Posts Tagged ‘electronic health record’

Today, almost 100.000 health and mobile apps are available for Android and iPhone. That means over 4.000.000 downloads a day. 300.000 of those are for paying apps. Obviously, people are willing to pay for health apps. We’re not only talking about fitness and diet apps. Some purely medical apps and Internet platforms are being very successful. Doximity, a collaboration network amongst doctors, is used by 25% of all MD’s in the USA. And Epocrates, an app giving clinical information on medication, is used by half of them.
But one thing is commercial acceptance, and another is scientific validation. After all, we don’t always spend money on things that are healthy for us! Medical opinion seems to be positive towards the use of apps. 93% of American doctors believe that the use of apps can improve patient health, and 40% that these can reduce the number of visits to the doctor. However, it is early to make a sweeping evaluation of medical apps in general. As with all technology, apps are a tool, and have the potential to change the face of healthcare. But the content created for this platform can be good, or it can be not so good. Most of all, it is extremely varied.
Let us examine what types of apps are being created at this moment. In the United States, platforms such as Carecloud and Practicefusion are being widely used for electronic health records and medical billing. However, European regulations, which are much stricter than American ones, make it unlikely they will be available, or even legal, here.
Most apps are designed to improve patient’s and caregiver’s lives. Mangohealth sends reminders of when to take medicine, and warns of any dangerous interactions with the meds. ZocDoc helps consumers find and schedule doctors’ appointments online in real time. It was recently the first health app ever to make it to iTunes most downloaded apps list.
Apps such as Serious Game et Maladie d’Alzheimer, developed in France, or Lumosity, use gamification techniques to stimulate cognitive skills. Others, such as SuperBetter, help us design our goals for healthier living, whether recuperating from an injury or living with a chronic condition. SuperBetter focuses on mental, emotional, social and physical health. Other apps such as Mobicare, in Canada, offer support and information for families and caregivers, of Alzheimer’s patients in this case.
Telemedicine is another area where mobile technology is starting to make an impact. The Mayo clinic is using smartphone cameras to remotely evaluate stroke patients.
Augmented reality is also beginning to be applied to healthcare, thanks to the use of tablets. Fraunhofer recently created an app thanks to which a doctor performing surgery can hold an iPad up to a patient’s body to see a digital overlay of key blood vessels, so as to avoid accidentally cutting them. The new Google Glass will also be useful for augmented reality apps, as well as for educational purposes. In Spain, a doctor recently wore his Google Glass for surgery, sending out images to 150 students worldwide.
Apps can also be used for data collection and analysis. Crohnology does this with Crohn’s disease patients, who record their treatments, lifestyle and health situation on an app. This data is crunched anonymously so that more is understood about this disease. Ginger.io works similarly for Diabetes type II, adult ADD and certain heart conditions. Another award-winning platform, Magpi, can be used to easily design health surveys and collect data through smartphones.
One of the great revolutions that mobile technology can bring about is thanks to how widespread mobile technology is in the Third World. Text to Change has been extremely successful by engaging patients through SMS to tackle issues that range from ensuring healthy pregnancy in Tanzania to following up malaria cure in Uganda.
As you see from this brief overview, there is a huge variety in what health apps can offer. Now, how can I, as a normal consumer, separate the wheat from the chaff? In a recent interview Cardiologist Eric Topol form California says “these days I am actually prescribing a lot more apps than I am medication”; this is probably the key for unlocking the bundle. Doctors are responsible for spreading the use of mHealth in general and apps in particular.
Let’s go quickly over very important issues in designing successful apps. To start with, they should be able to run on at least three different operating systems: iOS, BlackBerry, and Android. They should also be optimized for different mobile and tablet devices. Then there is the issue of data privacy regulations. And, all things going well, some form of validation should be performed. Now we will concentrate in the financing of the above process.
A recent study by PWC shows how conflicting interest can jeopardize the adoption of mHealth tools. Topping the list of drivers for adoption of mHealth among individuals are 1) improved access to health care providers; 2) reduced health care costs; and 3) increased control over one’s health. As for doctors, the drivers are 1) improved quality of care; 2) improved access to health care providers; and 3) reduction of administrative burden. Finally from the payer’s perspective the main drivers are 1) reduction of administrative burden; 2) improved quality of care; 3) reduced health care costs.
The outcome is that those who should prescribe apps, and most probably the ones driving their design, do so for reasons that do not always coincide either with the patients who have to use them nor with the interests of persons who have to pay for them. Just as an example, empowerment, which ranks third among patients’ priorities, ranks only sixth among doctors and payers.
The question is then, how can we convince anybody to finance a tool designed by somebody who is not thinking about the expectations of the end user and that will be paid for by a person who is looking for something else? The answer probably lies in designing for the customer; nothing new since that is what all successful consumer industries do.
Despite the hurdles, I think that it would be silly not to explore a massive new medium available to us. Cellphones mean mobility, connectivity, information and communication. All of this can help empower patients and caregivers, make more informed doctors and even help researchers. It is an exciting time to be involved in mobile app development, because there is so much to do. In the world of health, mobiles can contribute to finally bring about a change of paradigm through information sharing, both horizontally and vertically. Patients can teach doctors and doctors can teach patients, therefore making the health processes more efficient and user-friendly.
Given at:
European Knowledge Tree Group
Norrköping (Sweden), 24th September 2013

