Medical Media Arts Lab | Medical Futures Lab

Apr 25 2014

Design

mHealth to Improve Health Outcomes: Paying the Bill

As we continue to develop innovations in mobile health technology, one of the first questions that needs to be asked is “Who’s paying for this?” Effective mHealth campaigns should be tailored to their target audience, which requires preliminary research about the platform and its potential, conducting focus groups, and multiple rounds of pilot testing.This costs money, and most industries want to see profits in a timely manner. In answer to the growing interest in mobile health, the National Institutes of Health (NIH) has developed two grants to fund mobile health aspirations. Specifically, these grants are aimed at “utilizing mobile health tools aimed at the improvement of effective patient-provider communication, adherence to treatment and self-management of chronic diseases in underserved populations.”

The article I read, which outlined the NIH’s plans entitled “NIH grants to fuel adherence, patient-provider communication” initially caught my attention due to its direct alignment with the interests of my MMAL group: patient adherence and patient-doctor communication. In order for patients to adhere to their treatment plans, it is important for them to feel engaged in their health. The NIH notes the potential of mobile health to “educate patients about the importance of sticking with treatment regimens and changing behaviors,” a promising avenue to improving adherence.

These grants simultaneously address the need for increasing mobile health use and the importance of patient-doctor communication to foster patient adherence and better health outcomes. However, what makes these grants stand out to me as relevant is their direct address of “underserved populations.” It is all too easy to overlook the destitute when visualizing shiny new mobile health technology innovations. However, these populations suffer the worst health disparities, especially for chronic health conditions and could stand to benefit (possibly the most) from mobile health innovations. In its quest to serve all populations, the NIH also addresses one way in which they plan to avoid using mHealth to marginalize other populations. Specifically, they hope “to transmit patient data digitally from remote areas to specialists in urban areas,” taking advantage of the growing wireless infrastructure available to the population.

Finally, the projects funded by these grants should be designed to last two years, with costs not exceeding $275,000.

It is my hope that medical professionals will take this opportunity to address health disparities in their communities in a creative and innovative way. mHealth holds a growing potential to improve health conditions among those populations most strife with health disparities. Increasing patient adherence by using technology to foster patient-doctor communication will certainly prove effective in the very near future.

Apr 25 2014

Design

Transparency Is Not a Complete Solution: What Data Doesn’t Always Tell You

As a pre-medical student and a future doctor I’m well aware of the fact that it will be a number of years before I become a practicing physician. I’m also very well aware of the fact that the medical environment and community that I will be practicing in could be very much different than the medical environment of today.

That’s neither a good thing nor a bad thing, hopefully it’s good, but for now it’s just a fact. So I always do my best to keep an eye out for information that could help me understand the direction medicine is going so I can envision what medicine will eventually look like.

One thing I hear a lot about is this effort to hold doctors accountable and to empower patients to use data to select the most appropriate healthcare. I think the goal behind that mission is absolutely wonderful. Doctors are supposed to first and foremost help their patients, and patients deserve the opportunity to be able to learn and decide for themselves where they want to obtain their care.

The only concern I have though, is that the metrics and data being provided to patients to make their decision are not always truly indicative of good care. For example, one thing I’ve heard about is both paying and judging surgeons based on their rates of complications. Seems like a decently fair strategy. But what happens if you’re an amazing surgeon, but you decided you wanted to help a lower income population. Isn’t very much possible that the environment your patients are in after they leave the surgery could affect the degree to which they have complications? That doesn’t necessarily make you a worse doctor does it?

Just the other day I came across a phenomenal article about this subject from Lisa Rosenbaum MD, from the New Yorker titled “What Big Data Can’t Tell Us About Healthcare”. In this article she talks about a recent release of Medicare payments that was made available to the public. In this release anyone, including patients, can look up the amount doctors are billing and how they rank amongst their peers.

The basic idea is that transparency can help patients make informed decisions. And the implied message is that doctors who are billing higher are misusing the system and ripping you off.

“The hope is that members of the public will be empowered by their access to payments data, and will use this information to identify doctors who are behaving badly, helping to end fraud and profit-driven overuse.”

But that’s extremely missing. Just knowing how many Medicare specific treatments your doctor does , how much he or she bills for them, and what their total overall billing is does not provide nearly the whole picture. You don’t know what the doctor’s costs are; maybe the area they are in requires higher costs? You don’t know the exact breakdown of the doctors billing system within their practice. Often times a single doctor bills the entire practice’s procedures.

