NZMA Social Media Guide

As the use of social media has increased by medical professionals, the New Zealand Medical Association (NZMA) today released the "Social Media and the Medical Profession" guide. This document seeks to set up guidelines which medical professionals can follow to maintain a level of professionalism while engaging in the social networking realm of communication.

The guide provides case examples of situations where patient confidentiality, medical ethics, and doctor/patient boundaries could be called into question. At each stage of interaction, medical professionals must be aware of what information they are releasing and how the components could be pieced together to reveal more about the cases than they intend. Additionally, by crossing preset professional boundaries with patients on social networking sites, information about the medical professional may be revealed that impacts the way a patient views them and may damage the trust they are afforded.

When engaging in social media, some may mistakenly think they have complete control over what is and is not released. However, public information can still be accessed even long after its supposed removal from the net. Employers, patients, and colleges can do background checks on your name and turn up information that impacts their opinion of you. Mindfulness of how postings may be perceived is of utmost importance. The tools of social networking can be helpful, but also a hindrance. Don't let your online presence make a bad first impression.

Eliminating Barriers

Electronic medical records have become more widely used in practices across the country. Physicians can record and share information, allowing the patient's history to be accessed whether they are seen by their general practitioner or a specialist. EMRs have thus proven to be highly beneficial to the medical field. However, with the push to integrate technology into medical practice, it is always a good idea to keep in mind the patient interactions.

"It's great to have all the information readily accessible in one spot about a patient. But how you get it there, and how it interacts with the face time you have with your patient is a whole different thing." ~ LaVorgna (Former President of the Connecticut State Medical Society)

By bringing an electronic device into the examination room, physicians may begin to pay more attention to their tablets than their patients. Human contact, one-on-one interactions, cannot be sacrificed for the efficiency of data collection. Patients should be afforded the doctor's undivided attention when going through diagnostics. At present, even without technology intruding, this may be difficult, but the introduction of electronic medical records should aid instead of hinder that interaction.

The integration of technology will continue in the medical field. The benefits of such tools will increase the ability of physicians to provide improved care. However, it must be done mindfully. All healthcare providers must remember to avoid creating barriers when interacting with patients. Patients need to know their provider is listening and not setting themselves apart. With eyes trained solely on the computer screen, the first impression will not be a good one.

mHealth Summit

The mHealth Summit was recently held in Washington, DC. Marking its second year, the summit gathers together contributors in the mobile technology and health fields to discuss ways of integration. This year, the attendance tripled to 2400 and the summit hosted exhibitors from 125 companies. Key note speakers Bill Gates, Aneesh Chopra, Dr. Judith Rodin, and Ted Turner spoke on issues such as how to improve health outcomes by utilizing mobile technology for patient reminders and electronic health records.

The summit serves in partnership with both the NIH and the mHealth Alliance, and is organized by the Foundation for the National Institutes of Health. It is held for three days in Washington, DC so that industry officials can meet to discuss and plan the future of mobile health technology. This fostering of communication also leads to many worthwhile endeavors after the conference ends.

“The people, ideas and innovations at this year’s mHealth Summit are a testament to the fact that the mHealth moment has arrived, and is moving full-speed ahead. The mHealth Alliance was very pleased to announce a series of major grants and new partnerships during the Summit. It is these connections and commitments that make events like the mHealth Summit so important in helping to drive forward the field of mHealth.” ~ David Aylward, mHealth Alliance Executive Director

Because of its success, there are already plans for the 2011 summit to be health December 5-7 in Washington, DC. By joining the conversation and contributing to the future of mobile health technology, the future of medicine is ever-changing for the better. Better patient outcomes is within reach as we embrace what the latest technology can provide us.

Making Medicine Fun

Learning through case-based education is often more involved than simply reading from a textbook, but sometimes it's not as fun as it could be. That's where Medical Joyworks comes in. They have created a clinical case simulation app that turns learning into more of a game.

The Apple app, named Prognosis: Your Diagnosis, allows for individual and group case review. The scenarios are based on real patients who have come in for medical or surgical treatment. After being downloaded, the cases only take a few minutes to solve and new cases are released weekly, so there is always something new to review. Each case provides the patient history, the ability to examine that patient, order tests, administer treatment, and then complete the case. Your performance is then rated at the end and you can discuss the case with other users. Additionally, users can submit their own cases to be considered for inclusion in future app updates.

