Doctors are starting to redesign the way they work to link better with patients and to use the newly available multi-media technologies. This is an important process that will undoubtedly accelerate over the next 20 years. There is a need to substantially redesign many of the traditional processes used to practice medicine - and move to new ways of delivering health services, using what I call ATM Healthcare.
What, then, is ATM Healthcare?
When we think of the term ATM, most of us think of banks. The acronym ATM has entered our language so completely that many people don't even know what the letters stand for - they just know that undertaking an ATM transaction allows money to be drawn direct from their bank account, not from a credit account, and that they can do this at a special ATM machine usually in the street, or at a store checkout. ATM stands for Automated Teller Machine and is simply a direct electronic entry to your bank and your accounts. And it is very simple, convenient and consumer friendly. ATM has made banks and bank accounts much more accessible to customers, wherever and whenever they want. At the same time they have made the work of banks more efficient while dramatically cutting the cost of bank transactions to a few cents from an average of $10-15 per face to face transaction with a teller. This has happened because ATM machines now manage most of the simple bank transactions that used to take up a lot of the time of tellers. This frees up bank staff to spend more time on complicated transactions where human expertise is required. Who can now imagine a bank without widespread ATM facilities? And all this has happened in just a few years.
Computer scientists think of ATM in a very different way. For them ATM is a technical term describing how data can be passed across an electronic network. Here ATM stands for a protocol called Asynchronous Transfer Mode. This protocol was designed as a way of merging old telephone networks with more modern packet-switched computer networks in order to deliver data, voice, and video over the same channel. In other words it allows all sorts of differing data, from varying data sources, to be delivered at the same time.
So what have these two types of ATM have to do with healthcare?
Think of the obvious parallels.
The doctor-patient consultation is in many ways similar to the traditional bank interaction with a teller. It is confidential, about 80% of consultations are relatively simple, and if complications arise, a second person can be called in to give specialist advice. There are also parallels with the computer scientist ATM, because this consultation nowadays involves typically several different types of data - voice, lab results, paper and electronic documents (health records), and increasingly video and digital images. The consultation itself can be described in both computer language and clinical terms as consisting of three information processes – data capture (history and examination), data analysis (diagnosis), and business planning (treatment).
What we in healthcare need to do is start thinking like bankers, and focus on providing our services in a more consumer friendly way. As we do this, doctors need to follow two core principles. The first is the complementarity principle - computers do well, what humans do badly, and vice versa. Computers never forget, and are great at scheduling, remembering and reminding, but humans are much better at data analysis and decision making. So computers should be able to do many simple health transactions, remember and order prescriptions and lab tests, schedule appointments, and provide preventative health information. The second principle is the importance of redesigning business processes before introducing new technologies. There are a lot of similarities between banking and the practice of medicine. And doctors can learn from bankers in this area. There is no reason why we should not introduce ATM Healthcare, in just the same way as bankers have introduced ATM Banking.
What would ATM Healthcare look like?
Firstly, lets assume that, like banking, ATM Healthcare is going to be used for relatively straightforward consultations in many specialities, and will not replace the complicated face to face consultation or intervention that makes up about 20% of overall medical consultations, and will always remain the health "gold standard" consultation. We already have most of the tools of ATM Healthcare at our disposal. Electronic Medical Records, lab results and x-ray images are the health equivalent of bank statements. Telemedicine - video consulting either in real time (synchronous), or delayed time (asynchronous) - is now a proven technology, is already available in some supermarket clinics, and is the equivalent of the teller machine. Email and wireless telephony provide more mobile access to providers, and the whole internet is an amazing educational and clinical communication platform that is already delivering all sorts of ATM Healthcare. We have lots of systems to combine different types of data and present them simultaneously to doctors and patients, just as per the computer scientists version of ATM.
Patients need to encourage doctors to think of ways of redesigning their practice processes to make better use of available multimedia technologies so that they can continue to provide better and more available care. I am sure this will happen, especially as more of the “millennial” generation start receiving care. They will demand that doctors use these technologies, and increasingly change their ways, and hopefully use the example of banking as we move increasingly to ATM Healthcare.
