This is second part of the #HITsm at HIMSS15 Panel transcript. Read Part 1.
A special thanks to our four panelists:
- Keith Boone, Standards Geek for GE Healthcare
- Dr. Doug Fridsma, President and CEO of AMIA
- David Muntz, Senior VP and Chief Information Officer at GetWellNetwork
- Dr. Rasu Shrestha, Chief Innovation Officer at University of Pittsburgh Medical Center and Executive Vice President of UPMC Enterprises
John Sharp: Hi. John Sharp from HIMSS. So, this is a stimulating discussion with a lot of ideas, but going back to envisioning the future: Do you see a time when we will be incorporating the patient in the workflow? Do you see a kind of a convergence of FHIR-enabled mobile apps that include patient workflow?
This morning I heard a presentation from American Heart Association which has care paths that include the patient. Do you envision that kind of thing becoming common in the future, in the next five years, where patients will maybe be prescribed an app, a FHIR-enabled mobile app, for instance, that would help them manage their chronic condition?
Keith Boone: So, I think that we’re already starting to see people being prescribed wearables where they’re going to have some sort of health app and it’s going to support interoperability with FHIR. We are actually seeing that. But the reality is that people are already starting to build some of these apps.
There’s a lot of work in the SMART platform right now that is trying to build an app framework that not only supports the EHR space but also supports people being able to build mobile applications that can be used by patients.
So yes, that’s not the future, that’s today. Will it become ubiquitous? That really depends on how well that stuff works and how well the apps work as opposed to the standards that are underneath it. I think there’s a lot of creative people out there who are doing a lot of really cool stuff in engagement.
I’m glad you brought up workflow because I think that’s another area where we’re going to start to see issues. We’ve got interoperability with the data and the semantics. What we’re missing now is interoperable workflows between providers and we’re not going to get there until we have a much better understanding of what a best workflow is to implement for the patients. We won’t know that until we actually have a lot of the data that we need to break free from, to break loose from those silos.
Rasu Shrestha: I, for one, cannot wait for this distinction, artificial distinction between mHealth and health to really disappear. I think it should just be one. It’s already here, but it’s also coming at a broader level.
So, in our organization, when you look at high-cost, high-impact patient populations, it’s a no-brainer for us to prescribe an mHealth device, an app, an iPad or whatever to these high-cost, high-impact patient populations because the return of investment in those types of initiatives are tremendous.
I think, if we take a step back and we have this discussion on interoperability as well. As an industry, perhaps, in this journey for interoperability in the last decade, we just celebrated the decade of interoperability, maybe we bet on the wrong horse. We’ve been tasking the vendors, the EMR vendor community to essentially, look, let’s play ball here now. Let’s make sure that we’re able to exchange information and adhere to standards that are out there and then, with meaningful use and we’re pushing them along as well.
Perhaps, as opposed to betting against, or betting with our saying, let’s have the vendors actually lead interoperability, maybe the charge should really be let’s have the patients be the conduits for interoperability. So, I think with mobility, with mHealth, with FHIR, with all of these different initiatives that we’ve got going on, as well as this shift from volume to value that we’re seeing in the industry, there really is a lot of potential right now for us to get this right and it’s ours to lose if we don’t do this.
Doug Fridsma: So, I have to go back to history. It’s my history lesson. If you don’t understand history, you’re bound to repeat it. So, for those of you who read the Journal of the American Medical Association and I’m sure all of you do, in 1906, there was a whole series of articles about this new technology that was coming into medicine and they didn’t know what to do with it.
There are, between 1906 and 1912, a whole series of articles, probably every three months or so, on something called the Physicians Automobile. These articles are all about the return on investment, how it increases your patient engagement, there are technical discussions about whether you should have a steam engine because Philadelphia had a steam ambulance and it has statistics about how frequently that ambulance went out on runs, or electric or internal combustion because it wasn’t quite clear what was going to be the prominent technology at the time.
