Digital Health – views from around the world

It has been one year and one month since I started this website that focuses on real world applications of digital health.  I have had a lot of fun creating a this site and creating an online conversation about digital health.

The most exciting aspect of the website has been to see all the different areas of the world I have visitors to my website.  This March has been my 3rd best month in terms of total views.  While the majority of the views come from the USA, I have also had visitors this month from Brazil, Serbia, India, Venezuala, Belgium, Jordan and Spain.

I would love to hear from anyone outside the US about what digital and mobile health looks like in your country.  Add a comment to this article, or email me at dranderson@drmatthewanderson.com or reach out on twitter @DrAnderson19.

If you think fake news is bad for politics, you should try being a physician

This is an article that was originally published on KevinMD.  

       Much of the discussion surrounding the presidential election this year focused on “fake news.”  There were countless stories in newspapers and on television news shows about these obviously biased and fictitious posts that might have affected the outcome of the election. I could not help thinking during this campaign season that if you think fake news is bad for politics, you should try being a physician.

       As physicians, we are on the front line in the fight against fake news and deal with the fall out on a regular basis.  This is nothing new, especially for Primary doctors like Family Physicians, Internists and Pediatricians who have to deal with volumes of fake news within the limited amount of time they actually have with a patient. 

       Physicians are always trying disprove fake news with patients.  We talk about the limited benefits of numerous vitamin supplements in the face of countless publications and marketing efforts that do not have to be evaluated by the FDA.  Red yeast rice is not equivalent to statins for preventing heart disease.  Gingko biloba will not treat dementia, no matter how organic or pure it is, no matter how many people write about its effectiveness. 

       A website recently touted the 25 beneficial uses of Apple Cider Vinegar.  This list included treatments for acne, bad breath, under arm and foot odor, to kill bacteria causing a sore throat, prevent diabetes, lower cholesterol, improve digestion and remove warts.  But wait there’s more! Apple Cider Vinegar can give you healthier hair, whiter teeth and even better tasting barbecue sauce.  This is in addition to its ability to be a nontoxic cleaner for your kitchen and a weed killer for your garden.  This is a list of pure conjecture passed off as facts, and people believe it.  Even the comments section of the article has readers saying “good to know.”

       I have had several patients tell me about all the health benefits of vanadyl sulfate.  Specifically, they have stopped their medications for diabetes because of everything they have read about vanadyl.  Each patient’s course plays out the same way: these patients research for information, completely buy in to this natural supplement, stop their medications and then their A1c goes up dramatically.  But “Americas most trusted wellness doctor” says it works and is willing to sell the supplements to you as well.

       The most egregious and widespread item of fake medical news involves vaccines.  From causing autism to inciting sexual behavior, decades of fake medical news about vaccines exist.  Many times doctors are seen as complicit in pushing this harm on people.  A quick look at twitter for #vaccines, and the news of vaccination harms is overwhelming.  

       The whole fake news complex plays on the vulnerabilities of those searching for the information in the first place, looking for what mainstream media or money-loving, golf-playing doctors won’t really tell you.  You are being held down or missing out on critical information – information someone else doesn’t want you to know.  If you can get this information, everything will be better — your life, your health, your economy, your country.

       As a physician, I try to be a steward of medical information.  I want my patients to seek out good quality medical information on their own.  I steer them to websites such as Mayoclinic.org or Webmd.com and gently dismiss information from sources I do not trust.

       So fake news may have negatively affected the campaigns of Hillary Clinton and Donald Trump, but fake news affects every clinic and hospital in America every day.  This is not to say that political news is more or less important than medical information or that either is more susceptible to the “fake news” problem.  Inaccurate statements presented as facts should always be challenged, and the medical community has a unique and difficult responsibility to engage it.

February 2017 CDC Vaccine Schedules

cdc-opening-screenTitle: CDC Vaccine Schedules
What it is: A mobile app for all the CDC vaccine guidelines
What devices: Android and Apple devices
Cost: Free
Who should use it: Any healthcare provider or patient who wants to know more about CDC guidelines for vaccination
Why use it:  Vaccines are an effective and easy way to prevent disease and maintain healthy populations.  For many clinicians the source they use the most for vaccine schedules and information is the CDC website.  This CDC Vaccine Schedules app puts all the important information from the CDC website into a convenient mobile app.
    The information is broken down like most of the distributed vaccine information from the CDC.  The age categories include Birth to 5 years, Adolescents and Adults.  While looking at the graphics on a phone or tablet, turning your device horizontally allows for a broader appearance to the timetable.cdc-front-page
    There is also information on catch-up schedules for children, unique guidelines for pregnancy, immunocompromised patients and healthcare providers.  These are in separate listings on the front page of the app but there is also a lot of information available by tapping “note” from the vaccine schedule it self.
    Overall, this is a very easy to use reference from the CDC for all vaccination guidelines in the palm of your hand.

