Wired and Wireless Health

Steven Peskin, MD, MBA, FACP

6 February 2010

American College

of Physicians

The Three Components of Digital Health

Applications (clinical/institutional,

consumer-focused, and content).

Devices (mobile phones, sensors, medical

devices, and others).

Infrastructure (both wireless and

supporting wire-line and network services).

Triple Tree, “Wireless and Mobile Health Report and Survey” (Minneapolis: Triple Tree LLC, 2009).

Digital Health: Tremendous Potential

Improve clinical care delivery and patient-provider

communication

Maximize patient safety and convenience with patient monitoring

and patient tracking

More effective information dissemination and dialogue within all

medical disciplines

Enterprise-wide health information

Bridging the gaps hospital-based/other institutional, ambulatory/

office, home, pharmacy, self care

Collaborative approach to diagnosis and treatment

Simplified chronic condition and lifestyle management

Triple Tree, “Wireless and Mobile Health Report and Survey” (Minneapolis: Triple Tree LLC, 2009).

Bridging the Gap

Wireless Health Information Flow

Emerging Wireless Health Market

Triple Tree, “Wireless and Mobile Health Report and Survey” (Minneapolis: Triple Tree LLC, 2009).

Index

Part 1

Social Media and Physician Communities

Part 2

The App Revolution

Part 3

Into the Future

Part 1: Social Media and Physician

Communities

The “Arc” of Communities

Time

Act

ivit

y

The “Anti-Arc”

need

want

recreational vocational

Jobs Board

Affordable

EMR

Lab Results

Reimbursement

coding

Scheduling

“The Danger Zone”

The “Early Days of Sermo”

Observational data

Hotspots: Learn

CME

Hotspots: Earn

Content

New pharma interactions

New Peer-reviewed data

Jobs Board

Social Media and Physician

Communities

QuantiaMD:

Founded in 2005, has 70,000+ members

Features interactive 8-12 minute video lectures from top medical experts

Sermo:

Founded in 2006, has 110,000 members

Bills itself as “the world’s largest online community of physicians, where

you can exchange medical insights with colleagues spanning more than

30 specialties across all 50 states”

Medscape Physician Connect:

Founded in 2008, has 100,000 members

Invites clinical and non-clinical exchanges through video blogs and user

polls

Epocrates:

Founded in 1998, has 200,000 members

Not strictly a social professional network. It features Immediate formulary

checks and drug information, “point-of-care references,” discussion

topics, and an electronic game on Facebook called “Diagnose the

Disease.”

Social Media and Physician

Communities- Peace, War, or Harmony

Facebook Beacon

Business Model in

Harmony

Business Model in

ConflictNeutral

MySpace

Friendster

Linked-In

Sermo Dashboard

Sermo

AskRx

Threadless

Client Posts

c 1996-2003Ebay

Social Community Benefits for

Physicians

Social Communities facilitate sharing of clinical

insights and solutions to practical clinical problems

in a way that promises to hone “best practices”

Allows physicians to:

Access dialogs on best practices

Source and disseminate immediate

market research

Solicit useful feedback about preferred

treatments, protocols, and practice patterns that

yield best health and patient satisfaction

Build business arrangements

Steven Peskin, MD. “Can a Medical „Facebook‟ Help You Plan Thrive? (Yardley: Managed Care, June 2009) 25.

Part 2: The App Revolution: iPhone,

Blackberry, and Google Android

Point-of-Care Mobile Technology

88% of Physicians report

that their PDA/Smartphone

is essential to their clinical

practice

87% of physicians said the

PDA channel provides

clinical information that is

most influential on their

prescribing and treatment

decisions.

87%

2%6%

3% 2% 1%

Most Influential on Prescribing

PDA/Smartphone

Direct Mail

Journal Ad

Rep Visit

e-Detail

Pharma brand web site

Skyscape. “Effect of PDA-based Information On treatment Decisions” (MASS: Skyscape, March 2008).

Point-of-Care Mobile Technology:

88% of physicians report that “my

PDA/Smartphone is essential to my clinical

practice.

Strongly Disagree

Disagree

Agree

Strongly Agree

7%

1%

36%

56%

92% of physicians agree that “clinical

information on my PDA/S, Smartphone

improves my knowledge and capabilities.

Strongly Disagree

Disagree

Agree

Strongly Agree

5%

6%

43%

45%

Skyscape. “Effect of PDA-based Information On treatment Decisions” (MASS: Skyscape, March 2008).

“There’s an App for That”

Apps for patient information

delivery

AirStrip Technologies: offers a suite

of HIPPA compliant apps that collect

all relevant patient information and

sends it to your PDA (including: lab

results, cardiology, temperature etc)

Apps for electronic medical records

The software developer, Epic, just released a new

suite of apps that feature PHR access for a PDA

More Apps for Physicians

Apps for medical education and reference

Krames Patient Education: iPatientED is a quick reference

tool for physicians with 118 animations spanning 22

medical specialty areas, many with narrations in English

and Spanish

Modality: this company features 120 apps, 55 of which are

focused on medical education

MedCalc: a medical calculator with a wide

array of medical formulas and scores. Includes

information and bibliographic references for

each formula.