And there is an overall dilemma between doctor judgement and what’s deemed as necessary that this also highlights. Is a test unnecessary just because it doesn’t return positive results?

How do we define quality care and how do we provide patients with a data set that is truly reflective of that? That’s still a challenge that is yet to be answered.

http://www.newyorker.com/online/blogs/currency/2014/04/the-medicare-data-dump-and-the-cost-of-care.html

Apr 25 2014

Education, Health, Medicine

Has the Influence of Harry Potter Spread to Medical Education?

As the semester comes to a close, it’s not unusual to see clusters of seniors chatting eagerly about how they’re going to spend their last summer before starting medical school. According to a study done in 2006 by the Mayo clinic, students that enter medical school with mental health profiles similar to their college peers. Although they spend their next few years training and studying on how to improve the health of others, they tend to disregard their own in the process. Reports show decreased attention to getting adequate sleep, meals, recreation and show higher rates of mental distress as student’s progress through medical school. Sadly, the same study has also shown that depressed students are less likely to reach out for help because of the stigma surrounding mental illness.

With the worrisome consequences of depression in medical students including possible burnout and increased rate of contemplated suicide, it is important to contemplate how a change in culture within the medical school environment can be brought about to tackle some of the stigma surrounding mental illness.

So, what can we do to bring about this change?

Lisolette Dyrbe, M.D., and the lead author of the Mayo study, has encouraged a lot of conversation about the issue.

“It’s certainly important for the student to learn the right coping strategies, time management skills, and stress reduction techniques. All of that is important, but it is not the entire answer. We also have to look at school-level initiatives. There needs to be organizational change.”

So, how are institutions responding?

Including pass/fail options for courses, reducing volume of course material, and giving students more opportunities to work and teach outside the hospital are just some of the ways that universities are working to lessens the stressful burden on patients. Many programs also provide mandatory resilience and mindfulness courses that teach coping mechanisms and stress management techniques. In addition, other universities have incorporated confidential web sites and hot lines for counseling, hired mental health experts, and have developed elective courses in health and wellness.

But, is this really helping?

Recent studies have examined these changes and have identified an important problem: students aren’t participating. Despite the good intentions of the universities and resources provided to the students, only a few seem to be taking advantage of these opportunities and these, more than likely, aren’t the ones that are in real need of care.

One program, though, has been able to show some success.

The Student Wellness Program at Vanderbilt medical school, which provides a variety of health and wellness activities, has been seen to improve the health of students by effectively partnering and empowering the medical students themselves into organizing and promoting their own health and interests. The program has allowed the students to be divided into four “colleges,” similar to the Hogwarts houses in Harry Potter, that allow the students to connect and organize activities that provide an outlet outside of the classroom. Dr. Scott Rodgers, the associate dean of medical student affairs describes the aim of the program perfectly and outlines the importance of health and happiness for these students.

“It’s a challenge for anyone to stay healthy and happy. But when doctors are able to stay healthy and happy, that means patients get physicians who are more compassionate and selfless. They end up with doctors who really have the energy to invest time in them.”

As undergraduate students pursuing careers in medicine, this discussion brings up some interesting conversations. What can we do to better prepare ourselves for medical school going forward? Are there ways that we can contribute to not only helping ourselves and our peers reduce stigma surrounding mental illness but also to improve health within the medical community?

sources: https://www.aamc.org/newsroom/reporter/jan2013/325922/stress.html; http://well.blogs.nytimes.com/2011/12/22/a-medical-school-more-like-hogwarts/?_php=true&_type=blogs&_r=0

Tagged health, medical education

Apr 25 2014

e-patient, Medicine

ePatient Benefits for the Unconvinced Physician

When discussing ePatients, we’ve mostly talked about the patient perspective – how an individual can become more empowered, educated, electronics savvy, etc. – but what about the physicians?

Well, in interacting with ePatients, of course the physician themselves may also learn information they hadn’t known, learn to empathize more with the individuals, and even gain some tech skills in the process. These all sound great, but sometimes when a doctor is over worked and just plain tired from life, I’m sure the last thing they are thinking of is how to learn how to use a new app a patient has just brought in.

The culture of passive medicine is in part carried out by physicians’ attitudes towards such patients. Of course, if your patient is compliant to everything you say and doesn’t question any of your prescriptions or treatment notes – you’re life as a physician isn’t too difficult because everything is a one-way conversation. But with the incorporation of ePatients – the physician has to work to build that two-way relationship, which not all physicians are willing to do.

