New App Released By AMA

This week marks the official release of the American Medical Association's first mobile application. Named CPT® E/M, the mobile app provides a database of suggested evaluation and management billing codes which physicians can use to quickly code patient records. The information can then be sent by email. The app will run on iPhones, iTouches, and iPads and can be downloaded for free from iTunes.

“The AMA’s new CPT quick reference app helps physicians determine the appropriate E/M code for billing quickly, easily and accurately. To find the next great medical app idea we are going right to the source by inviting physicians, residents and medical students to participate in the first-ever AMA App Challenge.” ~ Steven J. Stack, M.D. (AMA Board Secretary)

This is in reference to the fact that the AMA has launched their 2011 AMA App Challenge. Medical professionals are invited to submit a medical app that can be used in their careers. You can find further instructions on what they are or are not looking for within their challenge guidelines. One winning app from a physician and one winning app from a resident or medical student will be awarded a $1500 Apple Store gift card, a $1000 American Express gift card, a trip for two to the November 2011 award ceremony in New Orleans, and a listing as author when the app is published. Eight other finalists will receive a $100 American Express gift card as runners-up.

The American Medical Association is taking full advantage of the mobile health market and the potential for benefit from these tools. Download the app today or come up with one of your own to share with the medical community. The repercussions of benefits could be widespread.

Drug Detailing and Academic Detailing

The influence of the drug industry is well-known; a practice commonly known as "drug detailing." Pharmaceutical representatives will offer physicians free pens, free lunches, and free seminars in order to get their foot in the door and get the doctor to listen to their sales pitch. Once the doctor accepts these gifts, they have the feeling of being indebted to the industry and are more likely to take the sales pitch seriously. This leads them to prescribing the promoted medication for their patients, even if it's more expensive or not the best option.

Medical schools have already noted their desire to decrease the influence of the pharmaceutical industry. JAMA published a report in which the influence of pharmaceutical representatives was found to increase the rate of prescriptions in general and decrease the rate of generic prescriptions, instead focusing doctors on name-brand prescriptions. Patients as well have noted a negative reaction to how much control the drug representatives have over caregivers. A 2008 Pew survey showed that patients are against the practice of the drug representatives providing free lunches and dinners to physicians (78% and 86% respectively), as well as the provision of free office supplies (70%).

In order to counteract this negative influence, medical schools have instituted an academic detailing in which pharmacists are trained on proper drug techniques and then sent out into the medical community to educate physicians as well. This has decreased improper prescribing significantly. It's also limited the influence the pharmaceutical industry has on individual prescribing.

By separating physicians from the pharmaceutical industry, patients can be more assured that they are getting care based on their symptoms rather than what latest drug on the market is being pushed by the pharmaceutical representative.

Residents in the OR

As a medical student, you are learning as much as possible in the area of medicine so that you can become the best physician possible. The training you receive while learning will prepare you for the challenges you will face when going into practice. This training comes both from classroom instruction and hands-on learning with actual patients. However, this hands-on training may not been seen as welcome by patients or their families.

The New York Times recently touched upon the issue of physicians-in-training being present in the OR. They mentioned how the family of one patient asked that residents be kept out of the OR while their loved one was being operated on. While the patient has the final say in who should or should not be admitted to the OR, patients and their families should consider all the surrounding information when deciding.

The Journal of American College of Surgeons recently published a report on The Influence of Resident Involvement on Surgical Outcomes. They found that while patient complications were slightly higher when residents were involved in the OR, patient mortality decreased. It may be that the residents are on increased look-out for major issue that may arise, thus preventing serious ramifications in care. However, since they are still learning, they are more apt to make minor errors that may lead to patients having to deal with lesser complications.

“The question might then become would you accept the risk of a urinary tract infection that required an antibiotic for several days if you knew it might save your life?’” ~ Dr. Mehul V. Raval, Senior Surgical Resident (Northwestern University Feinberg School of Medicine in Chicago)

The benefits to residents of having hands-on training means they can become better doctors through their experience. Patients, too, receive a benefit from their interaction because it may decrease their risk of serious, often deadly, complications arising from surgery. It's important that patients see the benefit to having students in the OR. It may make a major difference in patient outcome.