ICD-9 Lite: Contains all 13,677 ICD-9-CM

diagnosis codes for quick retrieval by disease

classification in a drilldown format with no

typing. Code to the highest level of specificity

every time.

Apps for Consumers

:Use your iPhone to track doctors’

appointments, medication schedules and other

health information.

: Offers 30+ free trackers for

BP, Cholesterol, Diabetes, and other health

indicators along with charting and other tools.

: A suite of apps that allow

mobile access and mobile recording of personal

health data for tracking and informational purposes.

Online Care: Digital Diagnosis

In 2009, 39% of doctors said they’d communicated with

patients online, up from 16% five years earlier, according

to health-information firm Manhattan Research, a unit of

Decision Resources Inc.

The most common digital doctor services are the

simplest ones, like paying bills, sending lab results and

scheduling appointments. But also can be used for

diagnosing, and chronic condition tracking.

Health insurers are beginning to pay doctors for treating

patients virtually Among companies that now cover

digital visits are Aetna, Inc. and Cigna Corp., and select

BCBS plans in Florida, Hawaii and North Carolina.

WellPoint Inc. and Humana Inc. are trying it in parts of the

country, and may expand their coverage.

Methods include: interactive questionnaires, web video,

live chat, and phone conversations.

Anna Wilde Mathews, “The Doctor Will Text You Now” (New York: Wall Street Journal, July 9, 2009)

Part 3: Into the Future

Don Detmer MD, MA and President and CEO of

American Medical Informatics Association

“The health sector's most avoidable shortcomings can be linked

to data, information, or knowledge that are inaccessible or

demonstrate poor quality…the health sector has begun to

unleash the transformational power of information and

communications technology.”

The federal government’s economic stimulus package is

dedicating $19 billion to speeding the adoption of electronic

health records, so demand for health informatics specialists is

skyrocketing. “My rough estimate is that we need about 70,000

health informaticians

“Significant value will be realized only when PHRs incorporate

systems, tools, and other resources that leverage the data in the

record and enable consumers to play a more active role in their

health and health care. Some of these functionalities exist today;

other applications are yet to be developed.”

Don Detmer, “Building the National Health Information Infrastructure” (BMC Medical Informatics and Decision Making 2003 3:1

Christine Larson, “Fresh Starts-Connecting the Dots of Medicine and Data” (New York: NYTimes April, 2009) BU13.

Don Detmer, “Integrated Personal Health Records: transformative tools for consumer –centric care” (BMC Medical Informatics and Decision Making 2008) 8:45.

Online Care: Digital Diagnosis

American Well’s “Virtual Visit”

American Well has created an Online Care

system that allows consumers to connect

with physicians immediately, whenever they

have a health need, from their homes or

offices. American Well’s service is available

to patients in Hawaii and Minnesota,

through Blue Cross Blue Shield, and to

some members of the military seeking

mental health care, through TriWest

Healthcare Alliance.

Claire Cain Miller, “The Virtual Visit May Expand Access to Doctors” (New York: NYTimes, Dec 20, 2009) B4.

After American Well’s service began in Hawaii last year, lawmakers passed legislation

that allowed doctors and patients to establish a relationship online

Online Care Personal Edition, allows consumers to see physicians on demand using

video, text chat or telephone. Online Care Team Edition, allows providers to deliver

coordinated care, using tools for provider-to-provider collaboration and the creation of

online medical homes

It allows physicians increased flexibility and an opportunity for practice expansion

“By 2013, 25% of patient encounters in North America, Western Europe and

Asia/Pacific that could be conducted virtually, will be.”

Gartner article: Predicts 2009: Healthcare IT Moves From Transactional to

Transformational

The Apple iPad

The iPad

“You can browse the Web with

it. It’s the best browsing

experience you’ve ever had…. a

whole Web site in the palm of

your hands.” –Steve Jobs at

the January 27th unveiling

Half an inch thin. Weighs 1.5

pounds. 9.7-inch IPS display

What can the iPad do for wireless health?

Will facilitate a better-than-ever digital experience for easier video

and Web site viewing

Increase user friendliness of all wireless facets of the Health Market

from community sites like Sermo and Quantia MD to improved

usability of apps for electronic medical record, patient information,

and medical education and reference.

Brad Stone, (New York: NYTimes January 27).

Into the Future (Cont’d)

Wired and Wireless will be a part of

everyday health care

Health care professionals will

embrace digital tools/

communities for clinical

performance improvement, time

and $$$ savings/ revenue

Increased availability, accuracy,

searchability and dissemination of

Information

Image from the Jan 2010

Consumer Electronics Show

in Las Vegas. Note “digital

health” in the center .