You can download the free app from the ITunes app store today and read about how the app came to be in the Medical Joyworks blog. Learning is fun!

Portable Ultrasounds

The bedside examination of patients has remained relatively unchanged for over a century. However, with access to new technology, perhaps these examinations can be supplemented with portable machines. One such device is the pocket-sized ultrasound.

Over the past year, these devices have come into use among some health professionals. With a rechargeable battery and a size comparable to a Blackberry, doctors can take them when they do rounds and easily administer a test that once had to be scheduled. Additionally, ultrasound technology can be used to scan the entire body without the presentation of radiation, which comes from x-rays.

“A surgeon can look for blood in the belly, a lacerated liver or for a broken bone in a person’s foot. An eye doctor can look into the eyeball. An OB/GYN can look at the uterus. There is no part of the body that this cannot be used on.” ~ Dr. Alexander B. Levitov (Professor of Internal Medicine, Eastern Virginia Medical School)

The portability of these devices also allows them to be brought into communities that may not have access to larger monitoring facilities. A diagnosis can be made in a shorter amount of time, as well as giving real-time results on the problem.

The next step, then, is to increase the use among health professionals. Perhaps focusing attention on medical schools is a good first step. By allowing the next generation of physicians to utilize these devices in their education, they can grow accustomed to them and they will become more commonplace when these physicians enter the workforce. Utilization of technology can allow the medical field to become more dynamic and able to provide better care for patients.

Focus on Healthcare

With the Patient Protection and Affordable Care Act set to take effect in 2014, the healthcare system is in for some changes. There will be an increased number of patients entering the system and physician shortages are becoming more of a reality. However, in consideration of ways to deal with future patient care, the nursing field has not been as strongly integrated into the changes considered. With a new report, titled "The Future of Nursing: Leading Change, Advancing Health" from the Robert Wood Johnson Foundation and the Institute of Medicine, the consideration of nursing has been explored.

Nurses are often the point of contact with patients, spending much more time on their care than physicians. The nursing field is also the largest segment of the healthcare population, with current numbers at 3 million. They are the healthcare professionals that should be the most involved in reshaping the future of healthcare to make sure it sustains itself and can fully support the demands placed upon it. In doing so, nursing roles must be redefined, as well as educational changes made, to keep up with the demand posed by the influx of patients.

Recommendations include making sure 80% of nurses hold a bachelor's degree by the year 2020, as well as increasing the number that obtain doctorates by double. Another suggestion is to require a nursing residency, to mirror the requirements set forth to physicians in terms of hands-on training. This could also translate into more hands-on care that can be done by nursing staff if regulations are lightened in terms of what nurses can and cannot do when providing patient care. By increasing the educational requirements of nurses, as well as the practice availability, the pool of providers will be more well-informed and better suited for the changing needs in healthcare. Nurses play an integral role in the healthcare system and must be considered as such when the healthcare system goes through its future changes.

New First Consult App

The use of apps among medical students and professionals has steadily grown as mobile technology becomes more integrated into the health field. The applications have provided instant access to invaluable information while in the lab, away from the classroom, or in the office. However, many of these apps require an online connection to access the information necessarily. As many know, there is not a constant guarantee that a data connection will be readily available where you are. A new app may have taken care of that issue.

The First Consult app, developed by Elsevier Inc., is available free for your Apple devices. This mobile application provides Point-of-Care clinical information for subscribers in an off-line database. The database updates automatically when an online connection is detected. Data is reviewed by physicians, peers, professionals from McMaster University, and an editorial board. A minimum of four physicians are involved before information is included in the final app update.

First Consult already integrates with both Zynx Health and various EMR vendors in order to seamlessly navigate between the two information resources. Additionally, the information in the app is delivered in a quick, succinct format so that medical professionals can quickly find what they need.

With the expansion of mobile technology, it is important to look into new and interesting areas of development which will ultimately make the acquisition of information fast and easy. Learning has expanded to the mobile market, so be sure that you're utilizing that avenue of learning!