So for those physicians unconvinced by the new ePatient movement – how about a very concrete and quantifiable benefit? EPatients can help you make money.

Now this sounds a bit crude. Money should not be the core of medicine, but sometimes it is and to some people it is. And in this sense, ePatients can bring in money for physicians by increasing physician referrals.

It has been shown that referrals are most effective through word of mouth. If a previous patient likes the way you work, then you get a referral. It’s just that simple.

Now how do ePatients factor in? Well, if you think about the grand scheme of things, creating an ePatient means a closer relationship formed by the physician and patient by methods of direct and indirect communication. This communication should ideally make the patient feel more secure and welcome in the portion of the healthcare system you have introduced them to. So simply (and idealistically) speaking, you put in effort to be a more engaged doctor in the patient’s life and treatment plan, and eventually they will like you and get you referrals.

Now, all doctors should communicate with their patients because medicine is not just about the biological treatment, but the social and psychological treatment as well. Social aspects of physician-patient interactions can go a long way. But – if you are still not into this ePatient thing – then maybe take into account how the ePatient movement can factor into your business plan. Is it a little more appealing now?

Apr 25 2014

Communication, Culture, Design, Education, Health, Story

Final Thoughts about the Medical Media Arts Lab

Last night was our final critique of our semester in Medical Media Arts Lab. It’s been a incredible journey being able to see a simple idea turn into a feasible project in just a few short months!

Here have been my three biggest takeaways:

1. Having a passion is so important. Many times throughout the semester I would feel discouraged or unmotivated, especially in the beginning when we were trying to figure out what exactly was the question we were trying to answer. Were we trying to make an exhibit to educate people about artificial heart technology or to tell the untold story of Dr. Akers’ contribution? After the first critique many of the comments expressed the same. But as Mijin mentioned in our presentation, it was the passion and excitement of the audience members during our first presentation that made us realize we had something bigger on our hands than we expected and helped us go back to the drawing board and see our problem in a different light. It was also encouraging each time we conducted an oral history interview with the individuals involved in the artificial heart project in the 1960’s. They each were so willing to share their story and eager to see it come to life in the present day, and the energy was contagious. Without a passion and an intrinsic motivation to continue, this project wouldn’t be happening.

2. Teamwork is essential. Our prototype and ideas honestly wouldn’t have come this far without the team I was in. Emily is an amazing speaker and hard worker, Mijin has valuable resources and skills with capturing stories from the past, and I contribute with my skills in digital media. This can be applied beyond the scope of our project into the subject of healthcare as well. All semester we’ve been talking about how to improve the communication, through whatever medium, between physician and patient. We’ve been talking about changing the conversation of the physician-patient relationship from the patient being a passive follower to the patient having an active voice and contribution to the dialogue about their healthcare. This can only happen if both the patient and doctor see themselves as a team rather than two opposing sides of a problem.

3. Start with Why. This is technically taken from Simon Sinek’s TED talk, but it’s been a common critique through the design process and practicing our presentations as well. Each time we’ve come up with a cool idea for a display we wanted to include in the exhibit, we were always stopped and asked “Why?” Would implementing this idea bring us closer to our goal, or do we want to add it because it looks cool? I saw the same principle applied in the other projects as well as they gave their final critiques. Many of the other teams designed a mobile app as part of their solution to their problem, but I liked how the ICU team recognized that although using an iPad to display information about rounds would be cool and in line with the digital health literacy trends of today, the current limitations of technology suggest that using a more traditional medium like a giant display screen would suit their problem’s needs a lot better.

I’m so thankful to my team members, our amazing problem-owners Dr. Grande-Allen and Dr. Igo, Dr. Ostherr and the teaching team, and all the individuals who helped us get to where we are today. I’ll be graduating this semester and moving to a different city so my contribution to our Artificial Hearts Project has come to an end, but it’s been an honor to be a part of this amazing process, and I can’t wait to visit when the exhibition opens!

Medical Futures Lab

mHealth to Improve Health Outcomes: Paying the Bill

Transparency Is Not a Complete Solution: What Data Doesn’t Always Tell You

Has the Influence of Harry Potter Spread to Medical Education?

ePatient Benefits for the Unconvinced Physician

Final Thoughts about the Medical Media Arts Lab

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