YOU IMAGINE – Doctors Connect to Patients in an mHealth World

Written by on November 30, 2012 in Research & Technology - No comments

In my last article I wrote about the increasing trend for doctors and medical staff to be using mobile devices in the clinical setting, and how this has changed the clinical setting: allowing for easier information and access to records right at patient bedside. In this article, I’d like to explore this question from the point of view of the patient. Has this clinical change impacted the patient’s experience? Are patients happy with the changes? How are patients using iPads and mobile devices? What is available for them to use? How is this changing the relationship to their health? And how can it change their relationship to their health?

Patients prefer the iPad when communicating with their doctors

The use of iPads in clinical situations sets a good trend for patients. Ferdinand Velasco, M.D., chief medical information officer at Texas Health, sees a change in the doctor-patient interaction from doctors who are often leaving patient rooms to access information at computer terminals, to doctors who are using iPads as an accessory and offering more engaged patient conversations.[1]

Los Angeles, CA: Cedars-Sinai Medical Center has adopted widespread use of mobile devices in their hospitals[2].  Lahey Clinic in Burlington, Massachusetts, has, too.[3] Those involved in these initiatives have been widely in favor of the changes: both patients and doctors.

Since it is the one-on-one relationship with a doctor that patients find most satisfying, patients in these settings experience what feels like less indifference[4]. Patients feel as if they are spending a lot more time with their doctors because of mobile devices. Dr. Finkel, co-chair of Lahey’s medical device committee, said that much of the time a physician typically spends away from the patient but attending to their medical needs, such as consulting with other physicians, reviewing, and ordering tests, can now be spent with the patient attending to those same tasks. He says patients see their own x-rays and test results, they are a part of the decisions made on the team, and they feel more in control and more connected than with the traditional setup.

And doctors say they enjoy being able to show patients the visual evidence of their medical conditions easily. It’s a situation where the human interaction is key and where the technology is making the experience better without dominating the human interaction. Elderly patients, specifically, benefit from this situation because physicians are sitting closer to them within good earshot, and pointing to data and visual details on their mobile devices so that understanding the medical details is easier. Even family members of the patients prefer this kind of interaction, as the mobile device is easily shared between people and passed around. The readily available content and medical records makes viewing x-rays and EKGs more accessible for family members and everyone involved in the patient’s care[5].

“I can do anything at the patient bedside that I can do at a physician station, which saves time in my day,” Henry J. Feldman, MD, chief information architect for Harvard Medical Faculty Physicians and a hospitalist at Boston’s Beth Israel Deaconess Medical Center[6].

An effective tool

This trend is extending beyond the hospital setting. More and more frequently, iPads are being offered to patients as they walk into their doctor’s office, where a dynamic eForm captures all information and signatures, and then transmits the data to an EMR or EHR system, places a copy to SharePoint or other collaboration platform, and e-mails a PDF copy to whomever requires a copy.

At the Duke Oncology clinic, patients access secure online Web portals to answer questions between visits. Three-quarters of breast-cancer patients reported that they were able to remember their symptoms more accurately, and one-third of them said the online questionnaire prompted them to bring up issues with their doctors. And the staff feels there is a sense of anonymity, which has led to greater honesty and accuracy among patients in answering questionnaires about alcohol, sex, anxiety, and depression[7].

On particular example I found was a medical student, Ales Chamessian, who made it clear to me how personal and helpful the mobile device can be:

“Our team cared for a newborn who was showing signs of what appeared to be benign neonatal sleep myoclonus. The baby’s mother was very disturbed by the sight of her new (and first) daughter contracting during her sleep. When I was presenting this case on rounds, I pulled up a Youtube video of benign neonatal sleep myoclonus and showed it to the parents and the rest of my team. When the mom saw the video of someone else’s baby twitching like her own, she  was reassured that her daughter’s condition was fairly common and of little concern. Likewise, the rest of my team, which included residents, medical students, nurses and attendings, got a better view of what benign sleep myoclonus looks like.”[8]

How convenient it is, for those who have watched the changes in medicine from the old paradigm to the new, simply to have medical and visual information so close at hand.

