By Kim Newell, MD
Our patients are getting overloaded with health information from more and more sources, and yet they often don’t get to the right answer. Recent studies have shown that more than 98% of the online health-related discussions take place without the input of a health care professional.
How do we make sure that we remain an integral part of our patient’s health care conversations? As a pediatrician in an increasingly complex health care delivery system, in which I must provide more care with higher levels of service to increasingly savvy patients in less time, I have begun to turn to technology, the Internet, and especially social media to help me do my job better.
There are many compelling reasons that I am active in social media.
There was a time when we physicians didn’t have to compete for our patients’ attention—we were the one voice in the room. I believe that the core of our healing still happens one on one, with patients in our examining rooms. However, we must also begin to meet our patients where they are: on their smartphones and tablets and computers, doing research and engaging in discussions on Twitter and Facebook and in the blogosphere.
There’s a conversation going on. About health.
In the end, the key is not in the technology or the tweets: It is in the trust that we build with patients. We, as a medical community, must figure out how to be not only a part of the health-related conversations happening in social media but also to lead those discussions. We can and must use these channels to combat misinformation, promote health, and engage the trust of our patients.
This article originally appeared in the May 2013 issue of San Francisco Medicine.
Dr. Kim Newell is a general pediatrician at Kaiser Permanente and a member of the SFMS board. She began to learn about technology and medicine upon moving to San Francisco for residency at UCSF and is now a technology lead at Kaiser, where she also teaches a class about vaccine safety for parents and helps lead an innovative obesity management program. She tweets at @drkimmd and sometimes blogs at drkimmd.com.
U.S. hospitals lose a total of $8.3 billion annually due to inefficient communications technology, according to a new report from the Ponemon Institute the Wall Street Journal's "CIO Journal" reports.
The report was sponsored by Imprivata, a provider of health care security software and services.
For the report, Ponemon surveyed 577 health care and health IT professionals at medical facilities that ranged in size from having fewer than 100 beds to having more than 500 beds.
The survey asked participants about the challenges they encounter in using communications tools, finding that:
The survey also asked participants about the effects of complying with HIPAA, finding that:
Survey participants also answered questions related to time spent communicating. The survey found that:
The report estimated that inefficient communications technology causes the U.S. hospital industry to lose:
Physicians should exercise caution—and “pause before posting”—when interacting in online settings in order to preserve professionalism and maintain appropriate patient-physician relationships, according to a policy paper released today by the American College of Physicians and the Federation of State Medical Boards.
“Online Medical Professionalism: Patient and Public Relationships” addresses the use of online and social media and electronic communication between physicians and patients. The two organizations looked at opportunities and challenges created by new technologies and online forums, and provided recommendations and strategies for physician behavior in these areas. Digital communications and social media use continue to increase in popularity among the public and medical profession. The ACP policy paper discusses best practices to inform standards for the professional conduct of physicians online and includes a chart of online activities, potential benefits and dangers, and recommended safeguards for physician behavior.
The paper will be published in the April 16 issue of Annals of Internal Medicine, and is authored by ACP’s Ethics, Professionalism and Human Rights Committee; ACP’s Council of Associates; and FSMB’s Committee on Ethics and Professionalism.
Patients love it. Physicians find it often saves them time and money. So why aren't more doctors burning up the email lines with their patients?
As the rest of the world has raced ahead with instant communication, medicine still lags far behind. Just under one-third of doctors reported emailing with patients in 2012, up from 27% five years earlier, according to annual studies of more than 3,000 doctors conducted by Manhattan Research, a health-care market-research firm. Those texting rose from 12% in 2010 to 18% in 2012.
Doctors who shun email cite concerns ranging from privacy and security issues to liability, inconvenience and the risk of miscommunication of important medical information. Some also say the time spent emailing with patients is time unpaid. Few doctors charge for the service.
Groups like the American Academy of Pediatrics' Section on Telehealth Care are working on developing initial guidelines on how to deal with electronic communication. Guidelines will address issues such as patient privacy and medical safety.
Those who do email say it is a convenient way to communicate with patients without the hassle of playing phone tag, and that it can keep patients from relying on Google searches that can sometimes lead to inaccurate information.