Targeting Primary Care

With the need to expand the number of primary care professionals in the medical field, schools are looking into ways to make the career option more appealing. One such plan has been undertaken by Texas Tech. This school has condensed the normal four years of medical education training into a three-year fast track if the student focuses on primary care. This is helpful both in gaining new professionals in the field, but also get them into practice at a much faster rate.

Additionally, medical schools are once again expanding. There is an expected 15 new medical schools opening in the near future. This raises the amount of classroom space for potential healthcare providers. And the focus is not limited to just doctors, as many nursing schools are trying to increase the number of Advanced Practice Registered Nurses (APRNs) in order to provide more primary care nurse practitioners. The potential benefit of primary care providers is high and can have many positive ramifications across the population.

"You get to have relationships with your patients for years. Plus, I like that you treat the whole person, rather than just their kidneys or their heart," Clay Buchanan, Medical Student (Texas Tech University Health Sciences Center School of Medicine)

In less than a decade, the PCP shortage may increase to 39,000. As healthcare reform comes to practice and more potential patients enter the market, the need for healthcare providers is pressing. But less than 10% of medical students currently go into primary care and that number has been decreasing. This emphasizes a real need to make primary care a more appealing and viable career option. If we all work together, the future of healthcare does not have to be in jeopardy.

New App Targeted To Melanoma

With the expansion of medical-related apps on the market, many different medical topics have the potential to benefit from mobile technology. The ability to access resources, expand on currently-available information on certain diagnoses, and find healthcare providers are all viable with the mobile market. One such medical topic, melanoma, is finding its footing with the CancerCommons app.

The CancerCommons app sets up a social network among those involved in melanoma (patients, physicians, researchers, etc.) so that patients can get information about current treatment regimines, possible clinical trials they could take part in, and the most up-to-date information on the diagnosis. By answering a few questions, the patient can receive individualized suggestions as to their care.

"Cancer Commons puts the patient at the front end of a remarkable experiment in translational medicine — one in which basic molecular biology, computational methods and a network of experts and institutions collaborate to work out personalized medical solutions." ~ Donald Kennedy, Ph.D. President Emeritus Stanford University and Editor of Science (2000 - 2008)

CancerCommons employs an 18-member editorial advisory board with leading scientists in the cancer field. Members include the former Editor-in-Chief of JAMA, a past President of the College of American Pathologists (CAP), a former FDA Commissioner, the President emeritus of Dana Farber, past President of the American Society of Clinical Oncology (ASCO), the current Director of the UCSF Comprehensive Cancer Center, the founder of the Association of Cancer Online Resources (ACOR), as many other leaders in the field of cancer research. As the success of the current app grows, they expect to expand their focus to other types of cancer which can benefit from the format.

The possibilities of mobile technology is expanding. By utilizing the benefits afforded by mobile apps, patients and caregivers can expand their reach and benefit from a much wider range of treatment opportunities.

Matching Patient and Doctor

The San Francisco Examiner recently had an article geared towards patients, helping them choose the right doctor. While the article itself is directed towards the consumer, the hints can be reversed and applied to healthcare providers as well. Your ability to best provide care for your patients is of utmost importance.

Realistically, the backbone to all selections for care will rely on your background. If you have strong educational credentials, as well as board certification and experience working with other leaders in your field, you are more likely to be looked upon favorably when a patient is making a decision about providers. But what about after that?

One suggestion was about potential patients asking their social circle for feedback and suggestions for providers. Word of mouth does wonders in promoting certain healthcare professionals. If your current patients feel you provide good care, they are more likely to tell their friends and family, thus increasing your number of potential patients. This means both the interactions you have with patients while they are in your office, as well as when they are not. If your patients have questions about their case and you make yourself available to answer their questions either on the phone or through email, you are looked on more favorably. And this will translate to positive word of mouth.

Your patients are your largest asset when it comes to publicity. By providing them the best possible care, they will want to extend that care to their loved ones.

Technology in the Room

With the increase in technology in medicine, the industry is looking into new and inventive ways to include the tools within patient interaction. One venture is the use of interactive technology in patient rooms. By providing a way for patients to learn more about their diagnosis and the standard of care they would be receiving, as well as submit requests for further information, patients can feel as if they're taking a more involved role in their care and healthcare providers can more easily prioritize their focus amongst all their patients.