Clickers In The Classroom

A recent New York Times article focused on the use of clickers in the classroom. These devices are part of an audience response system that serves many functions, from taking attendance to participating in a quiz, whereby professors flash a question onto the screen in the front of the classroom and the students use their clickers to choose an answer.

Ohio State and Harvard have looked at the impact this technology has had on students. They found that students actually understood the material better, perhaps because they were being engaged rather than simply taking in the information passively. Engagement in the learning process has always noted an increase in information retention, simply because many students learn by doing.

The possibility of utilizing clicker technology, whether with the traditional clicker system or through an app that can be accessed on students' smart phones, opens the door to many avenues of learning. The integration of technology into learning is a constant need and one that could help students become better suited for their future careers. Get students active in the learning process and the discussion may lead to some interesting and unexpected areas of exploration.

Twitter Doctors

There is an online directory (Twitter Doctors) which seems to be setting out to list every physician on Twitter. The listings disclose the medical professional's screen name, full name, location, number of tweets written, number of followers, and number of retweets. All of this information seems to be mined directly from their Twitter profiles. Additionally, this list ranks the physicians by influence as to how much they influence the public. The listing updates on an hourly basis and as of today there are 1326 in the database. In order to be included, you have to tweet about the list as well as follow its creator.

It's a fascinating cultural study, but what is the main purpose of the site? And does this open the door for the possibility of inappropriate patient information disclosure? Physicians who use social media have to be aware of what they can and cannot say in terms of their practice. Their opinion could be construed as medical diagnosis and that has many negative ramifications.

Perhaps, over time, the list can become more refined and made useful for purposes of finding physicians based on specialty or other categorization. For now, it's a look at the cultural significance of social media in medicine.

Mobile Apps On The Rise

Recently, a new report was released that looks at the future of mobile apps and its users. Portio Research Limited looked at the expected growth of mobile app users from 2010-2015 and they found that in the next five years those figures will likely grow by 37% and reach a user base of almost 256 million. Downloads of mobile applications by 2015 will increase by 53.2% and the revenue garnered will reach over $23 billion.

With these figures, it is vitally important that educators consider such technological avenues in their teaching. Instant access to mobile information is becoming more commonplace and the number of medical students who have a smartphone or equivalent has been steadily increasing. By using mobile apps, educators can supplement their in-classroom information as well as giving instant access to topics while students are in varying situations (studying, in the lab, etc).

While harnessing the varying technological opportunities available, educators can assure that the next generation of students have a more well-rounded and fulfilling background as they embark on their medical careers. Since mobile technology will be a large part of their careers, learning how to integrate the avenues early on will make the process smoother overall and make for a better prepared physician.

Delivering Bad News

All physicians, at some point in their career, will have to deliver bad news to a patient or the patient's family. Learning how to do this properly is vitally important in patient care. Sophie Harrison touched upon this issue in her Financial Times article "I'm Afraid I Have Bad News". Here's a brief summary of points she touched upon:

• Find somewhere private to speak about the issue.
• Turn off all cellphones or beepers so that you are not distracted from the information delivery.
• Gauge how much the patient/family already knows and proceed from there.
• Start the delivery gently, with phrases such as "I'm afraid I have bad news", and pause before proceeding.
• Outline the facts of the case in direct language.
• Do not overload the patient/family members with information when they are too upset to comprehend it.

When common sense is used, and patient reactions are considered, the delivery of bad news is not so daunting. 

Curbing Childhood Obesity

The issue of childhood obesity is one that comes up time and time again. Recently, at the mHealth Summit, the matter came up again in the presentation that Dr. Spruijt-Metz gave. "Pediatric obesity is a huge problem in this country and worldwide. We've been remarkably unsuccessful at combating it. . . . To change this behavior, we have to be revolutionary."

She and her research team have indeed taken a revolutionary approach to the problem. They've integrated mobile technology into a real-time monitoring device so that children can be sent physical activity reminders, as well as data collection that could help change the course of the problem.

The program, KNOWME Networks, includes wireless sensors that can record body fat, stress levels, location, physical activity, etc. Data is then sent to a secure server to be analyzed. The children involved in the study wore the sensors for about 11 hours per day when awake. Monitors would indicate if the wearer was stationary (sitting) too long and, if so, they would receive a message to take part in some sort of physical activity. In comparison, during the randomized trial, wearers will receive no message. Comparisons can be made to see if encouragement actually increases physical activity.

