The Physician Perspective

Transcription

1 The Physician Perspective Humanitarian Technology Challenges and Interoperability Workshop Brian S. Gould, MD Information Advantage Group

2 Current HCIT Trends Synergistic Digital Conversion of Health Care Information Electronic records (US trails, but ARRA 2009 funding will accelerate adoption) Electronic clinical processes (e.g. erx) Meaningful use requirement will integrated provider data-communications Medical journals and CME on Internet and podcasts Consumer Connectivity Increasing use of Internet health information Personal Health Records (WebMD, Google Health, MS HealthVault, Aetna) Health-related Web 2.0 social networking Telemedicine Increasing demand Increasing physician acceptance and innovation Payment formats lagging, but catching up Will boost Medical Tourism Mobility The Smartphone phenomenon Wi-Fi/cellular connectivity realization of Ubiquitous Computing

3 Third World mhealthinitiatives UN and Vodafone Foundations document four dozen mhealth projects now active in various developing nations Many use push text messaging to maintain private contact with HIVpositive men (e.g. Project Masiluleke, RSA) Others use mobile phones as EMR data entry points ( e.g. Rwanda public health officials routinely use mobile phones to transmit health data, order medicines, send public health alerts and download medical guidelines) In other parts of Africa, Doc in a box clinics use mobile phone system to provide remote medical support to community health workers Mobile devices can integrate with lab on a chip digital detection technology to improve distance diagnosis MedicallHome (Mexico) provides unlimited physician mobile phone consultations to 4.5m customers for $5/mo. Adding rumor registries to social networking sites make them useful for predicting infectious disease outbreaks and other public health surveillance

4 The Smartphone Phenomenon Physician adoption of smartphones accelerating 2001: 30% (18% reported using for clinical purposes) 2007: 50% 1Q 2009: 64% Physicians now routinely using to access online medical and pharmaceutical resources Representative from FDA Center for Devices & Radiological Health presenting at TEPR+ Conference, Feb. 2009: FDA may want to regulate iphone Health Apps as wireless medical devices

5 BlackBerry Docs Large groups, primarily contract-based Departmentalized; professionalit support iphone Docs Smaller practices, primarily FFS Haphazard IT support, often nonprofessional, often personal Formal financial management, ROI-focus Small business cash accounting Formal IT planning and specifications process Intolerant of advertising More tolerantof cost, inconvenience of EMRs itunes distribution of low-cost, personalized clinical applications More tolerant of advertising, other forms of sponsorship Extremely critical of EMR time-sink, operating costs, added liability exposure Predictions: Adoption of EMRs will proceed more quickly among BlackBerry Docs (AMGA reports 85% EMR adoption by its large groups) Use of mobile, smartphone-based clinical tools will initially be more popular among iphone Docs Different paths, but eventually both groups will achieve a new condition in the history of Medicine Continuous Patient Care based on ubiquitous computing

6 Ubiquitous Computing Continuous Integrated Care Smartphones are secure, portable but location-aware, single-user devices Automatically connect to broad, wireless system of distributed devices Optical and RF tagging Wearable sensors Other smartphone peripherals Medical Home Allows continuous, automated monitoring of data stream Treatment adherence Detection of abnormal conditions Always-on communications Source for additional educational information (incl. multimedia) Organizer for instructions, reminders, prompts, new data recording (incl. short-form video) Push alerts and messages to providers, patients, families Opportunities for environmental modification, active prevention Initiate rapid responses Social networking care communities

7 Clinician s Point-of-Care Workstation To achieve adequate Health Information Exchange must overcome high level of systems/data fragmentation, conflicting formatting standards, proprietary access barriers Needs high level of user-flexibility, personalization -- data stream aligned with physician thoughtflow how the individual clinician is thinking about the problem being solved; what info needed now? Needs user interface that s intelligent, customizable, adaptive. Should be personally owned by the clinician, so can be moved from location to location

8 Physician Concerns Implementation Systems are costly and largely stand-alone, with limited data exchange Impact on interdisciplinary staff training, clinical workflow, substantial Usability do current IT systems meet provider information needs? Management of electronic records requires significant additional professional time uncompensated Not yet clear how to manage the in-box Not yet clear how to handle from patients What are appropriate guidelines for patient-accessible medical records? Unknown consequences, but real fears HIPAA compliance security protection is easy, maintaining patient privacy impossible Increased malpractice exposure e-data makes imposition of outside arbitrary standards easier, can lead to regimented care even more defensive medicine easy identification and prosecution of outliers Cooling effect on clinical innovation

9 Emerging Ecology of HCIT Physicians will adopt IT as long as it eases work and improves outcomes (e.g. smartphones) The most popular new HC services pull through cellular network, add to pressure on wireless carriers to open The traditional health care organization model is outmoded office visits and hospital admissions will not fit the operating environment of continuous care or less location-dependent clinical care workflow Geographically distributed, patient-specific treatment teams are now a practical reality