Digital Springtime

       Spring is here and that brings thoughts of blooming plants and warmth, growth and

Spring Monet

Spring by Claude Monet

regeneration.  Everyone tends to revere spring, things are new and the cold dark winter is ending.  For me the winter coincided with a a rather trying period of time in my real day job.  While I love writing and blogging and learning everything I can about Digital and Connected Health, my day job doesn’t really involve a significant amount of that field.  Recently there have been numerous work priorities that involved a significant amount of my time and what time was left I dedicated to my family.  So my site here has been sitting fallow for a little while.

       By thinking about what topics to cover next, I found myself asking the question, Do I really even care about Digital and Connected Health?  Is it that Digital Health can fundamentally change the landscape of healthcare or am I seduced by the luster of technology?  Am I sucker taken in by the shiniest new objects in medicine?
       The truth is I don’t think there is a technological solution to every problem and that is especially true for medicine.  Technology in medicine does circumvent the modern behemoth that the American healthcare system is can speak directly to the people seeking care, our patients.  What I am most passionate about is Access to Medical Care and Patient Empowerment.  That is where our current system has failed and where Digital and Connected Health can lead.
       We now work as Physicians and Advanced Practitioners and we are patients in a system that is built on the infallibility of Physician.  It is a “Just Trust Me” model.  Do what I say and things will be fine.  For a myriad of factors that system is just not tolerated any longer but most people still have to seek care from his system.  Patients have to navigate this system as best they can.  Right now though patients want more control, more information and to take charge of their healthcare journey.  They want to make their own choices.
       The burden of paying for healthcare has been shifting towards the patient as well.  They are shouldering the cost of the care they receive and want a greater voice in how they use it.  Some people choose to exert control by not seeking care at all, eliminating interaction with a system that bypasses their wishes and is often unaffordable.  Others may seek alternative healers than the traditional modern doctor, who offer simpler options for patients to take more control.
       What limits patient access and empowerment today?  What about just asking your physician a question without an appointment?  Most people would laugh even at the thought.  It is not that as physicians we do not want to discuss important matters with you but often times we just can not find the time.  After a long day in my practice, a full day being 20-24 patients, reviewing lab results, refills medications and then actually charting and billing for visits there just isn’t a spare moment to eat lunch, let alone have conversations over the phone.  It may have a huge impact on a patient to talk through a medical issue, but spending 10-15 minutes of uncompensated time just isn’t viable for most physicians on a daily basis.
       What about being able to actually come into the office to have an appointment?  Most Physicians are booked out for weeks.  Many doctors wear that as a badge of honor and their administrators like to see that demand.  What happens to that patient that needs to be seen today, who needs advice and care and the biggest impact for positive change is today?  Will the impact of the message about their health be the same in 3 weeks?  Where else will they turn for information and care?  What about refills for chronic conditions that are vital for longevity but as a healthcare system we determine that you need to come into our office, our space, follow our rules just to keep you blood pressure in good range?  Hard to take a day off from work? Sorry we don’t see patients after 4pm.  We don’t open on Saturday.  Holidays?  You must be joking.
       Digital and Connected Health can be the flexible solution patients need.  They can take charge of their own health with newer tools that empower them and work outside the current unofficial rules just discussed.  Can’t get into your physicians office for weeks?  Well there is a telemedicine group ready to take your video call right now.  You can choose the time and you can do it from your desk at work over lunch or at home on your couch after your shift at work.
       Do you need a refill on birth control but it has been a year since your last PCP visit?  Well, you could wait another couple weeks or use an app on your phone to connect with clinicians who can review your history and prescribe the medication you need.  On your time and your direction.
       Those medical questions you have, the resources are endless.  It is almost cliche to refer to “Dr Google” but who doesn’t use a search engine to find necessary information before making any decision?  You can spend hours researching the car you want to buy before ever having to set foot in a dealership.  Between WebMD, Mayo Clinic, Patients Like Me and numerous other medical sites, finding detailed and relevant information has never been easier.  (Check out this post.)  No one has to wait for their physicians medical assistant to call back and relay a generic message.  No waiting for an appointment.
       Our current Healthcare System does not have the needed incentives for all parties and enough inertia to provide the broad access to care and empowerment of patients that we need to have an impact.  Digital and Connected Health provides everyone with an option that can empower everyone to access the care they need when they need it.

