TEACHnology in Medicine
As Emergency Physicians, unexpected deaths are part of our job. Telling families that their loved one has died does not get any easier over the years. Each time you do it, you have to remain stoic, you have to be the “rock” in the room. I often find my mind racing through pathophysiology to keep myself a little emotionally detached - sounds like a reasonable coping mechanism, right? A fatal accident or coding patient is not a loved one or a friend, but a patient with multi-system trauma or a massive MI unresponsive to treatment. This way I can compartmentalize that remaining bit of emotion so I can get through the family discussion and the rest of the day. It works most of the time.
But what happens when that patient is one of your own? A physician, a colleague, a friend?
This past weekend, the UCSF-Fresno Emergency Medicine family lost one of our own. Dr. Melissa Dowd, one of our interns, was killed after she was struck by a car while crossing the street. I had the pleasure of working with her a number of times this year and she was great - bright, full of potential, eager, loved learning, loved taking care of patients, and was just fun to be around.
But we are not invincible…we get sick, we get hurt, and sometimes so badly that we can’t be saved. We are not always stoic…we have sadness and we can feel loss.
It is times like this these that make you stop and re-evaluate. Tell your friends and families that you love them, cherish your time together. Life is random and sometimes, bad, unexpected things happen to good people, even to physicians.
Melissa, you will be missed.
Last week, Apple announced the release of the iPad mini, their new 5.3” x 7.8” answer to the growing market of smaller tablets and readers such as the Kindle Fire or Nexus 7. Since its release, I’ve received many questions as to the potential role of the mini in medical education - would its smaller size improve adoption rates, specifically in the clinical areas where the existing iPad may be too big? Or, should medical schools continue to stick with Apple or move to another device like the Kindle Fire or the Nexus 7? And possibly the most important question of all…do you have your iPad Mini yet?
Well first off…no iPad Mini yet - we purchase them through our campus computer store and our order only arrives next week. So with that in mind, this whole post may be invalidated as soon as I pick mine up. :)
Let’s look at its potential for Medical Education through the lens of the basic sciences experience and the clinical experience, since these two uses are quite different in their technology needs.
- Basic Sciences - primary functions are consuming large amounts of medical content, be it via PDFs, textbooks, podcasts, or apps. For this task, I don’t see how the iPad mini would be less useful than the iPad. Conversely though, I’m not sure that its smaller size would make it more useful than the regular iPad. For students in their 1st and 2nd years of medical school, I have yet to hear anyone say “this iPad is just too big.” Also, our students have gotten quite good at creating content while in lecture. I wonder if the smaller size, will make annotating notes and creating diagrams more difficult? Check out the great examples of student notes generated during lecture…
- Reference Material in Clinical Rotations - primary functions here in the clinical setting are just-in-time learning, quick references, and exam preparation. For the reference and study material, I can see the argument for a smaller iPad; however, most white coat manufacturers now make pockets for their lab coats. We have a post on MacHealthcare regarding some of the vendors for iPad-friendly white coats here. Some students and faculty have noted that at times, the iPad is more prone to bumps and getting knocked around in their coat, so they often add a protective case, which definitely adds to the heft and size. Some even come with their own shoulder strap as an alternative to the white coat. Is the iPad more bulky than all of the pocket reference materials students and residents have traditionally carried around in their white coats? Hard to say…
- Accessing the Electronic Medical Record in Clinical Rotations - now this is the area where the iPad Mini may have problems. EMR’s with dedicated iOS apps have different functional versions based on the device - Epic has separate apps called Canto and Bento, Allscripts has Sunrise MobileMD that has different functionality based on iPad vs iPhone/iPod. The iPad versions of each EMR provide a good deal of functionality because of the screen size - I worry that the iPad Mini does not have the screen real estate for looking at progress notes, lab trends, etc. Also, for those Citrix users, the iPad screen size is at the minimum size necessary to really be functional since you are running a full Windows desktop. The iPad Mini may have too much scrolling to be useful. This could be problematic for programs like the University of Chicago that rely heavily on Epic and their iPads.
