Feb 15 2015
Health Gallery

Technology and Measles: A Fatal Combination?

Guest post by Pooja Kapadia

 

Unless you have been living under a rock for the last week, you would have at least heard about the latest healthcare debate: to vaccinate or to not vaccinate a child against measles? What is interesting is that in 2000, the CDC declared that measles were officially eradicated from the US. This was after decades of vaccination promotion programs from the 1960s.  However, this preventable, deadly disease has again resurfaced.  According to the latest count 94 people are infected in the US, in over 8 states. This recent spread serves to remind us of the unintentional consequences of prolonged exposure to technology.

Technology has been touted for years as being the reason for new treatments and improvements in medicine. In fact, it is technology that enabled measles to be eradicated in the US. Before the creation of this vaccine, the CDC estimates that around 4 million Americans suffered from measles each year, leading to 500 deaths per year. With this vaccine, Americans recently lived in a world where the disease was but a distant memory, with most physicians with never having to treat, much less deal with the disease.  Other infectious diseases that also threatened infant and children lives, such as whopping cough and polio have also become less common due to advancements in medical technology.

These medical advances seemed to have jaded us to the fact that early childhood and infancy are dangerous times. We take for granted the importance that vaccinations have in not only improving, but also in saving lives. Melinda Gates gave a beautiful statement on this, stating, “ Women in the developing world know the power of [vaccines]. They will walk 10 kilometers in the heat with their child and line up to get a vaccine, because they have seen death. [Americans have] forgotten what measles deaths look like”.

Americans have become immune to advances in medical technology. Many people now believe that “too much” medical intervention is more dangerous then doing nothing at all. These people forget that not too long ago, many children commonly died from infectious diseases. According to HRSA, “The mortality rate for children aged 1-4 years declined from 1,418.8 deaths per 100,000 population in 1907 to 28.6 in 2007”. People seem to easily ignore the impact that medical interventions (aka vaccines) had in reducing these numbers.

I am not anti-technology. I think technology has obviously created remarkable advancements in medicine. I also think it has unintentionally benefitted health care, by creating an environment where people can readily share ideas and information about health and medicine. People can now join support groups for a number of diseases, get practical advice from patients who have the same condition, and make more empowered decisions about their disease and treatment plan. However, in the last week, it as been made obvious that technology also has unintentional consequences. By creating a world where the reality of infectious diseases and mortality are often a dream, technology has, ironically, given many people a chance to reject it.

Feb 14 2015
Electronic Medical Record Gallery

Healthcare Data Security and Privacy

Guest post by Rachel Marren

 

One of the top headlines of the last week is the Anthem security breach, which, according to USA Today, might be the biggest healthcare breach of all time, with up to 80 million individuals affected. Although no medical or credit card information was stolen, personal data such as names, social security numbers, and birthdates have been compromised.[1] As reported by The New York Times, this information could be used for identity theft or to target government or corporate leaders.[2]

The Health Insurance Portability and Accountability Act (HIPAA) requires public disclosures of healthcare information breaches involving more than 500 individuals,[3] which can be viewed on a page of the US Health & Human Services Office for Civil Rights[4] often referred to as, “The Wall of Shame.”  However, many industry experts argue that this and other measures required by HIPAA and the HITECH Act are not enough to protect patient privacy.

One big topic of contention is encryption, which is recommended but not required by HIPAA. Anthem did not encrypt Social Security numbers or birthdates, and claims that encryption would not have prevented the breach. However, outsiders have suggested that encryptions that limit the amount of data that administrators can access could help control major breaches.[5] With calls for increased encryption and the ubiquity of articles with titles such as, “10 Ways to Strengthen Healthcare Security”[7] and “Health Information at Risk:  Successful Strategies for Healthcare Security and Privacy”[8], it is clear that there are measures that can be taken that currently are not.

This breach has raised serious concerns among consumers, industry members, and public officials. Although medical information was not accessed in this specific incident, patients are seeing that information about their health is not as secure as they would like. This is extremely relevant today, with the electronification of medical records and healthcare apps on the rise. Now patients not only have to feel comfortable disclosing personal information to their doctors, but also must feel confident in the security systems guarding their doctors’ electronic records. If physicians and patients are to trust new technologies, it is crucial that information security in the healthcare sector undergoes major improvements.

