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Monthly Introduction to Tech Medicine
Tuesday, July 31, 2007
Joshua Schwimmer, MD, FACP, FASN
What's this blog all about?
My goal in Tech Medicine will be to explore the intersection of medicine, new technologies, and the Internet. This is a purposefully broad topic. Several times weekly I will post focused reviews of issues interesting to health professionals and nonprofessionals alike. Posts may include examinations of medical devices, pharmaceuticals, scientific advances, internet services, and other technologies involving health care and the practice of medicine. Mirroring as it does the nature of the Internet and the sometimes surprising nature of new technologies, the content may also include topics that are wonderful, unusual, hilarious, or strange.
What are some recent posts on Tech Medicine?
Recent posts have included discussions on medical uses of the iPhone (part 1, part 2, and part 3) and thoughts on patient-physician email (part 1 and part 2).
Who are you?
I'm trained as a nephrologist (a kidney and blood pressure specialist). For the last two years I've written Kidney Notes, a blog designed to filter and process medical news. Most recently, Kidney Notes has become a collection of links, commentary, and scraps of information -- a reference database of interesting things with the help of a popular social bookmarking service called del.icio.us. While I will continue posting to Kidney Notes, several friends have asked me to write longer posts of original content -- and this is what I will be writing on Tech Medicine. (Recently, I have also written a blog on personal productivity called The Efficient MD.)
There are many topics I plan to cover, but I'm also open to suggestions and tips. Please email them to techmedicine@gmail.com.
In part 1, I talked about barriers to patient-physician email. In this section, I'll discuss the many potential benefits of email communication between physicians and patients.
The time for the typical office visit has shrunk. Due to many factors including declining reimbursement and the need to see more patients per day, most office visits are now scheduled for 15 minutes or less. Neither physicians or patients are happy about this. Fifteen minutes is hardly enough time for adequate patient education or for forming a bond with your physician.
Enter email, a service which allows more time for physician patient-communication and helps people feel closer to their doctor. A few potential uses for email include:
Asking about lab results
Reporting potential side effects of medications
Clarifying whether it's safe to take a certain medication
Reporting home blood pressure readings
Reporting blood sugar readings
Giving positive feedback
Giving negative feedback
Asking for prescription renewals
Reporting new minor (but important) symptoms
Communication new medical issues when out of the country
And many others
Of course, any of these communications could also be made with a phone call -- but with a lot more hassle for everyone involved.
Take this example. Let's say a patient on a cholesterol lowering medication (Lipitor) has a twinge of pain in his left arm. He's heard that Lipitor can cause muscle problems, and is concerned that the twinge might be caused by the medication. One option is to schedule an office visit, but he's reluctant to do this for such a minor problem. Another option is to call the doctor's office, speak with a secretary (who would then take time deciding about the severity of the problem), have a note left for the doctor, who would then call him back later in the day to reassure him that this twinge doesn't represent a problem with Lipitor. Or the patient might not even ask the question, figuring that the pain is nothing significant, but still remain worried that it's a side effect of his medication and might even stop taking the Lipitor out of concern.
Alternatively, he could write an email describing the problem and receive a reply reassuring him that the pain is not consistent with a side effect from the Lipitor and he should make an appointment to be seen if it continues. Simple, almost effortless, and everyone is satisfied.
In part 3, I'll talk about ways of implementing patient-physician email.
The iPhone has an integrated YouTube player. Potentially, this means that patient education videos on YouTube can be identified and bookmarked, then played back at the appropriate time.
Here's an example. A patient has just been diagnosed with diabetes, and like most people, he doesn't really understand about the pancreas and insulin, but would like more information. The physician, while he's finishing writing out paperwork, helpfully hands him an iPhone, which plays this 2 minute introduction to diabetes from the Mayo Clinic:
The YouTube player is one way to display patient education videos on the iPhone, but it requires the presence of a Wi-Fi connection to work well. Another method is to download videos to iTunes and then play the videos directly (the iPhone is also a wide-screen video iPod). Certain sites, like VideoJug, feature patient education videos that (helpfully) can be downloaded in iPod format. (Thanks to my colleague Dr. Dimov for the tip.) The following video on high blood pressure is an example:
Finally, I've successfully tested TubeTv, a useful program for the Mac that allows you to convert any video from YouTube or Google Video into a format that can be saved in iTunes and synced with the iPod.
Using TubeTv, I've been collecting patient education videos on the following topics. (As a nephrologist and general internist, these are a few of the medical issues I take care of frequently.) Please comment if you have recommendations for any videos you think patients would find useful.
I'm a believer in patient-physician email communication. Let's face it -- just about every profession has enthusiastically adopted email as a rapid, non-interrupting, easily documented form of communication -- so why hasn't medicine?
2. Physicians may fear providing patients easy access to them through email. Some providers I've spoken to worry that their inboxes will be filled with long, nonspecific complaints from patients rather than communications on important topics. One study even suggested that emailing patients could decrease provider income.
3. HIPAA. The Health Insurance Portability and Accountability Act requires that electronic protected health information (EPHI), including email, be communicated in a secure way -- that is, through an encrypted system. There are many commercial services available that allow encrypted patient-physician communications. For examples, of this search Google for [HIPAA and email]. In practice, however, most physicians do not have access to these encrypted email systems and are unwilling to pay for these services. In addition, patients may be unwilling to use proprietary online systems to communicate with their doctors when their everyday (unencrypted) email system is quick and simple. I've had patients complain unhappily that an encrypted online email system was too complicated to use, and why couldn't they just send me a plain old email...?
More on the many potential benefits to patient-physician email in part 2.
I'm back. I was away on vacation in the North woods of Minnesota, in a cabin by a lake, without Internet or mobile phone service. Very different from life in New York City, and a quiet place to read, write, and think.
Dr. Salvatore Volpe writes the iPhone Medicine Blog. Medical Marketing and Media wonders whether physicians will get their continuing medical education credits on the iPhone. (As an aside, I routinely email myself articles from UpToDate and read them later on the iPhone.)
Unbound Medicine offers access to multiple reference materials formatted for the iPhone.
In the future, I'll be writing more about the iPhone and medicine. If you're aware of any medical resources for the iPhone, or if you have ideas for potential applications, please feel free to comment.
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