This article is based on excerpts from the recently published book “Your Health in the Information Age – how you and your doctor can use the Internet to work together” by Peter Yellowlees MD. Available at www.InformationAgeHealth.com and most online bookstores. A shortened version of the book, available as an e-Book for download to iPhones, Blackberry's, PDA's and other mobile devices called "4 simple steps to better health - an insiders look" is available at Smashwords at www.smashwords.com/books/view/1271
Wednesday, May 27, 2009
Thursday, May 21, 2009
Can social networking on the internet improve your health?
We have all heard the term Web 2.0. It refers to a second generation of websites and activities mainly involving social networking websites like MySpace and FaceBook. A related recent term is Health 2.0 which is the use of Web 2.0 methods for healthcare. There has already been one excellent Health 2.0 conference that was widely attended by industry, health providers and some patients, and another such conference is occurring soon in San Francisco. The whole concept of Health 2.0 and the use of social networking sites in healthcare is starting to gain momentum, and the increase in interest in what is being called "participatory medicine", where patients and health providers collaborate more equally than in the past, is likely to give it more of a boost.
Much of the history of these types of initiatives can be traced back to Dr Tom Ferguson, who was one of the giants of the early years of the Internet. He urged patients to educate themselves and share knowledge with one another, and encouraged doctors to collaborate with patients rather than command them. Predicting the Internet's potential for disseminating medical information long before it became a familiar conduit, he was an early proponent of its use, terming laymen who did so "e-patients." He classified doctor’s consultation styles on the net into two types. He talked about Type 1 doctors who are "advisors, coaches and information providers" but who specifically do not attempt to diagnose or treat. These doctors, or other health professionals, are typically available through their own sites, or through the many commercial sites. They generally don't advise the same patient twice, usually don't even give their name, although the commercial sites "guarantee" that they are fully qualified, and will often refer you to a local face to face doctor or hospital. Interestingly, I understand, this is how many of them receive payment for their services - the sites get a "spotters fee" from local services that they refer to.
Ferguson also defined type 2 doctors, the majority of medical providers on the net. These are doctors like me who provide normal face to face care, and who encourage their patients to also use email to contact them directly - a rational and sensible use of new technologies which, as long as guidelines for Internet consultations are followed, is a great way of working for both patient and doctor.
Full time Internet health services and providers will become much more common in the next few years, however, as we move to being able to use secure video systems over the Internet. I predict that eventually as many as 10-20% of all health consultations will take place in cyberspace within 10 years or so. This will be a real revolution in healthcare.
I do think that the emergence of online doctors who are prepared to treat their patients in a collaborative manner, both face to face and online, is the way of the future. The question is, how will this happen, and can it happen via social networking sites on the internet? I think this will be perfectly possible. There is no reason, for example, why groups of patients, along with their doctors, could not sign up for a "closed" social networking site that focused on their particular chronic disease, say diabetes, heart disease or depression. The social networking site could allow all patients to access many different doctors for advice and health education, and could be supplemented by educational information recommended by both doctors and patients who are members of the site. This is effectively the same as facebook, where "friends" are accepted into a social networking group, and not just anyone can join. The disease focused networking site, and all its activities, would occur as an adjunct to the patients having their own individual continuing doctor-patient relationships with their usual doctor, whether this relationship be face to face and/or online. I think it is time for some research in this area to see if this combination of conventional care, and social networking support, can actually improve patient outcomes in the long term. My bet is that it would.
This article is based on excerpts from the recently published book “Your Health in the Information Age – how you and your doctor can use the Internet to work together” by Peter Yellowlees MD. Available at www.InformationAgeHealth.com and most online bookstores. A shortened version of the book, available as an e-Book for download to iPhones, Blackberry's, PDA's and other mobile devices called "4 simple steps to better health - an insiders look" is available at Smashwords at www.smashwords.com/books/view/1271
Much of the history of these types of initiatives can be traced back to Dr Tom Ferguson, who was one of the giants of the early years of the Internet. He urged patients to educate themselves and share knowledge with one another, and encouraged doctors to collaborate with patients rather than command them. Predicting the Internet's potential for disseminating medical information long before it became a familiar conduit, he was an early proponent of its use, terming laymen who did so "e-patients." He classified doctor’s consultation styles on the net into two types. He talked about Type 1 doctors who are "advisors, coaches and information providers" but who specifically do not attempt to diagnose or treat. These doctors, or other health professionals, are typically available through their own sites, or through the many commercial sites. They generally don't advise the same patient twice, usually don't even give their name, although the commercial sites "guarantee" that they are fully qualified, and will often refer you to a local face to face doctor or hospital. Interestingly, I understand, this is how many of them receive payment for their services - the sites get a "spotters fee" from local services that they refer to.