 

[1] http://www.usatoday.com/story/tech/2015/02/04/health-care-anthem-hacked/22900925/

[2] http://www.nytimes.com/2015/02/07/business/data-breach-at-anthem-may-lead-to-others.html?ref=health&_r=0

[3] http://www.hhs.gov/ocr/privacy/hipaa/administrative/combined/hipaa-simplification-201303.pdf

[4] https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf

[5] http://www.pbs.org/newshour/rundown/lack-health-care-cyber-security-standards-raises-questions/

[6] http://www.wired.com/2015/02/breach-health-insurer-exposes-sensitive-data-millions-patients/

[7] http://www.informationweek.com/healthcare/security-and-privacy/10-ways-to-strengthen-healthcare-security/d/d-id/1306631

[8] http://www.ehealthnews.eu/images/stories/pdf/successful_strategies_for_ health care_security_privacy.pdf

Feb 13 2015
e-patient Gallery

A Doubtful Solution

Guest post by Nicholas Brown

 

For someone interested in healthcare, I was completely unaware of the true affect of

digital health on this field. As a matter of fact, I knew nothing of it. Surely, when a rash broke out

on my skin I turned to Google for answers and compared my rash to those I saw on Google

Images. Luckily, it wasn’t psoriasis. After my sisters got their wisdom teeth pulled, I did enough

WebMD and WikiHow searches to become a self-proclaimed expert on their treatment. New

gauze needed? I was ready. Without knowing its full effect, I was involved in these efforts of

digital health.

For me, the intersections of healthcare and technological advances of our current

society is amazing, yet paradoxical. Companies churn out and develop new systems and

machines that have capabilities to de-humanize surgery in the coming future. Nevertheless,

there is a clear and long lag. Hospitals are still very far behind the quick changes of healthcare

technology. Physicians and healthcare workers are further behind, and patients even further.

Between each step comes massive barriers and obstacles that decelerates the system.

Many Americans do not have the same experience I have with the changes within the

healthcare industry, and the most interesting thoughts and questions relating to class have

explored the effect of technology on different sections of the population. For low-income

Americans who have smartphones, but limited access to internet and cautious trust, there are

barriers of scarcity to overcome. For elderly, digital efforts must compensate for slower

understanding and lack of use amidst a fast-moving progression. For those with chronic

conditions, who find that pretty devices, but devices that are not wearable. These are massive

problems.

How can digital and technological advancements help solve these major issues while

they continue and create new problems? This is a question I continue to ask myself during

lecture and during project research. For me, I see it as another vicious cycle within our society,

and in an important field that many people trust. I guess that makes my perspective pessimistic

view. I think it realistic. Communication is a lost art within healthcare, and although digital

technology and social networks can alleviate that, the barriers they impose prevent

communication from a large portion of potential stakeholders.

The way we are approaching healthcare now, with several sides all walking with different

paces, looking at different pages, and following different missions, is conducive to moving

forward, but not to sustain connections between parts. Sewn patches make a quilt. Well

currently, I think the we see several patches, separate sections that we try to puzzle together; a

doubtful solution. The genuine solution comes when we find a way to sew the patches together.

Feb 12 2015
Design Gallery

Physicians and Technology-Use Considerations

Guest post by Jesal Shah

Our class readings have touched on technology/social media utilization across various demographics: the elderly, the low-income population, American adults, individuals with and without chronic diseases, etc. We also examined how the online infrastructure and community can be utilized in patient-disease narratives/data sharing (e.g. ePatient Dave) as well as creative physician expression (e.g. zDogg M.D.). However, our design project aims to create a physician-oriented campaign to increase HIV testing. This population emphasis poses a unique question: how can we best utilize technology for a group of physicians who are highly educated, scientifically engaged, restricted by time, ethnically mixed and varied in age, amongst other criteria. After all, eHealth, in addition to those involved in the technology process, is targeted to not only patients, but also physicians. Here are four out of several considerations when thinking about doctors and technology use:

1. Physicians rarely engage in e-mail conversation with patients.1

This conclusion serves as an indicator for general informal outlets of patient-physician communication. There are significant barriers, such as general negative attitudes and inertia, reimbursement issues as well as patient confidentiality, which challenge much more organic forms of interaction through technology.