Review of 2016

good-year-1911507_1920     2016 was a very exciting year for me.  I completed my MBA, took on a new role at my institution as Associate Chief Medical Officer and in February I launched this website, Digital Health and You.  This website has been an important outlet for me and I hope  has helped improve the landscape of medicine and digital health.
     This year the website had 11 digital health app reviews published.  These included apps for understanding your lab results, cognitive behavioral therapy, concussion prevention, zika virus and even to help monitor your caffeine intake.
     I am really looking forward to 2017.  We will be discussing EMR’s, PHR’s, more Profiles in Digital Health and of course 12 new Health App of the Month posts.  My readership waxes and wanes, as does my ability to publish often but creating and maintaining this website has truly been a joy.

Evidence of Digital Health Adoption by Patients

       A really exciting thing has been happening in my clinic the last few weeks.  In addition to holiday decorations and the rush year end refill requests, I have noticed an increase in the amount of times patients have talked to me about health apps.doctor-563428_1920
       The March Health App of the Month was Sworkit and I recommend it often.  Those who travel a lot for work or whose busy work schedule limits going to the gym can find good success in an app like Sworkit.  I am receiving good feedback on the impact of Sworkit.  During follow up clinic appointments with several patients over the last couple weeks they had followed my prescription of Sworkit and were using it regularly.  They all travelled extensively for work and found it was easy to have an intensive exercise session from the privacy of their hotel room.  For one patient is was really helping maintain good blood pressure control.
       In my clinic I usually have my diabetic patients come in for appointments a regular basis, around every 3 months.  I recommended to many the use of the MySugr Diabetes App.  Many are finding it a really intuitive and easy way to track their sugar and their insulin regimen.  The visual nature of the blog sugar graphs and the ability to export the data are features that patients appreciate and really use.  Especially when trying to help someone with uncontrolled high blood sugars, the more data points the better.  Since almost everyone has their phone on them at all times, it is easy to log every blood sugar taken, every dose of medication, calories and any hypoglycemic symptoms – and it is easy to look at in the clinic to make clinical decisions.  I have worked with patients to change insulin regimens while we both look at the MySugr App on their phone.
       Any intervention where a patient can see and feel the results can be more impactful and lead more permanent healthy habits.  It is clear that the Sworkit app and MySugr can have that kind of impact.  Physicians need to be more mindful of talking about digital health apps with their patients.  It’s clear that patients will listen.

Are you prepared for a video recording device in your exam room?

       During residency, one of my patients brought a tape recorder to his appointment.  It was a bulky old tape recorder, which was already antique technology 10 years ago.  He was older and wanted to record his appointment so he could remember every detail.  His children often called him and wanted an in-depth report of all of his medical visits.  He decided he would audio-record his appointments and send the tape to them instead. 

     His intent was good, but I could only imagine terrible outcomes.  Somehow, my voice would be used against me.  Maybe my documentation would not match my words.  Maybe it would be obvious on the tape that I forgot to ask a crucial question.  When he told me he wanted to tape our encounter, my mind almost immediately jumped to it being Exhibit A in a lawsuit.  

     Before he could plug in his tape recorder, I told him he could not tape his appointment.  (Looking back, I am not sure what made me think I had the power to say no.)  We compromised, and I wrote a letter to his children summarizing our visit and any tests or medications ordered.  He was satisfied with that, and this system worked for us throughout my residency.  

     My memory of this was brought to the fore today as I learned about the new SnapChat snapchat-3Spectacles, wearable glasses that go on sale soon.  Created by SnapChat itself, these trendy sunglasses are equipped with a small video camera.  After pushing a button on the frame, the glasses will take up to 30 seconds of video of whatever the wearer happens to be looking at.  Of course, Spectacles connects wirelessly with the wearer’s phone and can instantly post videos to the social media site.  