Is the iPad or smartphone secure?

With so many physicians enthusiastic about the use of iPads in the clinical setting, if there is reluctance among physicians about the mobile device, it has to do with security. Unless doctors are using encrypted apps that securely protect patient information, they can’t use the devices to communicate to or about patients’ personal medical information without violating the Health Insurance Portability & Accountability Act, or HIPAA.

But on September 28, new legislation was announced to make the approval process simpler and more streamlined for the FDA. The Healthcare Innovation and Marketplace Technologies Act (HIMTA) will allow the formation of a special Office of Mobile Health at the FDA[9]. This office will provide approval and recommendations for apps and offer a developer support program at the Department of Health and Human Services. Such support will give app developers understanding about the privacy regulations, and acknowledgment as to whether they are following the privacy regulations required by HIPAA.

While this effort to make apps secure is a hot topic in iPad technology, in the meantime, apps have are avoiding the issue by “dumbing down”. Apps do not include personal information or store data that might be associated with a particular patient. This may be unfortunate for the patient, according to Chris Wasden, Global Healthcare Innovation Leader for PricewaterhouseCoopers[10]. But it is an issue which may, in the long run, find a good solution. For those app developers who have made special effort to comply with secure protocols and have been cleared by the FDA, it is easy enough to find them on iTunes by doing a search for “AirStrip”.

Meanwhile, AT&T is developing the mHealth Platform to help bridge the gap between health and mobility. The platform will allow users to aggregate date from their insurance company, various devices and applications, and doctor’s offices, and hold it in a secure form, allowing applications to track health information with a secure infrastructure while sharing date with friends, family, and their health care professionals. This will all be integrated into one app platform, creating a powerfully useful tool for the consumer to authorize and offer to health care providers when needed. It also promises to make the use of this secure system easy for app developers.

Many of the apps available offer something interesting without the need to reference medical records. But there is freedom for developers, in designing apps with this purpose in mind. Recently I was speaking with an orthodontist to design a tooth-brushing app for children, and the question came up of being able to keep a tooth-brushing record that the child could share with the orthodontist. Presently this is not something the orthodontist can offer, with the security concerns on iPad. And for those settings where EHR transfer is secure, according to the Manhattan Research Study, 63% of doctors are using them[11].

It’s a future more patient-focused vision for medicine

Technology changes rapidly. We have as our vision an ideal: a future where both doctors’ and patients’ needs are met. This technology, mobile devices, offers a step in a better direction. Mobile devices satisfy doctors because they are an immediate and rich source of information. They also satisfy patients because they offer a closer and more interactive experience with the health professional. The future looks promising to offer secure apps so that medical records can be transferred confidentially. And developers are eager to create new application models with new possibilities. In my last article I offered a review of medical apps. Next month I will explore health apps and offer a review for some of the apps available in this expanding field of mobile health.

[1] Can the iPad Cure What Ails Us? By Tom Kaneshige.
HC industry needs to put the iPad in context By Brian Dolan.
[3] Have iPad—can travel. How tablets at the bedside save doctors an hour a day By Bonnie Darves
Trouble with the Caregiver – Patient Connection
See 4.
Today’s Hospitalist. Taking your tablet to work? The benefits and challenges of mobile computing in the hospital
The Economist Group. Saving Lives One iPad at a Time.
How a medical student uses an iPad for patient care and education. By Alex Chamessian. October 23, 2011 in TECH.
[9] Who Should Regulate Medical Mobile Apps? FDA or Some Other HHS Agency? By Carmelina G. Allis. Oct 4, 2012 in FADALAWBLOG.
[10] Mobile health is taking off but what’s still in its way? By Ki Mae Heussner. Jul 10, 2012 in GigaOm.
[11] Manhattan Research Physician Specialist Survey. “2012 Taking the Pulse” polling 3,015 U.S. practicing physicians in over 25 specialties.

by Laura Maaske, Medical Illustrator


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