A white paper recently released by The Beryl Institute showed the results of a survey conducted among patients while using interactive technology during their hospital stay. These patients were asked their satisfaction levels with the hospitals providing their care. Compared to previous satisfaction outcomes, those using interactive technology increased patient satisfaction by 10%. When asked to rate the educational materials provided by the hospitals, patient satisfaction increased by 42%. This is a significant result in terms of the positive benefit of interactive technology.

"Without a doubt, the positive patient experience generated from the use of interactive patient technology in the hospitals is significant...Research shows that improving the patients' perception of the care they receive is a major goal for healthcare systems across the country, and the case studies presented in this white paper show how modern technology can be used effectively." ~ Jason Wolf, Executive Director (The Beryl Institute)

By utilizing the technology available, the level of patient involvement in their own care can increase and the flow of information between patients and physicians can benefit greatly. Bringing interactive technology into the patients' rooms is not only helpful in terms of patient involvement, but helps make the entire care experience more pleasant for all involved.

Music in Medicine

A recent article on PopRx talked about the use of music in the operating room. Whether you're a medical professional or a consumer, we're all used to the image of surgeons entering the OR and putting on some music as background while they work. Soothing classical may provide the calming atmosphere needed to concentrate on the minute details of surgery. Or some classic rock may give the surgeon the boost of energy to sustain them through the hours-long process of operating. But are the results real or just a figment of our imagination?

A 1994 report, which was published in the Journal of the American Medical Association, shows that music does have a positive effect if the listener is allowed to choose it themselves. Surgeons were given the task of performing mathematical problems while listening to music of their own choosing or music deemed soothing by the researchers. Their vital signs were then monitored. When they were allowed to listen to their own music, their vital signs were much more steady compared to performing within the environment filled with soothing music. So, yes, music makes a difference. But other variables come into play rather than just switching on a random song. You have to enjoy music in the first place, else it can be a distracting presence. Additionally, the other members of the operating team should be consulted in deciding upon the music selections because, even if the surgeon loves the music, others may not, and that can cause them to become distracted from their job.

So, when taking a turn in the OR, feel free to put on some favored tunes as you work. Just make sure it's enhancing your team's performance rather than hindering it. The patient remains the most important person in the room.

iPad Curriculum

When the Class of 2014 entered medical school at University of California-Irvine last fall, they were presented with an iPad. This technology would allow them to engage in what may be the future of medicine. UCI has created a program which loads the iPad with the entire curriculum that will be needed amongst first-year students. In addition, there are apps and other tools loaded on the device which will help medical students begin their training.

“We are committed to using evolving technology to benefit the education of our medical students. It is our firm belief that a digitally based curriculum will be the wave of the future, and UCI seeks to be a leader in the innovative presentation of information to students.” ~ Dr. Ralph V. Clayman, Dean (University of California-Irvine)

This push by UCI is labeled the iMedEd Initiative, which seeks to create learning environments for individuals and small groups that foster discussion and enriches their entire medical school experience. This approach takes learning from passive to active by breaking out of the classroom model. And with the expansion of technology in the medical field, it's important that future physicians take full advantage of the tools that are being developed.

UCI is engaging in an intriguing experiment and it has the potential to not only be expanded within their school system, but around the country. By incorporating mobile technology into the curriculum early on, students will be comfortable with the devices and will be more likely to carry their use over into their own practices.

Preserving Empathy

As has been mentioned multiple times in this blog, the issue of empathy among health professionals is very important. While students may enter medical school with the ability to empathize, less enter the workforce with this ability still in place. Indications are that students are taught to keep their emotions in check, perhaps even completely removed, when dealing with patients. While this emotional-separation can prove vital in treating patients from a completely professional standpoint, it also puts patient interaction at risk. Now, a new study shows that students need not lose the ability.

"Showing compassion and approaching each patient with empathy is never naïve; it's called being a good doctor. If bad behavior can be contagious, then maybe empathy and compassion can be too." ~ Medical Student From Study

In the study, 209 medical students (Class of 2009 and 2010) at the Robert Wood Johnson Medical School who were taking a mandatory Humanism and Professionalism component to their learning. Unlike previous studies, where students showed a decline in empathetic ability, the study participants did not show a marked decline. This may be related to the added requirement of the Humanism and Professionalism component, as it emphasized the traits necessary for empathy. If this is the case, then it shows a need to teach the maintenance of this skill so that it is not lost after the course of medical education and can remain when students go into practice.

