* A special report by our Ask D'Mine columnist Wil Dubois *
The weather forecast today calls for radical change, patient empowerment, new roles for doctors, and a call for a return to some good old fashioned medicine.
Last week the 'Mine crew were privileged to attend the day-long Stanford Summit that was part of the larger academic Fourth World Congress on Social Media and Web 2.0 in Health, Medicine and Biomedical Research, called simply Medicine 2.0 for obvious reasons. Med 2.0 is a very big deal. This year medical and health research folks from 28 countries on six continents traveled to Stanford's Palo Alto campus to attend.
While the larger Med 2.0 conference is dominated by the presentation of research findings and scientific data, the shorter Stanford Summit's charter was to focus on presenting "forecasts from luminaries — from e-patients and bloggers to executives and industry insiders."
Now a quick disclaimer: AmyT, our fearless leader here at 'Mine, was one of those luminaries, and she totally rocked the house. And I'm not just saying that because she signs my paycheck.
The day was jam-packed both physically and metaphorically and ran from dawn to late into the evening. Twenty-five speakers gave short talks and participated in five moderated sessions. The air was practically alive with electricity and possibility. I filled half my report's notebook with quotes, thoughts, diagrams, ideas, exclamation marks, and asterisks. (Yes, even though everyone around me was using iPhones and iPads, I was writing with ink on dead trees by the light of their electronic wonders.)
Now I'm not a luddite. When I'm not writing notes on dead trees at prestigious conferences, I'm spending waaaaaaaaaaay to much time in front of a computer. The clinic where I run the diabetes program has had electronic medical records (EMR) for about three years. I knew we were early adopters of this technology, but I hadn't appreciated how cutting edge we really are in my remote neck of the woods. In fact, it was pointed out in one of the panel discussions that 30% of docs have EMRs at this time. No one said it, but what jumped out at me is that means a whopping 70% are still using paper charts today.
The migration to EMR, what it means today, and where we are going tomorrow, was a theme that wove through the summit like a thread. Sean Handel, a senior VP for the doc-popular Epocrates platform, shared an amazing statistic from his company's research. Eighty four percent of physicians use smart phones clinically, and another 20% use iPads. He states that of the half-a-million iPhone apps, fully 7,000 of them are medical. But patient apps and doc apps don't talk to each other. It's the ultimate in what Handel calls "fragmented connectivity."
So... I guess there really isn't an app for that after all.
The sad, brutal truth is that EMR systems can't/won't/don't accept patient-collected data. Speakers in one panel discussed the irony that patients can share medical information with each other more easily than they can with their health care providers. It occurred to me that in this bold new world of the networked patient, the patient's medical record isn't really part of the network!
Several years ago, I was introduced to the concept of Digital Natives, younger folks who were born into a different world than the one I was born into. At Stanford, I learned that concept is already obsolete. We all, young and old, now live in a "networked ecosystem." Dr. Alan Greene, the first doc ever to have a physician website, said "we live on a different planet than we were born on." He said this to drive home the point of how much the world has changed, saying "becoming network natives is the biggest change in the history of humans as a species." Another way of saying it, that I heard repeated several times, was: "Whose mother isn't on Facebook?" Mine is. And she's 86. Yours?
As patients migrate more and more to the web, how does that change their relationship with their docs? How does that change how docs feel about patients? Clearly, there's a lot of fear on the part of the physicians, but it seems to be misplaced. Ron Gutman, CEO of HealthTap, states that research shows people with chronic health conditions are actually less likely to trust the internet as a source of reliable information than healthy people are. Rather, patients still trust their doctors as their primary info source. Gutman advocates that physicians should not only not be afraid to be on the internet, but should have "virtual practices," and act as curators and validators of health content on the web for their patients.
Radical e-physician Dr. Jay Parkinson bluntly accused the medical profession of being "anti-creative" when it comes to new methods of health care delivery. He feels the medical community worries too much about patients getting mis-information from the internet. In Dr. P's words: "No one has died from Googling a medical condition."
According to the members of the panel discussion medical education for tomorrow, most current medical students are fully immersed in social media and the networked ecosystem for their personal lives, but they do not use any of these networks for learning. Weird. Parkinson blames medical culture and a training system that emphasizes "regurgitation" of information over "creative thinking."
We in the DOC were cited as early adopters of social media in the medical space, and panelists felt that people with other disease states will took to us for leadership. An afterthought that I had is that diabetes social media is undergoing a metamorphosis. It is changing from support to advocacy to revolution. The DOC is evolving into an engine for change. If other patient communities are looking to us to show the way, the future is going to be very interesting indeed.
But it wasn't all about technology. Physician-novelist Dr. Abraham Verghese of Stanford made a plea for physicians to not lose the roots of medicine in the rush to technology, and to take medicine "back to the bedside." He is a strong advocate of the old-fashioned physical exam — a ritual that builds trust between the physician and the patient, as well as being medically practical. He told one chilling story of a patient who had been seen and misdiagnosed by six separate clinicians, none of whom physically touched the patient, at all. This patient had a tumor that was easily detected by touch. But not by computer.
Medicine 2.0 moves on to Harvard next year, but Dr. Larry Chu, on point for organizing this year's Med 2.0 and the Stanford Summit, confessed to becoming addicted. Stanford, says Chu, "wants to continue to be part of the conversation. We want to create a program of inquiry that enables us to continue to engage the health care social media, and emerging technologies community."
Thus was born the idea for a Stanford Summit 2.0, which will actually be called Medicine X, short hand for "Medicine neXt," a new annual gathering about the future of medicine, with patients at the epicenter.
He then announced that 10% of the seats would be reserved for patients and e-patients so our voices and perspectives could be part of the conversation.
Chu diplomatically told the crowd, "If you can only attend one conference next year, you should go to Medicine 2.0 in Boston. If you can attend two conferences, please come back to Stanford!"
My bags are packed, Dr. Chu.