"In a sense, technology is part of the reason we have an obesity epidemic [because it provides] attractive, sedentary activities. We've got to...make [technology] part of the solution." ~ Dr. Spruijt-Metz

While this monitoring will not replace health professionals, it can aid in the situation by giving wearers a sense of direct connection as they go about their daily lives. This connection could create a behavioral change that combats the growing childhood obesity problem; a need that is ever-present in our population.

Rate of Uninsured Americans

The rate of uninsured Americans is increasing. Current figures show that 50 million people in this country are without insurance, compared to 46 million in 2008. However, those that are uninsured do not necessarily fit the preconceptions we may have that only the poor or healthy go without insurance.

"[H]alf of the uninsured are over the poverty level...[M]ore than two out of five individuals who are uninsured at some point during the past year had one or more chronic diseases." ~ Dr. Thomas R. Frieden, CDC Director

Cost is a prohibitive factor in care, so that those without insurance might skip certain treatments because they are too costly. Among those uninsured with chronic health problems, such as high blood pressure, diabetes, and asthma, 40% skip care because of cost. As a result, the health of the individual decreases, which in turn causes more costly treatment to be needed and can lead to early death. The same is true of disabled adults who are uninsured, as 30% of the population 18-64 delayed or skipped needed medical care because they couldn't afford it.

While the new Affordable Care Act may close the gap that now exists, it's important that physicians be aware of the immediate needs of the uninsured population. Alternative or selective care should be considered so that those in need do not have to go totally without treatment. The future looks brighter in terms of healthcare, but the present is not so sunny.

Online Presence

As the population becomes more intertwined with social media, it's important to be aware of what your online presence says about you. Students applying to medical schools, as well as doctors in the field, should know that employers and possibly even patients might search for your name on the internet. What will they find when they do?

"Google is your first résumé. If it could potentially embarrass you, it probably will." ~ Rick Gillis, Job Search Expert

Opinions expressed, as well as activities participated in, will build a mental image of the person in question. Patients and potential employers may get a negative opinion of you based on their search results. In response to this, some medical students have begun locking down their social networks, while doctors may be pulling away from online interaction, but it's not necessary to completely cut yourself off. Simply be conscious of what you say and do that may be construed differently than first intended. By being more aware, medical professionals can enjoy the values of being online while still maintaining a level of professionalism that others have come to expect.

Increased Prescriptions Does Not Equal Increased Health

The New England Journal of Medicine has released two studies concerning prescription drugs and health outcomes. Researchers found that higher spending on prescriptions does not mean that the health of patients will necessarily improve. This may be an indication of inappropriate prescribing; patients being prescribed medication that they don't necessarily need. Medicare has already started counteracting this, through the Medicare Modernization Act, by limiting the amount of money they will reimburse for certain medications. This has caused doctors to start limiting their prescribing of such drugs, so the changes have already begun, but more consideration is needed.

"We found that physicians respond to reimbursement, but they respond in a way that appears to be beneficial to the patient. They don't tend to cut out necessary care, but they tend to cut out unnecessary or inappropriate care." ~ Dr. Vahakn Shahinian, University of Michigan Medical School

It is important that medical students are trained to be conscious of the way they prescribe medications and the benefits that the patient will have as a result. Costs should be weighed against benefit and consideration made about whether the medication is actually necessary for treatment.

New Health App from Quest Diagnostics

The ability to have ready access to patient health information is a desire for many health professionals. A new app from Quest Diagnostics may make that access even easier. The app, named Gazelle, puts the power into the hands of patients and allows them to carry around any pertinent health information so that treatment can be provided even if they're unable to convey their history.

The app provides a section for emergency contact information, so that caregivers can contact others in case the person is incapacitated. It also allows the user to list their PCP, any allergies they may have, medications they take, and any medical conditions they have. In a locked database area, individuals can keep contact records of their doctor, pharmacy, preferred hospital, and any insurance information they may need. The same is true of the medical information management system. Records of immunizations, recent travels, and blood type can be stored for reference, along with health information of family members. The user can share health information readily through various communication methods which integrate into the app. Gazelle even goes further and links lab results straight to the user's phone so that instant access can be attained and allows the user to instantly schedule lab tests through Quest Diagnostics.