There were discussions about whether you should have hard tires versus soft tires because the hard tires were really good because they didn’t pop, but they give you a really tough ride with everything. Anecdotal evidence about people that were crazy, early adopters to this new technology around transportation that was now sweeping through health care.
In 1912 they stopped writing those articles. Does anybody remember what happened in 1908? Henry Ford developed the Model-T. It was no longer the physician’s automobile, it was really the consumer. A whole host of changes had happened. Now, there were six Duesenbergs created. They were beautiful machines, but they didn’t change transportation.
What changed transportation is when you get it out of the hands of 500,000 primary care doctors and you put it in the hands of 300 million people. That’s what’s going to make the real change. So, we have to remember the lessons of history. We are, right now, developing the physician’s automobile and somebody, on the floor in this arena, is actually got the Model-T. We don’t know who that person is yet. But somebody’s going to develop a Model-T that’s going to make all of the other stuff seem irrelevant.
Mandi Bishop: All right so, as the health care IT social media community we have to ask a social question.
As health care social media is coming into its own. What is the feasibility of its widespread use for administrative, clinical and even therapeutic modalities?
Rasu Shrestha: I think, when it comes to social media in health care, we’re just flirting with social media right now. We’re just flirting with it, we’re not even scratching the surface. I think the potential is tremendous.
We don’t want patients in our beds, we don’t want them in our EDs we don’t want them with our PCPs even. We want them at home. What are they doing at home? They’re watching the TV, they’re engaging on the internet. They go to Dr. Google before they come see Dr. Shrestha.
How do we leverage the potential, the power, this massive interest that we’re seeing from consumers in really caring for their own health and engaging in their own health. I think that’s the tremendous untapped power of social media. So, to really leverage this and to drive it forward in a big way in such that we’re able to gameify, we’re able to exactify the healthy behavior, we’re able to really tap on some of the benefits that we’re already starting to see in terms of patient communities.
These are the types of efforts that I think will really sort of drive the adoption of social media in health care. I think there are also other things that we should be doing in terms of looking at massive levels of engagement that, hopefully, will be coming even more of in the next decade and looking at opportunities like Pharma. What does big Pharma benefit from when they’re looking at patient communities across chronic diseases that we have in healthcare. So, lots of untapped potential, I’m sure.
Mandi Bishop: What is it going to take for us to get there and is the resistance on the side of the health care industry itself, is it on the side of physicians, is it on, I mean, what is the barrier?
Keith Boone: So, we’re in such a hurry to get there, what we forget is that we’re already on that path. Talk to kids.
People tell me, aren’t you worried about your daughter being on Facebook, she’s going to expose something that’s going to prevent her from getting a job? I said, no way, no way, guess what, that HR director is going to be, will have done on Facebook too, unless he’s done something stupid.
We are going to learn from those and we’re going to learn how to use it. Maybe we need to hurry this up, maybe we don’t. Maybe we just need to let the cultural shift that’s going to happen, happen and see where it goes. There will be people who experiment. They’ll be people who do really cool stuff with it. But, I don’t see this as being something that is really worth getting into a huge tussle over because, quite honestly, it’s going to happen. The technology is here. We’re going to learn how to use it.
Doug Fridsma: I’m going to give this to David because I’m going to say two words, I’m going to talk patient and family and social media and I’m going to ask David to comment.
David Muntz: Well yes, I appreciate that. We did talk about community and I think that’s critical and I do think that social media will definitely benefit patients and families.
I’ve seen where communities exist where you couldn’t possibly have gotten the community together. The truth is, most of the significant events in life are accompanied by community activity, births, weddings, are really all about, deaths, all about community.
There is one aspect of medicine that I would like to see a dramatic sea change and that is from really thinking of medicine as a transactional activity to moving into an aspirational activity. We have focused so much on the transactional things that we gather scale and statistics to talk about how to describe us. We use representations of things. It’s certainly not easy to represent a person in a difficult format.