     There are other products on the market right now that can do similar things.  The iOn Snapcam weighs less than an ounce and is a 1.5 inch-wide square camera with the ability to take pictures or video.  It can clip to clothes and, at just a tap, start recording.  It can even live-stream for up to an hour!

     What does this have to do with healthcare?  Recent advances in technology have propelled many new ways to access healthcare, but these two products have the potential to be detrimental.  

     How long will it be until someone’s Spectacles video becomes admissible in court?  A simple tap of someone’s glasses, and 30 seconds of a full patient encounter could be taken out of context.  Plus, it could be posted to multiple social media sites as well.  What about the privacy rights of other patients around someone with these video recording devices?  If someone posts a video to their social media profile from a physician’s office lobby, other patients will likely be in those videos.  How will we protect  privacy of the other patients in those situations?  snapchat-1

     If you are a physician, would you recognize any of these social media video tools?  What about your staff?  Would you feel comfortable telling your patients to make sure they were not collecting video or live-streaming their appointment?  Do you have a written policy to provide patients about limiting video capture in the office?

     There are many rules and regulations that require healthcare providers to obtain very specific consents before using any type of image or video recording of our patients.  Protecting the privacy of our patients is both the law and our responsibility.  Being aware of the new video technologies and preparing for their use by our patients are increasingly more important parts of that responsibility.  

Should you care what EMR your Doctor uses?

       When you are looking for a physician, what kind of criteria do you use?  Location is probably a priority as is whether or not the physician accepts your insurance.  You might review your states medical board, make sure there are no issues with licensure.  Reviewing a physician’s medical school and residency training is important.  Some people even like to go in for an appointment just to meet a physician.  As one of my patients once told me, he had to “kick the tires” on a new doctor before he would commit to seeing them regularly.
       While all of that is important, should patients start asking which Electronic Medical Record a prospective doctor uses?
       At first glance, it doesn’t really seem to be something that a patient would care about. Patients have enough to worry about, let their physician worry about the Electronic Medical Record, or EMR.  There may be some reasons that you may want to include an EMR into your decision making process.
Physicians spend a significant percentage of their day using the EMR.  From scheduling an
appointment to checking in to prescribing medications to reviewing test results, the EMR is at the center of any clinic.  Does your physician like their computer-1149148_1920EMR?  Does it make them more or less efficient?  Will your care suffer if the EMR drags your doctor down and causes them to be chronically late and attentive only to the computer screen, not to you the patient?  The EMR is the tool physicians use to make their encounter notes, and those notes are the basis for insurance coverage, referrals and prior authorizations.  Is the EMR good enough to make it easy for your physician to create good notes?  Is it portable, can your doctor easily access it at home or when out of the office?
Most EMR’s can not integrate with EMR’s at other healthcare institutions.  Many people will have more than one physician that they receive care from.  Can those physicians use their EMR to communicate?  Can your physician’s EMR provide information to the local hospital if you are admitted for an illness, or will they have to wait for your doctor’s staff to print out your chart and fax it in?  Are you going to have to tell your medical history every time you see a different doctor or go to a different clinic?
You want to communicate with your doctor.  It isn’t enough anymore to call your doctors office, leave a message and wait for a call back.  Can you communicate directly with your doctor through their EMR?  Is it easy to receive your labs and test results?  Can you ask the questions about your medical care with email or text?  How comfortable is your doctor with digital communication or will they just have their nurse leave your results on your voicemail?
Sharing data with your healthcare team is important.  There are many connected health devices in your life.  Can your doctors EMR integrate with any of these connected devices?  Can you send your weekly blood sugar log to your physician for review?  What about a picture of a new mole on your arm, can that information be transmitted electronically?  Will your doctor have to ask you how much you exercise if they already have your daily average of steps, miles run and calories burned?
       While not the most important criteria when choosing a doctor or healthcare facility, the fact is the computers and EMR’s are central to healthcare today.  Choosing the right combination of physician and technology could be the difference between a good and bad experience in healthcare.
       I would love to hear about experiences with an EMR from both the patient and physician perspective.  Send us an email (dranderson@drmatthewanderson.com), leave comment on the site or Tweet your thoughts @DrAnderson19.  Next week I will have a review of a company trying to help solve the EMR problem.