A Physician Perspective On Mobile Healthcare by Brian Gould M.D.
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A unique and global physician's view of mobile healthcare by Brian Gould MD at the Mobiquitous Conference in Toronto, Canada, July 2009. DRAFT Slides from a Flash presentation. Contact Dr. Gould through Information Advantage Group.
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A Physician Perspective On Mobile Healthcare by Brian Gould M.D.
- 1. The Physician Perspective On Mobile Healthcare Humanitarian Technology Challenges and Interoperability Workshop Brian S. Gould, MD Information Advantage Group www.iagllc.com July, 2009
Notas del editor
- Smartphones allow users to create highly personalized environments configured for preferences location-awareness ability to manage all data formats – audio, data, photo, video (live and recorded) iPhones account for only a fraction of smartphones/PDAs worldwide (15.1 iPhone and iPod Touch devices in May 2009), but the overwhelming majority of smartphone Internet traffic “ Medical Tourism” as local center of excellence, technology diffusion point
- Leadership in mobile health innovation does not automatically go to the industrial West. Third world projects are proliferating and scoring impressive successes “ mHealth” = mobile health technology Ubiquity Multidirectional information flow Interactivity Personal convenience Phones are inexpensive, already in common use. Can be re-charged at night with generators if necessary. To make the user interface simple and friendly, the hardware/software infrastructure needs to be sophisticated (complex), but that is being developed. (Frontline SMS is a free application that allows health officials to analyze a large volume of text messages with the need for central servers or even Internet access.) Dr. Nathan Wolfe, head of the Global Viral Forecasting Intiative (GVFI): “If the Internet is humanity’s planetary nervous system, we are now building our planetary immune system.”
- Hardware/software purchase model – common for IT – is wrong for small practices
- #1 examples – “meaningful use” requires physician to have all relevant patient data at point of care, regardless of origin or network carrier. Conflicting standards example – decision of CMS to pay for Zostavax vaccine under Medicare Part D. No way for medical offices to get reimbursed (they are not pharmacies). #2 -- Quoting Max Planck, “in the correct formulation of the question lies the key to the answer”, Ball et al. ask, “Why has health IT failed to provide the systems and appliances that clinicians will use?” They answer themselves, (we are dealing with) “… a more fundamental ‘systems’ failure. The computer science domain lacks the methods and tools to represent the complexity of user tasks, the contexts and sets of information and knowledge that must be harvested for context-relevant information push and pull in health care.” platform independence diverse input/out capabilities ubiquitous access easy user customizability ability to work with existing and emerging systems open architecture – accepts commercial off-the-shelf components ability to manage multiple tasks, and multiple patients Workstation “inbox” (Ball et al.): information broker – interface the workstation system with existing information resources and network services task/context manager - to track and support multiple activities and multiple patients human computer integration manager – to present information to and gather information from the clinician in ways that are easily understandable and consistent with the physician’s preferences
- Physician resistance not just a US phenomenon. Compared to European HCIT conversion, US docs have had more opportunity to reject the technology; in Europe, was not an option. Just happened despite some significant physician resistance. (What the Dean of Harvard Medical School describes as “a forced march” for the profession.) European physician objections noted [good summary of US physician objections as well]: failure to include physicians in the design process* failure to demonstrate value to the clinical process (e.g. clinical decision support) ensure the privacy of personal data “ Changing systems means changing behaviors” -- unintended consequences to patient care? Who looks at impact at point-of-care? (“e-iatrogenesis”) Workstation “inbox” (Ball et al.): information broker – interface the workstation system with existing information resources and network services task/context manager - to track and support multiple activities and multiple patients human computer integration manager – to present information to and gather information from the clinician in ways that are easily understandable and consistent with the physician’s preferences
- Attention in US right now is on conversion to EMRs, but that shouldn’t be confused with the actual goal. The long-consequences of HC digitization will be far more penetrating. As was often said about other industries during the Internet bubble days a decade ago, “ … will change everything.” Pressure to open networks so location-based services, universal access to data, interoperability