Connected Health Conference Day 2

       The second and final day of the Connected Health Conference was another great and engaging way to spend a day indulging in digital health technology.  Several themes continued to emerge as the conference wound down.
Personalization
       Many Digital Health companies are trying to provide personalized experiences for their customers.  Using video, text and even digital personal assistants like Alexa, these companies are looking to make something unique for each patient.  Patients may change behaviors and make more lasting changes with personalized experiences and regular communications.  A lot of the options included regular coaching and taking a more holistic look at a disease process.  I found it quite fascinating that results one company was able to obtain with weight loss when they incorporated virtual mental health care.
AI
       Whether its called Artificial Intelligence, Augmented Intelligence or Assisted PilloIntelligence, it is clear that AI is going to become a large part of the healthcare landscape very soon.  As above, some of the personalization of digital health technology can be algorithmic to guide diagnosis and treatment options.  AI can predict a diagnosis based on symptoms as well and physicians in many cases and are even better at identifying skin cancers.  Fairly soon, a patient may be able to use AI to help understand the symptoms they have, maybe even diagnose themselves and then guide a patient through the next step in the healthcare system.  The picture to the right is of Pillo, a new AI driven droid like robot that will dispense your medications on time, discuss your health, call you family and even activate emergency services if needed.
       For physicians, we will have to start to adapt to having AI as part of our work flow.  Initially it might just be technology with natural language processing allowing physicians an easier way to interact with EMRs.  But as AI proves to be more any more effective at synthesizing and analyzing data, physicians may find that they no longer need to spend much time on the process of diagnosis.  As above, if a patient can check a worrisome more at home with an app on their phone, the physician may just be needed to confirm and remove the lesion.  Physicians may find that they are spending much more time creating treatment plans and executing a treatment plan than looking for a specific disease.
Convenience
       A fascinating statistic was discussed at the Connected Health Conference that has been churning around my brain.  The average American has 4 physician visits a year and spends about 15 minutes of face time with a physician each time.  That adds up to just one hour of face to face time with a physician every year for the average American.  When you think about it from a patient point of view, there is so much that is inconvenient about medical care.  Most outpatient care follows business hours, so an appointment requires taking time away from work.
       It is almost a cliche to talk about wait times but once a patient takes time off from work, spends time driving to their physician’s office, they will need to wait for 15-60 minutes in the waiting room.  Then once they are actually taken to an exam room they usually wait there, allowing the physician to determine the beginning and end of every appointment, simply by walking in and out of the exam room.  There are insurance hassles and paperwork hassles and call-back issues.  Trying to see a physician is inconvenient for a lot of people.  Digital health is trying to change that, providing technology that can bring the healthcare system to the patient on their terms.  I heard many times at the conference that a patient’s home is going to become the center of their healthcare delivery.  Withe remote patient monitoring, home diagnostics, AI driven personal healthcoaches and virtual visits, digital health can provide convenient care that a patient is more likely to use and use in an effective manner.
       Overall, I felt the Connected Health Conference was a huge success and I had a profound impact on me.  By empowering patients to be at the lead of their own care Digital Health will revolutionize where and how we provide and receive medical care – and sooner than we think.

Scenes from the Connected Health Conference

HoloLens 3D

Using the HoloLens 3D from SphereGen.  Used it to review cardiac anatomy and to review radiologic images of a foot and ankle.

 

Me and Pillo

Here I am with my new friend Pillo.  Pillo is a home health AI healthcare companion.  Can dispense your medication, record your blood pressure, call your family and tell you a joke.

Pillo

Pillo reminds of a droid from Star Wars.

 

Reflections on Day 1 of the Connected Health Conference

       The Connected health Conference in Boston has been a great experience for me so far.  It has been so fun to be immersed in everything digital health.  Discussed Artificial Intelligence and machine learning as well as telehealth and wearable technology.  There have been a few themes that resonated with me that I would like to share.
       As clinicians and as any provider of healthcare, in the very near future it will be expected that we meet the patient where they are, not where we would like them to be.  Remote patient monitoring was a constant motif throughout the day today. There are so many telehealth and virtual visit opportunities for patients.  Anyone who thinks that medical care should happen exclusively within the walls of a medical office or hospital will be the least successful healthcare providers moving forward.  Digital health is many things, but is it clear to me today that it is really about providing convenience to patients.
       More than any other group, those involved in Digital and Connected Health are acutely aware of the exponential growth in healthcare needs in America over the next decade.  One stat that absolutely drove this home was the idea the in 2020, less than two and half years from now, there will be more people over 65 years old than there will be children under 5.  The needs of those older adults will preclude most one on one care and the virtual care provided these patients will be able to fill in the gaps of care.
       It is 100% clear to me that Fee-For-Service payment models holds back new models of care.  Physicians, health care teams and administrators can not focus on experimenting and creating brand new models when you have to work so hard to on Fee-For-Service.  I heard Clayton Christensen speak today and he mentioned that in a lot of health systems, they make money when a patient is sick.  Better models would allow a healthcare system to make money to keep the patient well or to get well faster.  That is not where many of us are but where we all wish we could be.
       Many of the companies I met today are looking to go directly to the patient or caregiver to sell their product.  That has two consequences for physicians and those that provide medical care.  Traditional healthcare providers may find themselves marginalized in the decision making process for their patients.  We will find that our patients obtain devices and apps without any physician guidance.  The second issue that we, as physicians, will be expected to review and evaluate said data.  This will be expected of us, regardless of how beneficial we think the information is.
       Finally, one of the Keynote Speakers this morning was Futurist Chunka Mui.  He said something that will stick with me for a very long time.  He said that the “fast learner wins.”  That is applicable to everything in today’s medical and business environment.  When you think about it, it applies to everything.  Those who learn the fastest can adapt to changes faster.  It’s that adaptation in a rapidly changing world that leads to success.  I can’t wait to learn more tomorrow.  And learn it quickly.