With this step towards health records being more easily accessible, it is hoped that patient outcome can be improved. Doctors need as much information as possible to diagnose and treat patients. Mobile apps are seeking to make that a bit easier.

Lack of Insurance

With the proposed changes in the healthcare system, it is hoped that the barrier created by a lack of insurance will be improved. However, at present, it is a large problem that leads to patients often foregoing necessary testing and may even lead to death.

 Lack of health insurance increases the risk of premature death by 25%. In 2009, FamiliesUSA has estimated that 23,400 Americans age 25-64 died because of lack of health insurance. Since 1995, that number totals 294,000.And these deaths could have likely been prevented if patients didn't have to budget and estimate what treatment they could or could not afford. 

“When you’re working with uninsured patients, there’s not just one system that works. As a provider, you end up developing systems to manage care that you wouldn't use otherwise." ~ Debra Howenstine (Medical Director, Columbia/Boone County Department of Public Health and Human Services)

While it may be harder to arrange proper care for patients when presented with this barrier, it is important as a health professional to try to provide the best course of treatment for your patient. That may mean more carefully choosing which tests to order or coming up with a non-traditional treatment plan. However, if it is in the best interest of your patient and will provide a course of care when there was previously none, it is worthwhile. 

Technology in the Body

Instead of asking patients about their health issues, soon it may be possible to just scan an embedded chip to receive such information. That's the hope of the Queen's University Belfast's Institute of Electronics, Communications, and Information Technology. They are working on a microchip that would be put until the skin, recording and transmitting data to a central server.

“The availability of body-to-body networks could bring great social benefits, including significant healthcare improvements through the use of body-worn sensors for the widespread, routine monitoring and treatment of illness away from medical centres." ~ Simon Cotton, Researcher

With the integration of mobile technology into society, advancements have often made our lives easier. By being able to continually monitor health, problems have the prospect of being caught earlier, thus improving treatment outcomes. It would also improve patient data, since the information would be shared accurately and instantly rather than having to rely on patient recall.

What do you think about the prospect of embedded medical monitoring? Is this a step in the right direction or is it a step too far?

Continuing Education vs Lifelong Leaning

As a health professional, you will often have to take continuing medical education courses to continue your credentials. The problem is that sometimes CME training becomes more about quickly accumulating the necessary hours and less about the actual learning process.

Clinical competencies are only a small part of needed education, since the ability to work as part of a team structure and the ability to use current technologies are also vitally important. Two reports released earlier this year highlighted areas where the CME system would be warranted to undergo revision and perhaps more emphasis placed on life-long learning rather than short-term knowledge acquisition.

Perhaps this is an indication that the CME system needs to be restructured and changed so that it's more individualized, taking into account the physician's practice when teaching skills necessary rather than giving a more generalized approach. It's important to keep up to date on the latest topics when it comes to patient care, but it's also important that the education received is actually beneficial rather than just another requirement that must be completed.

Alcohol Most Harmful Drug

A new study in the UK has found that alcohol tops the list of most harmful drugs. Funded by the Centre for Crime and Justice Studies, The Lancet medical journal ranked a list of 20 drugs to determine the amount of harm in terms of social, physical, and psychological problems. Harm to others was determined in the areas of economic cost, international damage, decline in community cohesion, environmental damage, crime, and family conflict. Determination of harm to self was made in the areas of injury, loss of tangibles, loss of relationships, dependence, drug-related impairment of mental functioning, drug-related damage, drug-specific damage, drug-related mortality, and drug-specific mortality.

Top Ranking For Most Harm to Self

• Crack Cocaine
• Heroin
• Methamfetamine

Top Ranking for Most Harm to Others

• Alcohol
• Heroin
• Crack Cocaine

Top Ranking for Most Harmful Overall

• Alcohol
• Heroin
• Crack Cocaine

These findings indicate a strong need to educate about addiction, as well as a heightened need to focus on legal drugs such as alcohol. While preconceptions weigh illicit drugs as being a larger problem, weighted consideration for the impact the drug has upon both self and society shows that legal access may lead to worse effect.