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.

December 2016 WebMD Mobile App

Title: WebMD Mobile App

What it is: A mobile medical reference app

webmd-front-page

Front Page of the WebMD Mobile App

What devices: Apple and Android products

Cost: free

Who should use it: Anyone who wants broad reliable medical information at their
fingertips

Why use it: There are numerous medical websites on the internet and if you are looking for medical information it can be hard to know where to start.  What is good information and what sources can be trusted?  The first place to start can be the WebMD mobile app.

The mobile app has many different features that make is a very useful first step to researching medical questions.

1 Symptom Checker – to guide you towards potential medical diagnosis based on symptoms you are experiencing

2 Reference of medical conditions – broad list of medical conditions with useful information for each condition, all presented in a format that is easy to understand and geared towards patient usewebmd-med

3 Drug reference for pharmaceutical information. – listing pertinent information about what it treats, what to look out for, what a specific medication interacts with other and what to do if you miss a dose

4 First Aid – Basic How-to for caring for injuries and medical conditions on your own and instructions for when to seek carewebmd-first-aid

5 Provider database – You can even search your area, or any area you might be traveling in, to look for physicians and hospitals.

The WebMD mobile app is a nice way to have reliable medical information at your fingertips.  The app is definitely geared for lay-person use.  This app not rigorous enough for physician use.  The Medscape mobile app may be better suited for that.

While the WebMD mobile app may not meet the needs of physicians in daily practice, it is a great useful reference for anyone looking to obtain quality medical information from a reputable source.

November 2016 ASCVD Risk Estimator

ASCVD Risk Estimator
What it is: A mobile app that uses an algorithm to determine risk of cardiac disease
What devices: IOS and Androidfront-page-app
Cost: Free
Who should use it: Physicians who want more guidance on cardiovascular risks and treatment guidelines for hyperlipidemia.  Also patients who want to be more proactive win their own healthcare, who want more information on their own heart risks and what they can do about it.
Why use it:  The goals physicians set for cholesterol levels change based on a specific set of risk factors.  Essentially this makes cholesterol levels a moving target at times.  Not every patient will have the same goal.
       The American College of Cardiology and the American Heart Association has developed a mobile app to help physicians and patients make the most informed decision about cholesterol treatment.  The app is called the ASCVD Risk Estimator.  ASCVD stands for Atherosclerotic Cardiovascular Disease.  The uses published medical guidelines to set a 10 year and lifetime risk of heart attack, stroke or death from a cardiac cause.
     To use the app, one needs information regarding age, gender, race, total cholesterol, HDL cholesterol, systolic blood pressure, diabetes status, smoking status and use of blood empty-front-pagepressure lowering medications.  By inputting this information, one can see the 10 year and lifetime risk of heart disease.
      The app also uses the current published guidelines on treatment.  Based on the risk that is calculated it will review current treatment options.  For instance if the risk for a patient is calculated to be 14%, then the app can easily show you that the next step is high intensity statin and lifestyle modifications.statin-therapy
       There are two educational sections of the app, one geared for physicians and one geared towards patients.  The Physician section is more technical and comes with a strength of recommendation rating that physicians will be familiar with.  The Patient section is much more approachable.  Conveniently there is a section that provides definitions to common medical terms that could be quite helpful for patients.

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.  

September 2016 Caffiend

Caffiend 

logo-caffiend
What it is: A medical app that helps you track your caffeine and water intake
What devices: iPhones and Apple Watches
Cost: $0.99
Who should use it:  Anyone looking to monitor their caffeine intake
Why use it:  As we move into September, students are back in school, on college campuses and the days are shorter, many people turn to caffeinated beverages to give themselves a boost.  While caffeine can be very useful, we can get too much and it can cause medical problems.  Insomnia, palpitations and dyspepsia can all occur with ingesting too much caffeine and many people will have withdrawal symptoms when they do not have their usual amount of caffeine.  That is where this month’s health app comes in, Caffiend.
       Caffiend is a mobile health app that help you track and measure your caffeine use.  It easily allows you find the amount of caffeine in your favorite beverages.  You can see how much caffeine is in each drink and how much you have consumed each day.
       The benefit of tracking your caffeine use is two fold.  By tracking, you can make sure to limit your use to an acceptable level.  Most consider less than 400mg to be a good goal, although that is something that you should discuss with your own personal physician.  The other benefit could be to compare any symptoms you might have that could be caffeine related.  For example, is your caffeine intake too high in the evening and if you adjust your caffeine intake, does that improve at all.
       The Caffiend app also is set up to help you monitor your overall water intake as well.  It is a nice way to track both at the same time if you so choose.caffiene-healthkit-dashboard
       The one drawback to the Caffiend app is that you can not visualize your caffeine intake
graphically at all.  The easiest solution to this is to sink the app up with your HealthKit.  You can keep track of your caffeine along side your steps, miles and weight.

 

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.