Ferguson also defined type 2 doctors, the majority of medical providers on the net. These are doctors like me who provide normal face to face care, and who encourage their patients to also use email to contact them directly - a rational and sensible use of new technologies which, as long as guidelines for Internet consultations are followed, is a great way of working for both patient and doctor.
Full time Internet health services and providers will become much more common in the next few years, however, as we move to being able to use secure video systems over the Internet. I predict that eventually as many as 10-20% of all health consultations will take place in cyberspace within 10 years or so. This will be a real revolution in healthcare.
I do think that the emergence of online doctors who are prepared to treat their patients in a collaborative manner, both face to face and online, is the way of the future. The question is, how will this happen, and can it happen via social networking sites on the internet? I think this will be perfectly possible. There is no reason, for example, why groups of patients, along with their doctors, could not sign up for a "closed" social networking site that focused on their particular chronic disease, say diabetes, heart disease or depression. The social networking site could allow all patients to access many different doctors for advice and health education, and could be supplemented by educational information recommended by both doctors and patients who are members of the site. This is effectively the same as facebook, where "friends" are accepted into a social networking group, and not just anyone can join. The disease focused networking site, and all its activities, would occur as an adjunct to the patients having their own individual continuing doctor-patient relationships with their usual doctor, whether this relationship be face to face and/or online. I think it is time for some research in this area to see if this combination of conventional care, and social networking support, can actually improve patient outcomes in the long term. My bet is that it would.
This article is based on excerpts from the recently published book “Your Health in the Information Age – how you and your doctor can use the Internet to work together” by Peter Yellowlees MD. Available at www.InformationAgeHealth.com and most online bookstores. A shortened version of the book, available as an e-Book for download to iPhones, Blackberry's, PDA's and other mobile devices called "4 simple steps to better health - an insiders look" is available at Smashwords at www.smashwords.com/books/view/1271
Tuesday, May 12, 2009
e-patients and participatory medicine
Dr Tom Ferguson, who tragically died aged 62 in 2006, was one of the giants of the early years of the Internet. He urged patients to educate themselves and share knowledge with one another, and encouraged doctors to collaborate with patients rather than command them. Predicting the Internet's potential for disseminating medical information long before it became a familiar conduit, he was an early proponent of its use, terming laymen who did so "e-patients." He classified doctor’s consultation styles on the net into two types. He talked about Type 1 doctors who are "advisors, coaches and information providers" but who specifically do not attempt to diagnose or treat. These doctors, or other health professionals, are typically available through their own sites, or through the many commercial sites. They generally don't advise the same patient twice, usually don't even give their name, although the commercial sites "guarantee" that they are fully qualified, and will often refer you to a local face to face doctor or hospital. Interestingly, I understand, this is how many of them receive payment for their services - the sites get a "spotters fee" from local services that they refer to.
Ferguson also defined type 2 doctors, the majority of medical providers on the net. These are doctors like me who provide normal face to face care, and who encourage their patients to also use email to contact them directly - a rational and sensible use of new technologies which, as long as guidelines for Internet consultations are followed, is a great way of working for both patient and doctor.
I deliberately don't recommend any online doctors from any particular sites because it is really impossible to tell how good they are, although there are many such sites easily accessible via Google. Interestingly a recent study undertaken by ABC’s “Good Morning America” found that, while consultations from three major web sites could be useful for routine problems, the sites doctors made misleading diagnoses in more difficult cases. The program concluded that patients should avoid online consults for problems that couldn’t wait more than 24 hours, but that it would be reasonable to consult with their regular physician online about routine problems that they had had before.