- Patient Education in the Clinical Setting - the larger screen size of the iPad is really great for educating patients and showing them the images of their radiology images and patient education apps like DrawMD. The size is also great for sharing data during walking rounds - definitely easy to show trends in lab values, etc to a team of 5-6 people without too much squinting. The iPad Mini may be too small for this…
- Mixed platform deployments - iPads and Kindle Fire, iPads and Nexus 7? Always a tough idea to institutionally support multiple platforms, especially if the goal of using a mobile platform is to consolidate all of your resources in one place. There is a still a fair amount of digital textbook and app content exclusive to the iPad. Also, many hospitals don’t allow Android-based devices on their networks since they lack built-in hardware encryption and security…
This article from FastCompany is a little bit scary - medicine is becoming a very data driven field and even though we have all of these systems in place, data breaches and cybercrime still occurs.
If you need a bit of perspective as to why we jump through all of the hoops of complex passwords, multiple logins, device encryption, HIPAA training, secure email servers, etc - then this article is worth your time.
No solutions offered up yet, but it is good for all healthcare providers to be aware of these issues.
At the University of California, Irvine, School of Medicine our philosophy on technology use during patient encounters is that mobile technologies, such as the iPad, are a useful patient education adjunct, though they should not distract from the purpose of the encounter. To assist in this endeavor, the iMedEd curriculum at UC Irvine has developed a list of 15 self-assessment questions to help providers better integrate mobile technology into patient encounters.
View the original post at:
http://machealthcare.org/articles/24/uc-irvine-s-mobile-technology-et
A recent report from PricewaterhouseCoopers (PWC) entitled “Emerging mHealth: Paths for Growth” found that consumers are ready to adopt mobile health faster than the health industry is prepared to adapt. As an interested observer and now participant, I would have to agree. Much of what we’ve seen in the past few years has started at the consumer level with the field of medicine slowly catching on.
However, this is not an unseen phenomenon - many smart medical thinkers and “philosophers” have picked up on this and are doing their part to educate physician colleagues. This will seem like a “shout-out” list, but some of the big players so far are Eric Topol (Creative Destruction of Medicine), Jay Parkinson (Hello Health, The Future Well, Sherpaa), Wendy Sue Swanson (@SeattleMamaDoc), Larry Chu (Stanford Medicine X), Bertalan Mesko (The Social MEDia Course) - they have all done amazing things to help promote mobile health and patient empowerment.
Ryan Faas from CultOfMac.com takes a look at the same study in an article entitled “Why Your Doctor Doesn’t Want You Using iPhone and iPad Health Apps.” I will disagree with his interpretation of the data as it seems to spin physicians into a “tech-averse” group of individuals that do want to let their patients participate in their care.
From the report, here are the stats as presented:
- 64% say that mHealth offers exciting possibilities, but there too few proven business models
- Only 27% of physicians encourage patients to use mHealth to become more active in managing their health - 13% actually discouraged it. You could make the assumption that the other 87% just aren’t familiar enough to make a judgement or recommendation
Naturally, my position and technology background make me biased and different than most physicians in terms of comfort with emerging technologies. However, I feel that the statement “your doctor doesn’t want you using iPhone and iPad Health apps” is a little too broad and overstated - if this were a manuscript submission to a peer-reviewed journal, I would choose “Accept, pending revisions” since the claims don’t necessary match the raw data.
Yes, healthcare is slower to adopt, and yes, many physicians are unsure how to use technology best with their patients. This is where the physicians and medical students who embrace technology need to step up and educate their colleagues.
Medicine and healthcare are changing whether we like it or not - we might as well take advantage of the new opportunities!
One of the first documented cases of harm from a mobile device - one caveat though, the device needs to be within 1-2.5 cm away from the VP shunt itself.
For those of you rotating in a clinical setting, this degree of close contact between your patient and your iPad seems unlikely; however, for parents with children with VP shunts, please be careful about them falling asleep next to their devices as that 2.5cm buffer can easily be overlooked.
Really great article about the context for technology and some thoughts on how to teach your young ones to use it responsibly. As parents we often set boundaries for other behaviors - TV watching, eating healthy, sleep habits - we should do the same for mobile technologies such as smartphones and tablets.
As medical educators, these are issues that we should take note of - even though our users are not children (though have been known to act that way -j/k) there is still a shortage of good information on how to best teach healthy usage of these devices within our daily lives. Restrictions on texting and driving and in some places, texting and walking, are designed to prevent serious injury, but do we have any recommendations for prevention of injury and maintenance of health - repetitive stress injuries, hearing compromise, eye strain?