Physicians Leading Patients to Quality Medical Information Online

To create and foster high patient engagement, every patient must be able acquire thebook-1659717_1920 necessary knowledge to be informed. For the longest time, the main source of medical information for patients was their actual physician. Physicians were the gateway into understanding one’s own body and disease process. This has rapidly changed because of the internet.  No longer is medical information trapped in old books or a physician’s mind.  Now there are thousands of ways to find medical information, much of it completely useless, inaccurate, not widely applicable or simply plain wrong.

Many physicians will complain that their patients find medical information online and want to discuss it or use it to drive diagnosis and treatment. They are worried that the information their patient found is not accurate, that it will distract a patient from the real medical issue.  To some degree, all physicians worry about losing their position as an arbiter or gatekeeper of what medical information their patient receives, losing that feeling that their patients see them as the expert.

The next natural step for physicians is to become a guide and help patients navigate health information themselves. It should be a physician’s responsibility to to lead their patients to high quality medical resources. As physicians we need to steer our patients towards good information, which will limit opportunities for them landing on less accurate or just plain quack medicine sites. Below is a good place to start when trying to find good quality medical information

General Medical Information
To find high quality medical information on a wide variety of medical conditions I would start with WebMD, Mayo Clinic, FamilyDoctor.org, KidsHealth and the Center for Disease Control.
www.webmd.com
www.mayoclinic.org/patient-care-and-health-information
www.familydoctor.org
www.kidshealth.org
www.cdc.gov

Condition Specific Medical Sites
To research a little more deeply on specific conditions I would recommend the following sites. Both Cancer.org and Cancer.net are excellent resources for information on cancer. Heart.org and Diabetes.org are great for researching cardiovascular disease and diabetes. The National Alliance of Mental Illness has great resources on mental illness.
www.cancer.org
www.cancer.net
www.heart.org
www.diabetes.org
www.nami.org

If you are looking for an objective reference for alternative medicines and treatments, the best place to start is the National Center for Complementary and Integrative Health. The website for this division of the the National Institute of Health is full of useful information to make better decisions on alternative therapies and can be found at nccih.nih.gov.

Lastly, I would recommend looking at two two parts of the Healthfinder website. Using the guides provided there, it can give every patient a template for how to prepare and get the most out of their time with their own physician. The section called Take Charge of Your HealthCare provides a step by step guide to maximizing your use of the the healthcare system and you can find that here. My favorite part is the section on Talking With the Doctor. This has many common medical conditions and provides a series of questions that you should be sure to ask about each condition. These prompts can make a visit with your physician much more efficient and may propel you to better decision making with your physician. You can find that site here.

Record Breaking

Very happy to announce that this October, Digital Medicine and You has surpassed all of last years visitor metrics.  This website has had more visitors and more page views so far in 2018 than we had all of last year.  Very excited about this and thought I would share.  As always, love to hear any feedback or have conversations about Digital Health.

Inspiration from Healthcare Podcasts

       In healthcare it’s pretty easy to get stuck in a rut. Sometimes you find yourself doing the exact same things the exact same way every single day. Answering the same questions, doing the same procedures. You find yourself coming up against the same obstacles and feel like you’re beating your head against the same wall over and over.
       One way that I like to fight the rut is listening to digitalhealth and healthcare podcasts. I find it very inspirational to hear about leaders in healthcare who have found innovative and disruptive waves to make healthcare more accessible, more efficient and often with better experiences for patients and providers alike.  It’s always great to hear about the trials and obstacles that other people overcome.  When you yourself are struggling, it’s always nice to hear about the success that eventually happens with  hard work.
       Digital Health Today, The Digital Health Podcast and Relentless Health Value all have some of the best entrepreneurs and leaders in the field Digital Health and medicine.  Whether I’m in my car driving, on the treadmill or if I just need a little break from my day-to-day work, I am usually listening to one of those podcasts.  Check out these podcast and I would love to know about any other good ones you are listening to.
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