Category: Digital Health

Do Not Let Patient Care Interfere With Documentation

Obviously, a dollop of sarcasm there from this blogging physician’s post. Check this out. What you will see is an important piece that documents the history of the “patient record.” In the old days, he notes, the patient record was mostly a doctor’s notes to himself (seldom herself at the time) about the patient that would provide hints on future care. Patient “charts” were rather sparse at the time, even for the most complicated of patients. This, of course, was in the days where the PCP handled virtually all of a given patient’s care. Along come multi-specialty teams with multiple consults, and the use of medical records got more complicated. 

Also in the mix here are the multiple purposes that EMR’s are now supposed to serve. Communication among consulting physicians. Documentation of services to obtain reimbursement. Evidentiary support in case medical legal issues arise. Etc. No wonder there are so many “clicks” that need to be made for each patient.

Bottom Line. However the EMR got to be the behemoth that it is now, this Pediatric Intensive Care Physician is only asking for a record keeping system that does not, literally, take more time to administer for a given case than was actually spent on patient care. 

That sounds fair!

Remote Patient Management

Check this out.  This URL literally takes you to the bottom line of Remote Patient Management. It shows you the new CMS guidelines on how physicians can bill for keeping track of patients health through the use of in-home sensors and monitors. While you are there, roam around the website and see the different product and service offerings of Care Innovations, a company dedicated to extending telehealth way beyond online consultations. Sleep, activity level, etc. can be monitored remotely, giving the clinician a more well-rounded understanding of a patient’s health and wellness.  

Bottom Line. While I find myself increasingly blogging about Telemedicine and its wildly rapid growth in the era of the COVID-19 epidemic, it is increasingly occurring to me that we ain’t seen nuthin’ yet!

The Algorithm Will See You Now

Check this out.  What you will see is an amazingly thorough (sorry about its length!) and well researched piece about the applications of Artificial Intelligence (AI) in the practice of medicine. Read it. It is worth your time.

Several important top lines here. First, we learn that about 33% of physicians are already making some use of AI in their practices, and we get exposed to some of the “early successes.” As I am prone to say under such circumstances, “The future is already here…It is just not widely distributed.” 

We also learn what success looks like in the application of AI to clinical practice. In a nutshell, faster and better diagnoses!

We see from surveys that doctors are almost evenly split between doctors that are bullish about the use of AI in clinical medicine, and those who are more reticent. The latter group site risks such as malware being introduced into the system as reasons for their concern.

Bottom Line. Fascinating is the fact that you will note from the article’s masthead and some of the contents that this piece was penned from the perspective of a malpractice insurance company. Yup. AI has some pretty substantial capacity to reduce the risk of malpractice suits. How? By making sure the physician doesn’t “miss something.”  

As I close many posts by saying quite candidly, you are going to want to keep your eyes on the application of AI to the practice of medicine.

AND…You may want to start to think about how you can inveigle your company’s product line into the “algo.” This could well be the crux of pharmaceutical marketing in the future!

Telehealth Meets Digital Health

Check this out.  What you will see is an article that is important in two different ways. First, and most poignant for us in the healthcare vertical, we see the blending of two movements, each of which has gotten a lot of attention and each of which has, in its own way, hit a dead end.

First, Telehealth. A lot of activity and chatter in this area of healthcare delivery. BUT. Some disappointment with telehealth encounters since up until now they have been limited to talk.

Second, Digital Health. Again, a lot of chatter and deals being done, but the major hurdle of showing clinical relevance to physicians has not yet been cleared.

Now we see Best Buy marketing a kit that will allow patients engaged in a Telehealth encounter to utilize a digital instrument “kit”  to examine several of the body systems that might be relevant to reaching a diagnosis, and to transmit this information to the clinician at the other end of the encounter. Very promising, to say the least.  

I am thinking back to when my sons, as babies, used to awake in the middle of the night shrieking in pain from ear infections.  How nice to be able to crank up a telehealth practitioner, show her the inside of the kid’s ear, and get a prescription for appropriate treatment. Immediately. 

Keep your eyes on this one!

Secondly, this article is important as a business statement for big box store Best Buy. The company has been looking for ways to maintain relevance in the age of Amazon. Betting on healthcare as they are doing could be a very good move, although Bezos’ crew are not slouches in this area.

Bottom Line. I am picturing Telehealth meeting Digital Health as a very important linking moment. Sort of like when the golden spike was driven in the construction of the transcontinental railroad. All of a sudden, two dead ends became a major thoroughfare that really went somewhere.

I believe that this might be just such an event. 

Google Buys Fitbit…So What???

Check this out.  What you will see is the story about Google’s acquisition of Fitbit for $2.1 Billion. In it, you also find a lot of important information.

For example, you will see that the sales price is roughly half the value of Fitbit at its IPO. Meaning that a lot of the excitement about “wearables” in general, and this one in particular, seems to have waned.

Relatedly, you will see the comment that a problem with Fitbit data is that it has no medical relevance. Take your Fitbit data to your doctor and she will simply scratch her head in dismay. Despite all the hype, wearables aren’t really “there” yet in terms of genuinely contributing to managing your health.

You will also see that while 100 Million Fitbits have been sold, there are currently only 25 Million Fitbits in use. SO. The fact that 75% of the devices are now likely reposing in dresser drawers is another pretty good indicator that consumers have yet to find a compelling reason to keep using them.  