One of the things that I don’t think we pay enough attention to is, this gets back to the wear-ables and what you should do. Wear-able is really picking up data that’s interesting about what’s happening somewhere on my body, but not in my mind. So, the behavioral aspect of medicine is huge. Trying to determine where somebody is in their willingness to change really does impact the care.
If I’m in pre-contemplation, moving to contemplation to planning to action to maintenance, really has a huge difference on how it is I approach the patient. So, the question is how do you change the conversation that occurs between the provider and the patient in a way that allows a much more meaningful expression of what the correct care plan is based on where I happen to be.
So, let’s spend the time on the people who are in pre-contemplation and move them down the pathway and let’s spend the most time on people who are contemplating and planning in order to make the changes. Until the wear-ables have a behavioral health aspect, I’m ready to do the exercise, I’m ready to change the diet, I really don’t think that we will get the impacts that we need.
If we can figure out a way to make the transactions describe the mental state or the behavioral activities that will allow us to interact with the patient more effectively, I’d like to see that.
Mandi Bishop: Well, we talked about Dr. Google and we just talked about some behavioral modifications and I see that I have a question, but before I ask this questions, do we have any of the HIStalk Patients Scholarship recipients in the room? Is anybody in the room aware of the chronic conditions social media communities for patients that are available? Does anybody know?
If you’re on Twitter and you guys want to take a look at what’s happening from an patient perspective for communities and how health care social media can change the lives of the patients and can help them better engage with doctors, there are a number of hashtags out there. #bcsm for breast cancer social media, #lcsm lung cancer social media are two of the big ones. #lupuschat.
So if you, collectively, wanted to get a sense for what’s happening in the patient community and how they’re getting information that helps them better inform their engagements with their doctors, I just wanted to give a shout-out to those communities because I think they’re doing an amazing job and they’re performing a really wonderful public service. We have a question.
Audience Question from Jenny Laurello: My question is related to data, social media data, and actually applying … whether it’s looking at using the … Twitter data to prevent heart disease … or … children’s hospital … insomnia. What are some of the really innovative cases of social media … you guys receive.
Doug Fridsma: So, I think you mentioned several of those. One of the things that I know we’ve seen in just Twitter-mining is the [inaudible 00:36:36] social media to predict flu outbreaks and outbreaks of other infectious disease. There’s a lot of interesting challenges in use of social media for population health use.
Matter of fact, I was reading an article yesterday for one of my [inaudible 00:37:03] classes. I found a case where it was a patient who actually had an infectious disease and a friend posted on a Facebook account, the friend posted on his Facebook account, if you know duh-du-du-du-du-dah and have been in contact with him in the last several days, he’s come down with whatever this disease was and went into the specific ethics of using social media for some of that kind of thing.
We’re starting to explore all of these different, innovative ways to do stuff on social media. There’s a lot of stuff that you can find out by doing data mining, there’s a lot of predictions that you can make. So, it’s an interesting and emerging area in terms of cool stuff you can do. There’s a lot of opportunity. So, just a few comments.
Audience member asks a question about how Dr. Google can influence a care encounter.
Doug Fridsma: So, when I was practicing medicine, I don’t practice now, but when I was practicing medicine, I made part of my review of systems to include what did you read on the internet. It creates a conversation.
The thing is that there’s good stuff and there’s bad stuff. But if you make it okay to look on the internet and if have it okay to talk to your doctor about it, you actually will find that patients will use it ways that will be very supportive to their health and health care. So, I encourage physicians to have that conversation, like what did you learn about this as you were thinking about coming in to have your visit?
Rasu Shrestha: Really quick comment, in actually look at the emergence of social media in health care, I think one of the biggest challenges that we’ll continue to have be is in the validity and the neutrality of the information that’s out there.
To tackle that, I think it’s really important for us to focus on having really great content, top notch quality, and make sure that we continue to curate a lot of this content as well so that patients know where to for really valid information. Validity and neutrality is, I think, really important.
Keith Boone: Any parent can tell you the value of social, in any form, in dealing with health care for your children. Any parent.
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