Empathy is an important skill to have. Patients need to know that you'll provide them the best care possible. By showing empathy, you can show your patients that you are invested in their treatment and that this will truly be a team effort.

Sleep-Deprived

Millions of Americans, including medical students, rely on technology to help them through the day. Whether it's your laptop or your iPhone, many of us use such devices to interact and catch up on events even up to the time when our bodies tell us that it's time to get some rest. But such usage may actually be throwing off our natural rhythms and causing us to have less productive sleep. This is the finding from a new National Sleep Foundation survey whose results were released today.

"Falling asleep isn't like flicking a switch. We don't put our heads on the pillow and fall off to sleep. We take time to wind down at night. If we've got bright light conditions, we're not giving ourselves a chance to get off to sleep and stay asleep." ~ Allison G. Harvey, Sleep Specialist and Professor of Psychology (University of California at Berkeley)

The survey sought to understand the sleep habits of Americans. They took responses from 1508 Americans (ages 13-64) and asked them about their daily habits and their feelings on getting enough shuteye. 63% admitted that they don't think they're getting enough restful sleep during the week. A surprising majority (95%) also said that they used an electronic device at least one hour before bedtime multiple times per week. Perhaps there is some correlation between the two, as electronic devices create artificial light that suppresses your body's ability to produce necessary melatonin.

While each person's sensitivity to light will be different, it's important that you give your body time to unwind and get into a natural sleep pattern that will leave you rested. Perhaps it would be best to set the laptop aside for an hour before bedtime and just focus on relaxation. Listen to your body's natural rhythms or else you'll be feeling the effects the next day.

Testing Overload

Amongst previous generations of physicians, the hands-on approach of treatment was often the default. If a diagnosis could not be determined, then the physicians would resort to more expensive and complicated testing. In current medicine, there seems to have been a switch to a more defensive medicine technique where physicians would rather run every test possible before venturing a guess as to what might be wrong. The question then becomes does the benefits outweigh the negative effects?

Tests cost money, which comes from patients or more regularly the insurance industry. That in turn raises rates and puts medical coverage in danger of becoming too expensive. That's one large motivator in eliminating unneeded testing. A second reason is the negative health effects unneeded testing can have on a patient. Between the stress of anticipation, both in taking the test and awaiting results, and the exposure to radiation and testing dyes, the physician may be causing more harm than good. 

To make a change, there needs to be input and progress from any different sources. A change in attitude is needed from the patient, who may perceive that they're getting better care if their doctor orders a test as opposed to simply making a diagnosis from what they observe. In terms of money, a fixed rate charge could be placed on cases so that unnecessary testing wouldn't be rewarded and instead would cost the doctor money in their total reimbursement. This proposal should be done carefully, though, as it may mean physicians would stop ordering needed tests in fear they wouldn't be reimbursed enough to cover their costs. And finally, more emphasis on hands-on diagnosis must be made in medical schools. If the next generation of physicians can trust their instincts rather than relying on expensive testing, the ultimate cost of care can decrease dramatically.

iPad 2 Coming Soon

With the announcement of the iPad 2 coming soon, there is even more reason to focus medical school training on mobile technology. The versatility of the iPad and its associated technologies can open the door to a wide range of educational potentials for medical schools and physicians in practice.

The iPad allows for accessibility to a wide range of reference materials. Students can run apps on topics ranging from anatomy to surgery. With the new release, FaceTime gives the potential to run live, remote Standardized Patients in order to practice proper interviewing skills. The benefits from iPad technology can also follow through to practice, as physicians can have instant access to patient records and reference materials while in the room with the patient.

This is not the first time mobile technology has been proposed for integration into medical training. Many medical schools have already utilized the iPad in their own curriculum, both as an additional tool or by replacing standard learning materials with the iPad. It certainly illustrates the potential that these mobile technology advances can have upon education in general. By using these tools, medical schools have the ability to create a stronger medical system and a well-prepared generation of physicians.