As physicians who work with children and parents, we will likely see more of technology usage by little ones in our practice environments - how can we best guide our patients for health habits? Something for us to think about…
Highlights from the article:
- Original source article about 3 year-old kicked off the plane for his temper tantrum after getting his iPad taken away from him - http://newsfeed.time.com/2012/06/02/3-year-old-kicked-off-airplane-for-crying/?iid=ec-main-mostpop2?iid=ec-main-mostpop2
- “Parents are lost about managing technology to fit appropriately into children’s developmental needs and family life” - Dr. Eitan Schwarz
- “First, you are the child’s model and have the home-court advantage, so stop texting while parenting and straighten out your own tech life.”
- “Enforce tech-free times and zones.”
- “Teach that these are powerful tools, and learning their correct use is a careful long-term task, like hygiene and other self-care”
- “While there is lots of debate about “screen time”, not all screens are the same and no general rules can apply here except to use these devices only to benefit the young child’s development and family life”
Cool article and video about the use of smartphones to monitor your carseat! Interesting application of technology for injury prevention.
Physicians, keep an eye out for these coming your way and consider checking one out so you can possibly recommend it to your patients!
Here’s the link for the iTunesU course for UCI’s Clinical iPad Orientation. Please review this material to help you get a better handle on how to use your iPad clinically.
Please check this material frequently as new apps and clinical pearls will be distributed via this course!
Story from the AMA, adding more examples of physician adoption for tablets. Has some interesting highlights:
- Great example of patient use of iPads while waiting for providers at the clinic in Wake Forest Baptist Medical Center’s Downtown Health Plaza
- The article also gives some examples of why the tablet is “more than a bigger smartphone” - EMR access and patient education with a shout-out to DrawMD.
Also some great data from Manhattan Research’s “Taking the Pulse US 2012” survey:
- 3015 physicians in 25 specialities, surveyed in Jan-Mar 2012
- 62% of physicians owned a tablet (up from 27% in 2011). Of those 62%, half use them at POC
- 81% with smartphones
- Physicians with three devices (smartphone, tablet, computers) spend more time online on each device and go online more frequently during the workday than other physicians
- Adoption of physician-only social networks (sermo, doximity) remained flat
- More than 2/3 of physicians use video to maintain their knowledge base - no comment on if this is true CME or if this is the primary source for knowledge maintenance
Highlights:
- Survey data from ZocDoc implies that younger users of healthcare are dissatisfied with the lack of access to healthcare appointments - i.e. in addition to prolonged waits to see a provider, there is the inherent difficulty in making an appointment
- Technologies employed in the healthcare setting have terrible usability and UI, which can lead to more errors and time consumption
- Smart design means that it should be easy for patients to navigate the system and for doctors to exchange information
Really interesting article based on some work by Joan Green, author of “The Ultimate Guide to Assistive Technology in Special Education.”
For medical students, residents, or clinicians, this should serve as a good reference for technology that become very useful in both the short and long-term care of patients with special needs. This would be a great resource to distribute to parents as well.
For parents and families of special needs children, the potential benefit is pretty clear.
Something to think about - technology in clinical environments should not just be limited to clinician support; it can and should also be used to create better care environments and healthcare-family-patient interactions.
Makes you think a little bit…”a doctor’s image isn’t controlled by anyone but the doctor.” Dr. Vartabedian is a Pediatric Gastroenterologist at Texas Children’s Hospital / Baylor College of Medicine and one of the most well thinkers/writers/bloggers on social media and medicine.
Get to know him if you don’t know him!
Great Read! Best quote: ”We will never have Web 3.0 because the web’s dead”
Someone who hasn’t fallen for George Orwell’s trope ‘whoever is winning now will always seem to be invincible.’
Here’s Why Google and Facebook Might Completely Disappear in the Next 5 Years - Eric Jackson via Forbes
In the tech Internet world, we’ve really had 3 generations:
- Web 1.0…
(via stoweboyd)
A great article by Pamela Lewis Dolan from the AMA regarding smartphone and tablet usage influence systems change.
Some highlights:
- 81% of physicians using smartphones (Manhattan Research Survey of 2,041 physicians)
- Top 3 smartphones - Blackberry, Android, iPhone
- 75% of physicians surveyed own at least one Apple product
- 30% of physicians surveyed using iPads to access the EMR, with an additional 28% planning an iPad purchase within next 6 months
- Very few mobile EMR apps, most often accessed remotely
