pushing frontiers of healthcare delivery
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PUSHING FRONTIERS OF HEALTHCARE DELIVERY
IRIS THIELE ISIP TAN MD, MSC @endocrine_witch
Professor, UP College of Medicine Chief, UP Medical Informatics Unit
QUANTIFIED SELF
CARE HACKING DEVICE
DIVIDE
Johnmar & Bhargava. ePatient 2015: 15 Surprising Trends Changing Healthcare
QUANTIFIED SELF
CARE HACKING DEVICE
DIVIDE
Johnmar & Bhargava. ePatient 2015: 15 Surprising Trends Changing Healthcare
THE RISE OF THE QUANTIFIED SELFhttps://youtu.be/V08dWCtDyd8
— Lisette Hilton
IMAGINE WEARING ELECTRONICS POWERFUL ENOUGH TO TRANSDERMALLY MEASURE THINGS LIKE HYDRATION … THE TECHNOLOGY IS SO THIN,
BREATHABLE, SOFT AND MALLEABLE, THAT YOU DON’T NOTICE IT ON YOUR SKIN. IT CAN BE ON
YOUR EYELID, ON YOUR LIPS, OVER HAIR. IT SEAMLESSLY DOES ITS JOB WHILE YOU LIVE
YOUR LIFE WITHOUT CONSTRAINT.
”
“
Wearable technology meets dermatology Dermatology Times 5 Jan 2015
Sci Adv. 2015 Oct 30;1(9):e1500701.
Ultrathin, soft, skin-conforming sensor technology that offers advanced capabilities in continuous and precise blood flow mapping
NATURE COMMUNICATIONS | DOI: 10.1038/ncomms5779
QUANTIFIED SELF
CARE HACKING DEVICE
DIVIDE
Johnmar & Bhargava. ePatient 2015: 15 Surprising Trends Changing Healthcare
JAMA Dermatol. 2013;149(11):1300-1304
0
50
100
150
200
250
HCP PATIENT BOTH
n =229
51.1%41%
7.9%
Brewer et al. JAMA Dermatol. 2013;149(11):1300-1304
10 MOST REVIEWED APPLICATIONS
a renamed to SkinVision
ULTRAVIOLET ~ UV INDEX By Robocat FREE
SPOT MOLEBy Cristian Munteanu FREE
First smartphone app to do automatic mole analysis using the device's camera/gallery Detect signs of melanoma using image processing and pattern recognition
SKINVISIONBy SkinVision B.V. In-app purchases
First CE certified melanoma / skin cancer app in the EU
— Brewer et al. JAMA Dermatol. 2013;149(11):1300-1304
These patient-oriented apps directed toward skin cancer screening may promote self-surveillance. However, patients and clinicians should maintain a healthy sense of skepticism because studies regarding the safety and accuracy of such apps are limited.
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“
Patients face a dizzying array of healthcare apps to choose from, with little guidance on quality or support from their doctors.
“
Even if medical app may meet the definition of a medical device, the FDA can choose to not enforce requirements because risk to patients is low.
ENFORCEMENT DISCRETION
QUANTIFIED SELF
CARE HACKING DEVICE
DIVIDE
Johnmar & Bhargava. ePatient 2015: 15 Surprising Trends Changing Healthcare
Launched 24 July 2015 at National Science & Technology Week
High speed wifi up to 50 MB/day
The demand for medical dermatologists exceeds the current supply Teledermatology may partially solve health-care disparities
J Am Acad Dermatol 2015;72:563-574
TELEDERMATOLOGY
Store-and-forward
May require repeat consultation for incomplete clinical histories
Most widely used
More efficient for physicians practicing across time zones
J Am Acad Dermatol 2015;72:563-574
Less opportunity for patient education
TELEDERMATOLOGY
Real-time
May save time by clarifying consultant’s questions
Requires significant bandwidth
Less convenient for physicians practicing across time zones
J Am Acad Dermatol 2015;72:563-574
Greater opportunity for patient education
Video images lower quality/resolution than still images
TELEDERMATOLOGY
HybridRequires significant bandwidth
Less convenient for physicians practicing across time zones
J Am Acad Dermatol 2015;72:563-574
May improve patient satisfaction compared to store-and-forward alone
Time-saving aspects of real time plus quality of digital still images
J Am Acad Dermatol 2015;72:563-574
TELEDERMATOLOGY: PRACTICE MODELS
Teledermatologists make recommendations from afar; providers assume the responsibility for adopting recommendations
CONSULTATIVE
To prioritize patient care and determine need for in-person visits
TRIAGE
Direct communication between dermatologists and patients with skin complaints
DIRECT CARE
Remote monitoring of chronic skin conditions that would otherwise warrant frequent clinic visits to assess disease activity and optimize therapy
FOLLOW UP
Diagnostic & management decisions made by teledermatology are reliable and accurate Clinical outcomes are reportedly similar to those of standard care
J Am Acad Dermatol 2015;72:563-574
EVIDENCE SUPPORTING USE OF TELEDERMATOLOGY
Patients & providers report high satisfaction with tele dermatology Patients are typically willing to pay for tele dermatology consults
J Am Acad Dermatol 2015;72:563-574
PARTICIPANT SATISFACTION
Patients generate & send images of their skin lesions, enables rapid communication with healthcare providers Patients are reportedly satisfied with this convenient modality and take images of sufficient quality for telediagnosis
J Am Acad Dermatol 2015;72:563-574
PATIENT-CENTERED TELEDERMATOLOGY
Patient consent, confidentiality and privacy are of paramount importance and care should be taken to ensure they are not sacrificed for the sake of ease and convenience.
