The Economist discusses the reasons for the current boom in digital startups and not only its economical but cultural repercussions.

Much like the Cambrian Explosion which led to the vast proliferation of life on Earth, the current explosion in internet startups has created a variety of services and products that penetrate a multitude of markets and user bases. Cheap technologies and ubiquitous online services and resources are the main reasons for this boom in the internet business. These startups also benefit from being able to move overseas with ease and access a larger audience due to the extensive reach of the internet around the world.

The author of the article compares this current boom with that of the dotcom era in that most of the newly released products and services are simply iterations of existing ones. This leads to a high rate of failure much like what many dotcom businesses faced in the late 90’s. However, the author does point out that today’s boom has much more solid foundations with more dependable platforms and better tools. This leads us to believe that this current economic episode will continue for years to come.

This article also delves into the cultural implications of this phenomenon. Since the recession millennials have preferred less conventional jobs and have looked to be more entrepreneurial than the previous generation of young professionals. The growing business of internet startups is very attractive considering the relatively low startup costs to enter the industry. There is also huge potential to make it big due to the abundance of other programs and services offered online and free of charge that can be used to distribute products and market them globally.

Since the article does not argue how to improve and sustain this boom in economic growth I offer my suggestions here. This explosion in digital startups would be even more fruitful if there were fewer regulations on access to internet tools and databases. Why not let loose the reins of this economic dynamo and sustain this boom to see where it takes us and how much good it can do in the spaces of health and government? Especially when one considers the growth in mobile technologies over the years the possibilities for benefit in these industries is limitless. However, in order to ensure real improvements to current systems true visionaries not hype filled get-rich-quick firms are needed. If visionaries are squeezed out of the market by spammers and hollow products consumers will lose interest and abandon the industry. The bubble will burst much like the dotcom bubble of the late 90’s, allowing many rewarding opportunities to drift into afterthought.

Mar 08 2014

Communication, Electronic Medical Record, Medicine, Technology

Through the Looking Google Glass

As I was scanning my twitter feed this last week I came across an article discussing one of Google’s newest technology accessories, Google Glass. Google glass is essentially a lightweight pair of eyeglasses that works like a headset equipped with camera, GPS, Bluetooth, microphone, and viewfinder. This technology allows the wearer to connect to smartphones, allowing them to search for and access information online and to use the camera, GPS, etc. all hands-free.

Google Glass: What It Does

With all this information less than a click away and viewable without having to carry a physical device I wondered, what possibilities could this technology have in the world of medicine?

I decided to look at how Google Glass was currently being used in the medical field. I found that this technology provides a means to change the ways the doctors work and communicate both with each other and with patients.

In class we’ve discussed how the internet has come to change how information is spread throughout the medical community, from simple avenues like the increased access to information to more creative paths like the live tweeting of surgeries for the public to access. Technologies like Google Glass make these information sharing “innovations” of today look small in comparison.

A perfect example of this can be seen in an article that discusses a surgery performed by Dr. Pedro Guillen earlier this year. Dr. Guillen was able to perform a highly complex surgery while wearing Google Glass, allowing the surgery to be streamed around the world in real-time. This feature allowed him to serve as an interactive teaching tool to university students and physicians all over the world, opening non-traditional avenues to improve medical education around the globe. The technology, as reviewed by Guillen, also revolutionized the way he performed surgery. The split-screen display allowed him to maximize access to valuable information such as images of the knee, notes, or past surgery videos without having to lift his eyes from the table. While all of these features were impressive one that stood out the most was in the off chance that an error occurred, Dr. Guillen possessed the ability to rewind the tape to review the surgery while standing at the table. This feature can serve to drastically change the way we approach and view medical error in the future.

Video of Dr. Guillen’s Surgery

I also found an account of how Google Glass is working to improve doctor-patient interaction. One company, IOS Health Systems, has developed a native EHR app that can be used with Google Glass. This means that doctors could access patient information such as medical history, vitals, etc. and display it into the heads-up display while talking to the patient. This opens the possibility for doctors to reduce reference to a stationary screen and engage in more direct conversation with the patient, working to improve the doctor-patient interaction.

As I reviewed the literature I marveled at the possible impacts that technology like Google Glass could have on the practice of medicine and considered the role that Google Glass could play in our design setting. In the cardiovascular ICU physicians are required to both consolidate and communicate vast quantities of data into a simple and informative patient narrative and plan of care. In the current system often hand copy detailed data from the patient EHR onto sheets of paper. This practice, while necessary within the system, has created a sort of presentation “crutch,” where fellows will focus and rely on the data that they have spent so much time collecting rather than giving a cohesive patient narrative. Technology like Google Glass can work to eliminate this crutch. By allowing for the information to be readily available and accessible, physicians can focus more on preparing a patient narrative and care plan for presentation during rounds.

While Google Glass offers many positive aspects for the world of medicine it also holds many cautionary aspects. With the adoption of any new technology there come many unanswered questions. How will the ability to stream in real-time at any moment change privacy? Will the knowledge that your doctor is viewing information that you cant see change the way that doctors and patients interact? The positive impacts that utilizing revolutionary technology in medicine can have are great, but as always we must move carefully as we move towards the future.

Tagged EHR, medicine, technology

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.

Medical Futures Lab

Category Archives: Technology

Can Telehealth and Integrative Medicine Coexist?

The Opportunity of a Lifetime

Through the Looking Google Glass

There Are No Dumb Questions

Walking a Mile in a Patient’s Shoes

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