Monday, November 14, 2011

What I Learned in Denmark II: The Online Health Track

In a previous blog post ( I discussed how much I learned at the J. Boye Aarhus 11 Conference in Denmark from a fabulous opening keynote by Michael Edson and from presentations on search and going mobile. Today I would like to summarize the discussion at the Online Health Care Track that was expertly moderated by Lau Hesselbaek Andreasen.

In my opening remarks I revisited some of the themes from Edson’s brilliant keynote and tried to understand what they might mean for health care. Kathy Sierra’s observation that the digital world makes “every user a hero” was extended to embrace the idea that “every patient is a hero.” The concept that the patient is the most underutilized resource in health care was introduced, and social networking sites like Patients Like Me were given as examples of mass collaboration in health care that results in patients learning from others with the same disease and presenting themselves to physicians as empowered and engaged patients. Lawrence Lessig’s observation that synchronicity is a costly impediment that can be overcome by digital means was briefly mentioned, and Clay Shirky’s books Here Comes Everybody and Cognitive Surplus were discussed.

We then talked about the two worlds of health care: the evidence-based medicine world of doctors and clinical trials and the patient experience world of people living with their diseases and coping with help from others. I mentioned Clayton Christenen’s observation in The innovator’s Prescription that “doctors spend about two hours each year with their diabetic patients, but patients spend 8,758 hours managing the disease on their own.” The two hours are spent in the evidence-based world, and the 8,758 hours are spent in the patient experience world of unclogging insulin pumps and learning when hypoglycemic crises occur for an individual patient. We discussed the need for more clinical trials to increase the percentage of proven knowledge in the evidence-based medicine world from the current 25%, and the fact that the right answer changes when new scientific studies are completed. We also discussed how much the patient experience world has changed with the advent of patient social networking sites and the ability of amateurs to avail themselves to much of the scientific literature about their medical conditions.

I completed my overview opening presentation with a survey of how American hospitals were using social media compiled by Ed Bennett of the University of Maryland. I also presented slides examining how social media could be utilized for personal health records, clinical trial recruitment, treatment and hospital selection, health professional training, disease management, and wellness. My slides are available here

Dr. Abir Al-kalemji of the Odense University Hospital in Denmark delivered the second talk: Do Patients Benefit from Social Media? The short answer is we think so, but we need to do research to document what does and does not work. Al-kalemji reviewed YouTube videos for teaching patients exercises, smartphone transmitted pictures of rashes, remote monitoring of anticoagulant therapy, and psychotherapy via social media. She discussed the obvious advantages of improved access, time saving for both patients and physicians, increase in patient safety, and the possible enhancement of therapeutic possibilities. She also listed the limitations of not being able to perform a physical examination, trust and privacy issues, and reservations about the quality of health care information available on the Internet. Al-kalemji finished up with a discussion of Facebook. Some physicians believe becoming friends with patients on this social media site reveals important information about the patient; others were opposed to physicians ever relating to patients via Facebook. Dr. Al-kalemji slides are available here

Dr. Poul Jaszczak, Chief Surgeon, Department of Gynecology and Obstetrics at Herlev Hospital and Chairman of Danish Medical Association Ethics Committee, presented his views on digital strategies and methods for communication. Dr. Jaszczak stated that social media can blur the boundary between a person’s public and professional life, and he recommended adopting conservative privacy settings on social media sites. He emphasized that the ethical and legal duty to protect patient confidentiality applies equally to both the Internet and other media. Dr. Jaszczak does not believe that health professionals should accept Facebook friend requests from current or former patients, and he worries about derogatory comments posted on public Internet forums. Dr. Jaszczak’s slides are available here

Dr. Jaszczak shared the following posting from a social networking site:

“Dear emergency Registrar:

Thanks a million for misdiagnosing my patient’s perforated bowel as constipation and treating aggressively with laxatives. I’m sure she appreciated the subsequent cardiac arrest and multiorgan failure. Don’t worry, she just needs a new set of kidneys and a liver and she’ll be right. And with that kind of performance, I’m sure you can help her acquire them.

Kind regards,

Lowly intern”

Line Berg Ostergaard, Manager Global Digital Marketing for Zimmer, presented how one medical device company is using social media in the health care space. Ostergaard nicely summarized statistics about patient use of social media, and she emphasized that many patients have changed the way they view authority figures when dealing with a serious health issue. Zimmer has recognized that patients like to talk to other patients, and their website allows patients contemplating hip replacement to talk to patients who live nearby and who have already undergone the surgical procedure. Acknowledging that Zimmer has not yet leveraged the full power of Facebook and Twitter, Ostergaard discussed some of her ideas for the future. She also addressed the current obstacles of the complexity of providing both global and local information and the lack of guidance from regulators. Her slides are available here

Jens Ole Henriksen, the former CIO at Odense University Hospital, wrapped up our online health track with Smartphones: Healthcare in Your Pocket. Henriksen reviewed the Danish strategy for welfare technology and telemedicine with its emphasis on cost containment, building super hospitals to replace rural facilities, and attention to the needs of the elderly. He also commented on how new technologies like smartphones and cloud computing are disrupting the IT department. According to Gartner, by 2014 the IT department will lose control of over 25% of the organizations’ IT budget and by 2015 there will be four times as many mobile development projects as PC development projects. Comparing the smartphone with its apps to a Swiss Army Knife, Henriksen taught me that all of the following can be done on a smartphone: geographic locator, movies, speech recognition, connect to USB device for weight, blood pressure and other metrics, compass, connect to Internet, accelerometer, light sensor, speaker, and proximity sensor. He also did a masterful job of explaining to the layperson (me) the differences between the three platforms for smartphone apps: IOS (Apple), Android (Google), and Phone7 (Microsoft), and he described the advantages and disadvantages of producing apps for each of the three platforms.

Perhaps most useful was Henriksen’s description of a smartphone workshop he held at Odense University Hospital where physicians, IT experts, administrators, and developers brainstormed on how to best use smartphones in a hospital environment. After coming up with ideas for clinical, patient, encyclopedia, and location applications, the workshop concluded that they should concentrate on creating interfaces for the apps to the old legacy electronic health record, developing patient information apps to help them navigate a complex and large hospital plant, create lab result notification apps, and create an app to support anesthesia and preop processes. Henriksen’s slides can be found here

The online health track at the J. Boye Aarhus 11 Conference succeeded in opening my eyes to different ways to look at digital strategy. The informal and warm atmosphere during the keynotes, the breakout sessions, the refreshment breaks, and the conference dinners made networking effortless and effective.


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