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Do we really measure the efficiency of the health care system? When introducing a new ICT, do we carry out a proper cost-effective analysis comparing its outcome to different alternatives? Or do we allow ourselves to be carried away by the prospect of introducing the latest technology?

A recent study carried out by a regional health care authority in Spain supports the alert given by the WHO according to which 30% of health care processes are useless. On the same lines, a new study published in Health Affairs suggests that physicians who have access to  electronic health records are more likely to order additional imaging tests and laboratory tests than doctors who rely on paper records.

In times of crisis, when authorities are looking everywhere for ways to save,  when in most countries the easy way out has been taken by slashing the work force (physicians, nurses, …) it would be good to pause and think. Could we not take another, perhaps more difficult, route and analyze where the money really goes? Human knowledge is the most important ICT tool we have. It also has an ability that most hardware does not have: it can switch jobs and perform multiple tasks with a flexibility that no gadget can achieve. Why don´t we start carrying out comparative cost-effective analyses of alternative care processes comparing human based processes against ICT based processes? I have no doubt we will have some surprises.

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There has been a lot of effort put into designing an Electronic Health Record (EHR) in almost every country that regards the use of ICT as a cornerstone of health in general and e-health in particular. EHR becomes, under this perspective, a panacea for almost all ills that affect our National Health Systems (NHS).

As far as I know, the effort and the money spent on such an undertaking have not been rewarded with a very high return of success. Nevertheless, so much money and time have been spent on its development that, nowadays, EHR could fall more into the category of placebo.  The effect is that those in positions of responsibility in the NHS can pretend to be doing something without doing any real harm to the system.

The reason could be found in the narrowness of the approach. It is a fact that the interest and objectives of practitioners in hospitals and those of family doctors have in common exactly NOTHING.

Family doctors or general practitioners (GP) have customers for life: they start caring for them shortly after they are born and “get rid of them” when signing their death certificate. A specialist in a hospital has a different approach: the trend is to tend the customer for as short a time as possible; a “vini, vidi, vinci” kind of approach.

Why don´t we stop wasting our time and money and recognize that those two groups of health practitioners, paraphrasing Sue and Ray Bohlin, perfectly fit the description of “specialists are from Mars, GP’s are from Venus”?

Maybe we could then start thinking of a different approach and distinguish between the specialist’s needs as opposed to those of GP’s (and other social and health service providers) who take care of us our entire lives. 

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It is a fact, as far as I know, that the only available project manager in the process of healing is oneself. To be sure, specific support is provided by some of the organizations involved, aimed at helping the project manager to ease the burden along the process, but such support is limited to the area in which the organization is directly involved.

However, the system relies on the ability of the subject to understand a very complex process, with multiple organizations involved, with professionals in those organizations who care more about efficacy than human behavior, and that have a very limited connection with the organization that will follow up the continuous process of healing.

If we are aiming at promoting a long, safe and fulfilling life at home for our citizens in general, and our elderly in particular, the least society can do is to provide some kind of tool that enables them to manage their life efficiently.

Probably, in an ideal world without any kind of budgetary restrictions, this tool would be a social worker. This professional, through permanent contact with all socio-health providers, would be able to assume the role of project manager.  Such a figure would inevitably be, in most cases, a very intrusive entity and will be rightly resented: who wants somebody permanently interfering in one’s life?

The conclusion is that, except in cases of incapacitation, the best available solution is for us ourselves to manage our lives. For most people, having the proper tool that facilitates the chore is enough. An agenda has been such a tool for most of our lives, but as the project gets more complicated and the inputs get more complex, the tool has to evolve into something more sophisticated. I believe that an Electronic Health Record enhanced to include social care related events, constituting a veritable Electronic Socio-Health Record, based on an off-the-shelf third generation mobile phone could prove to be such a tool. This will represent moving from eHealth to a more comprehensive eSocioHealth.

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