2. Time strengthens resistance to change.1

Those within one decade of medical practice were more likely to use technology (tracked by online journal access and utilization of real-time clinical decision making services) in their profession than those in their third decade of work. This also reflects general trends of society and age. For our project, it may be interesting to examine age demographics of the Harris Health primary care physicians.

3. Patients have surpassed physicians in incorporating IT for health purposes.1, 2

Patients tend to be much more willing to explore healthcare topics online than even physicians. Is this because of pedagogical methods in medical schools, information abundance online, poorly designed real-time clinical decision making services or something else?

4. Digital divide amongst Physicians: the adopters and the restrainers.

While there is considerable survey data that point to certain specific technologies/applications being adopted more widely by physicians, a study by Deloitte highlights the existing digital divide amongst physicians. They found that 78% of the 57% of physicians who don’t use smart phones for clinical purposes do not intend to change in the future. Those who adopted were more inclined to show greater enthusiasm for health technology in general.

Overall, this is only the beginning of the discussion surrounding physicians’ relationship with technology in the medical sphere. Hope to share more knowledge and firsthand experience in another blog post this semester!

 

1. Grant, Richard W., Eric G. Campbell, Russell L. Gruen, Timothy G. Ferris, and David Blumenthal. “Prevalence of Basic Information Technology Use by U.S. Physicians.” Journal of General Internal Medicine 21.11 (2006): 1150-155. Web. 8 Feb. 2015.

2. Baker, Laurence, Todd H. Wagner, Sara Singer, and M. K. Bundorf. “Use of the Internet and E-mail for Health Care Information: Results From a National Survey.” JAMA: The Journal of the American Medical Association 289.18 (2003): 2400-406. Web. 8 Feb. 2015.

3. Glenn, Brandon. “Nearly 60% of Physicians Don’t Use Mobile Technology for Clinical Purposes.” Medical Economics. N.p., 15 May 2013. Web. 08 Feb. 2015.

Feb 11 2015
Design Gallery

Behind Closed Doors

Guest post by Sanjana Puri

Every spring, thousands of high school seniors gripe, moan, and complain about the seemingly unfair process that is elite college admissions.  One complaint that stands out amongst them all: it’s done behind closed doors. Applications go in, acceptances and rejections come out, but nobody can see what happens inside.

But what happens when this door gets pulled open?

That’s what happened when a group of Stanford students asked the University in January for a copy of their admissions records.  According to the New York Times, the university was forced to comply, in accordance with a federal law that has been in place for years.  Students highlighted the 1974 Family Educational Rights and Privacy Act, which stipulates that students have a right to see their educational records.

Tina Fey in Admission

Tina Fey in Admission (2013)

As someone applying to medical school, and a fairly recent alumnus of the college admissions process, I can sympathize with those who want to know the why in decisions. During the process, I felt both nervous and vulnerable. My admission into the most elite colleges seemed distant, behind a wooden door of admissions officers picking apart my carefully crafted application.

Translate that same feeling to a patient in a doctor’s office.

Patients eagerly await the arrival of results from a screening or bloodwork.  When the doctor arrives, the diagnosis and treatment seem out of their control, perhaps instead behind the privacy of a blue curtain. Depending on the situation, it can be a nerve-wracking experience.

Curtain & Patient in Greys Anatomy

Curtain & Patient in Grey’s Anatomy 

However, Stanford students took control into their own hands, empowering themselves and others throughout the country to level the information playing field.  Many said the comments on their application records were frank, like they were never intended to be read. But honesty can facilitate quality of applicants, accountability of the process, and advice for the future.

It’s time for patients to take action.

Now more than ever, patients have the opportunity to take control of their health. In the digital age, patients can have access to a PHR, or personal health record, a collection of information (immunizations, allergies, medications, etc.) pertinent to a person’s health. While different from an Electronic Health Record, which is controlled by doctors, employers, and insurance companies, a PHR enables patients to share information with all care providers and manage their health in between patient visits.

Americans who have access to their health information through personal health records (PHRs) report that they know more about their health, ask more questions, and take better care of themselves than when their health information was less accessible to them in paper records, according to a ground-breaking study released by the California HealthCare Foundation (CHCF)in 2010. However, only a mere 7% of Americans had used a PHR.

Advocate for your health.  Ask your doctor if they provide the option for a personal health record, and if not, encourage them to do so in the future.

The doors are open for you.

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