As an interesting aside, you will see a reference to an historical privacy issue with Fitbit. Seems that back in 2011, information that you provided about your sexual activity when filling out your Fitbit profile wound up being searchable on the Web. Whoops!

Bottom Line. As a freestanding device company, Fitbit had largely run out of steam. BUT. Coupled up with Google, we might indeed see some interesting developments. There is clearly potential in the wearables space. It is just not as easy to achieve that potential as we originally thought.

But here’s the real punchline. This writer of this piece holds forth that whether or not Fitbit provides clinically relevant data doesn’t really matter. Google can still sell a lot of the little devices if potential customers believe that Fitbits can contribute to their health.


Google Says, “No Stem Cell Ads!!!”

I must confess I have been wondering about ads for “Stem Cell Clinics.” Every day in the newspaper servicing Hilton Head Island, the same clinic has been running an advertisement. Full page, full color. Including pictures of the practitioners who work there. Two Chiropractors and an MD certified as an ER doc! Chiropractors???  

Numerous free seminars are featured. Learn all about stem cells, where they come from, the ways in which they can help virtually any ailment that might be bothering you, etc.  

So, what does this all have to do with Google? Lots!!! Google has just issued a policy refusing to run ads for any “unproven” medical treatment, including stem cell therapy. Check that news out here.

And who is that lady whose picture appears above? An unfortunate patient who was blinded by the quacks (editorial comment added) who administered stem cell therapy to her.  

Bottom Line. Good for Google! There is enough medical nonsense online that we don’t need this behemoth piling more on!!!

Why Investors In Digital Health Are Whimps!!!

Put somewhat more politely, this article rather profoundly and clearly explains why investors in digital health are more focused on wearables that track the number of steps that we take than they are on devices that would actually help patients with significant medical problems. The first reason the article offers pretty much says it all. “Healthcare is not designed to be open to innovations.” SO. We can jerk around with “activity trackers” all we want, but the developmental time and clinical trials necessary to introduce digital devices that are of clinical significance are sufficiently daunting as to make the investment in developing them unlikely to yield a profit commensurate with the risk involved. 

Bottom Line. Since the business model here doesn’t seem to work for most profit-oriented investors, the article suggests that organizations like the Bill and Melinda Gates Foundation, that offer “grants” for digital healthcare solutions, might well be the only funders likely to get something genuinely significant off the ground in this space.

Sad, but likely true!

“I’ll Put My Cell Phone Away When You Put Your Computer Away!”

Picture the reactions of an HCP who is greeted with these words when she walks into an exam room to find her patient’s nose in his iPhone. Yes, she was initially horrified. But if you check this out, you will discover that what followed next was a teaching moment for HCP and patient alike. You will see that she did close her computer to interact more personally with the patient. BUT. You will also see that HCP and patient alike learned the value of the information that each of their devices brought to the clinical situation, and how they could compare “notes” and actually improve the quality of the interaction by seeing if his Google search on his condition had turned out to be correct and if her notes about his case turned out to be complete.

Bottom Line. Sort of a fascinating outcome actually. A rather clear demonstration that the mores of the digital age are changing rapidly. What used to be totally inappropriate behavior now actually makes sense.  

What next?  

Can Artificial Intelligence Make Healthcare More “Human?”

Funny question, right? But stop for a moment to take it seriously. If AI were to take away much of the grunt work involved in the practice of medicine, like note taking and diagnosing simple medical problems, physicians might have the time to again take a more humanistic approach to their practices. And have their treatment practices automatically thumped into alignment with the latest treatment guidelines. At least, that is the premise of  Deep Medicine, the latest book by noted healthcare futurist and prolific author Dr. Eric Topol.  Recently published, it is already well on its way to becoming a best seller that everyone involved in the healthcare vertical should explore.  I must confess. Every time I interact with Siri or Alexa, I wonder what AI can bring to the practice of medicine. My guess is that the answer to that question would be “A lot,” and Dr. Topol’s thinking can help us figure out the answer more specifically and help us to identify where the opportunities lie for us to become involved in this process.

Bottom Line. I must confess that I have just downloaded the book onto my Kindle, and have only started to get exposed to the insights that lie therein. BUT. Let me assure you that this is good stuff.  For today’s purposes, I wanted to add the book to your list for summer vacation reading. Look for my more thorough commentary on the topic in the near future. Right now, I am headed for the beach. Deep Medicine in hand!

Death By A Thousand Clicks

Check this out. What you will see is a URL with one of the longest riffs that I have ever sent you to. I am sorry about that. But it is also an important piece. And you don’t have to read the whole thing to get its simple message. Here it is. EHR’s are not perfect. AND. Their imperfections can kill people.  

The article starts with the story of a young attorney who died because an EHR failed to transmit an order for a diagnostic test which would have found the aneurysm that was killing her. AND. As the story evolves, we find that a significant percentage of patients find errors in their personal EHR’s. 

Watch the embedded video. The irony here is that the Federal Government promised, including through Presidential proclamation, that EHR’s would greatly improve healthcare. The Fed’s felt strongly enough about this that they provided financial incentives, and eventually a mandate, for practitioners to move from paper records to EHR’s. And doubtless they were correct. EHR’s make sense. But they are not perfect.  

Bottom Line. And the moral of the story? Good intentions and well-reasoned solutions can carry with them a dollop of problems. Don’t overlook them!