Jocelyn Bonneau of Manhattan generally asks her doctors up front if they give out an email address. The barriers to actually speaking with a doctor "can be frustrating," said the 28-year-old financial analyst, who said she sometimes will "just give up and Google [my symptom] or just say, 'I'll get better,' and that's probably not the best way." Being able to email with a doctor, like her endocrinologist Andrew Martorella, makes a world of difference, she said.
Dr. Martorella said his patients email him to get blood-test results, refill prescriptions or to say they're running late. He estimates he gets up to 40 or 50 a day, which can take a few hours to respond to. Without email, he said he would probably need at least one extra person on staff to field patient phone calls: "I think it is definitely made a big change in terms of reducing costs, especially for solo practitioners."
Dr. Martorella ends new-patient visits by asking if they'd like to communicate via email. If so, he asks them to sign a form agreeing to electronically communicate about health matters and giving him authority to discuss medical issues over email. The form, he said, ensures that he's in compliance with the federal Health Insurance Portability and Accountability Act (HIPAA) designed to protect the privacy of health information. HIPAA compliance is the main concern raised by doctors who don't email.
The law requires that electronic communication related to an individual's health is protected and secure, said Jane Thorpe, an associate professor of health policy at George Washington University. If someone communicates protected health information electronically through a phone or other mobile device, Ms. Thorpe said, "it needs to be in a secure system," such as one that encrypts messages or through a secure portal. Personal email such as Gmail, she said, is "absolutely problematic."
As part of the federal government's stimulus act, physicians are being encouraged through financial incentives to use electronic medical records. One part of that effort includes the use of secure messaging to share health information with patients through, say, an online portal.
Source: The Wall Street Journal, March 26, 2013.
By Toni Brayer, MD
One of my tennis friends asked me about new innovative smart phone technology and why it hasn't been embraced in health care. She had just watched a video about Dr. Eric Topol, Chief Academic Officer at Scripps Health in San Diego, and his demonstrations of how a smart phone could monitor blood sugar, take EKGs and cardiac ultrasounds, and really deliver health care to the patient at home. My friend's question, "If this technology is here, why isn't it being used?" According to Dr. Topol, new apps for the smart phones could eliminate 80% of echocardiograms that are done in facilities at costs between $300 and $1500 each. Having patients come into the office when they experience symptoms or for diabetics to get their blood sugar regulated could be eliminated. New technology could be data driven and personalized and save millions of wasted dollars in health care. So why is medicine so far behind the innovation curve? The answer: No-one pays for it. Why aren't all physicians using email to communicate with patients and save them an office visit? The politically correct answer is "remote medicine is not as good as seeing the patient in person and making sure the diagnosis is correct". The real answer is: No-one pays for it. United States health care has complicated payment systems for work done. The payor for health care services is either Medicare/Medicaid (CMS) or hundreds of different (for-profit) insurance companies. CMS sets the payment rules that everyone follows. Medicare and all insurers will only pay for face to face visits. Reimbursement is for doing more and the more you do the more you get. The doctor that tries to save a patient time and travel by covering a number of problems in one office visit will not be rewarded and, in fact, will be reimbursed less. If you do a skin biopsy on the same day you do a visit for arthritis flare, CMS and insurance companies will not pay for both things. Do them on separate face to face visit days and... voila!... a better reimbursement for your time and skill. Email, remote monitoring, remote echocardiograms, discussing tests via a smart phone are freebies. No patient visit means no reimbursement. The cost of putting in high technology is borne by the physician too. Most physicians and hospitals and surgery centers and labs and pharmacies are happy with this status quo. There is great fear of change and so we continue to spend more on health care than any nation in the world. We do wasteful mass screenings and 1/3 of all prescriptions are a waste. People who need care are not getting it and others are getting too much that they don't need. ObamaCare is trying to make some gradual changes by supporting pilot programs to change the way healthcare is delivered. But it is slow going and innovative answers are out there. If we could just figure out how to pay for services, while using new cost-saving technology we would all be following Dr. Topol's future dream.
Originally published in EverythingHealth, February 10, 2013.
Toni Brayer, MD is an internist and Chief Medical Officer for Sutter Health West Bay Region. A SFMS member since 1987, Dr. Brayer has served as President, CMA delegate, Editor of San Francisco Medicine, and on numerous committees over the years. She is a Fellow of the American College of Physicians and an Assistant Clinical Professor at UCSF. Dr. Brayer blogs at EverythingHealth.net.