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REASONS WHY DERMATOLOGY REGISTRARS TAKE CLINICAL PHOTOGRAPHS OF THEIR PATIENTS
n = 13
Kunde et al Australasian Journal of Dermatology 2013 doi: 10.1111/ajd.12063
HOW OFTEN THEY TEXT OR EMAIL PICTURES TO COLLEAGUES FOR ADVICE OR OPINION
Kunde et al Australasian Journal of Dermatology 2013 doi: 10.1111/ajd.12063
n = 13
SITUATIONS FOR WHICH VERBAL CONSENT FOR CLINICAL PHOTOGRAPHY WAS OBTAINED
Kunde et al Australasian Journal of Dermatology 2013 doi: 10.1111/ajd.12063
n = 13
— Karen Michelle Devon, MD
I WAS SURPRISED TO FIND AN IMAGE OF MYSELF, WEARING SCRUBS, AND
HOLDING A THYROID GLAND.
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Devon KM. JAMA 2013;309(18):1901-1902
Palacios-Gonzalez C. The ethics of clinical photography & social media. Med Health Care & Philos DOI 10.1007/s11019-014-9580-y
USE OF CLINICAL PHOTOGRAPHY
PRIMARY For patient care
SECONDARY For research and medical education
Clinical photography + social media DOES NOT equal telemedicine.
Palacios-Gonzalez C. The ethics of clinical photography & social media. Med Health Care & Philos DOI 10.1007/s11019-014-9580-y
Patients do not have adequate information to give informed consent.
PRIMARY
Even if patients recant consent, nearly impossible to retrieve or delete clinical images.
Palacios-Gonzalez C. The ethics of clinical photography & social media. Med Health Care & Philos DOI 10.1007/s11019-014-9580-y
Moderate comments to avoid derogatory remarks about clinical images or patients depicted.
SECONDARY
www.healthxph.net/manifesto
I will value the patient’s dignity & privacy by not taking selfies, groufies or videos during encounters with patients that include patients’ body parts, surgical specimens or that show patients in the background without their consent.
#HEALTHXPH
www.healthxph.net/manifesto
I will refrain from posting information online that will compromise patient confidentiality and privacy.
#HEALTHXPH
J Am Acad Dermatol 2013;68:1030-3
Sarah liked Dr. W’s Facebook page. She commented on a discount coupon for tattoo removal. Sarah’s mother fears that “everyone will know” about Sarah’s tattoo. The mother demands that the clinic inactivate the Facebook page immediately.
DR. W SHOULD …
A. Make no changes to the Facebook site. B. Institute a system for monitoring the site on a regular basis to purge inappropriate posts. C. Disable the site’s comment section to eliminate the possibility of patient’s disclosing personal information. D. Discontinue the requirement that patients “Like” the Facebook page to receive discount coupons. E. Discontinue the Facebook site.
Orenstein et al. E-professionalism at the dermatology office: New challenges to confidentiality in the era of social networking. J Am Acad Dermatol 2013;68:1030-3
DR. W SHOULD …A. Make no changes to the Facebook site.
Sarah has the right to post protected health information (PHI).
Exercise vigilance when establishing a web forum with foreseeable risk of unintentional disclosure of PHI.
Orenstein et al. E-professionalism at the dermatology office: New challenges to confidentiality in the era of social networking. J Am Acad Dermatol 2013;68:1030-3
DR. W SHOULD …B. Institute a system for monitoring the site on a regular basis to purge inappropriate posts.
Approach is labor-intensive and imperfect
Instantaneous dissemination of information on social networks
Impossible to remove information from cached Web pages
Orenstein et al. E-professionalism at the dermatology office: New challenges to confidentiality in the era of social networking. J Am Acad Dermatol 2013;68:1030-3
DR. W SHOULD …C. Disable the site’s comment section to eliminate the possibility of patient’s disclosing personal information.
Limits potential for patient education
Orenstein et al. E-professionalism at the dermatology office: New challenges to confidentiality in the era of social networking. J Am Acad Dermatol 2013;68:1030-3
DR. W SHOULD …D. Discontinue the requirement that patients “Like” the Facebook page to receive discount coupons.
Prevent the MD’s direct complicity in exposing the patient’s treatment for a potentially stigmatizing condition
Upholds social justice
Orenstein et al. E-professionalism at the dermatology office: New challenges to confidentiality in the era of social networking. J Am Acad Dermatol 2013;68:1030-3
DR. W SHOULD …
A. Make no changes to the Facebook site. B. Institute a system for monitoring the site on a regular basis to purge inappropriate posts. C. Disable the site’s comment section to eliminate the possibility of patient’s disclosing personal information. D. Discontinue the requirement that patients “Like” the Facebook page to receive discount coupons. E. Discontinue the Facebook site.
J Am Acad Dermatol 2013;68:1030-3
#HCSMPH Apr 21 PICC
bit.ly/hcsmsummit2016
IRIS THIELE ISIP TAN MD, MSC Professor, UP College of Medicine Chief, UP Medical Informatics Unit
@endocrine_witch
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