There is another group of health care providers, however, who attempt to provide full health services only on the Internet. Many of these provide counseling or therapy services for mental health problems, or alternative therapies of an often bizarre and inappropriate nature. At the present time my advice is generally to stay away from many of these, unless you can be sure who they are, and ideally can also see them face to face. Full time Internet health services and providers will become much more common in the next few years, however, as we move to being able to use secure video systems over the Internet. I predict that eventually as many as 10-20% of all health consultations will take place in cyberspace within 10 years or so. This will be a real revolution in healthcare.
I do think that the emergence of online doctors who are prepared to treat their patients in a collaborative manner, both face to face and online, is the way of the future. This approach to care has been termed "participatory medicine" and features the empowered "e-patients" that Ferguson also described, communicating with their online providers. A fascinating example of a website devoted to participatory medicine, and which includes an excellent white paper written by Ferguson, is www.e-patients.net.
This article is based on excerpts from the recently published book “Your Health in the Information Age – how you and your doctor can use the Internet to work together” by Peter Yellowlees MD. Available at www.InformationAgeHealth.com and most online bookstores. A shortened version of the book, available as an e-Book for download to iPhones, Blackberry's, PDA's and other mobile devices called "4 simple steps to better health - an insiders look" is available at Smashwords at www.smashwords.com/books/view/1271
Ferguson also defined type 2 doctors, the majority of medical providers on the net. These are doctors like me who provide normal face to face care, and who encourage their patients to also use email to contact them directly - a rational and sensible use of new technologies which, as long as guidelines for Internet consultations are followed, is a great way of working for both patient and doctor.
I deliberately don't recommend any online doctors from any particular sites because it is really impossible to tell how good they are, although there are many such sites easily accessible via Google. Interestingly a recent study undertaken by ABC’s “Good Morning America” found that, while consultations from three major web sites could be useful for routine problems, the sites doctors made misleading diagnoses in more difficult cases. The program concluded that patients should avoid online consults for problems that couldn’t wait more than 24 hours, but that it would be reasonable to consult with their regular physician online about routine problems that they had had before.
There is another group of health care providers, however, who attempt to provide full health services only on the Internet. Many of these provide counseling or therapy services for mental health problems, or alternative therapies of an often bizarre and inappropriate nature. At the present time my advice is generally to stay away from many of these, unless you can be sure who they are, and ideally can also see them face to face. Full time Internet health services and providers will become much more common in the next few years, however, as we move to being able to use secure video systems over the Internet. I predict that eventually as many as 10-20% of all health consultations will take place in cyberspace within 10 years or so. This will be a real revolution in healthcare.
I do think that the emergence of online doctors who are prepared to treat their patients in a collaborative manner, both face to face and online, is the way of the future. This approach to care has been termed "participatory medicine" and features the empowered "e-patients" that Ferguson also described, communicating with their online providers. A fascinating example of a website devoted to participatory medicine, and which includes an excellent white paper written by Ferguson, is www.e-patients.net.
This article is based on excerpts from the recently published book “Your Health in the Information Age – how you and your doctor can use the Internet to work together” by Peter Yellowlees MD. Available at www.InformationAgeHealth.com and most online bookstores. A shortened version of the book, available as an e-Book for download to iPhones, Blackberry's, PDA's and other mobile devices called "4 simple steps to better health - an insiders look" is available at Smashwords at www.smashwords.com/books/view/1271
Thursday, May 7, 2009
Narcissistic America? Do computers have feelings too?
Narcissism seems to be the word "du jour" on health sites on the internet right now. Articles and blogs on the topic of narcissism abound. Doubtless this is partly because the pieces easily find a very interested audience - narcissists themselves. Not surprisingly narcissists love reading about themselves, and there are a lot of narcissists in our culture, so this topic is always bound to be popular in cyberspace. But is it only us physical humans who are narcissistic? Is this a trait held by virtual people, such as avatars, or even by inanimate objects such as computers and cell phones?
Our faces show our emotions. They are the window of our feelings. Physicians are trained to both consciously and unconsciously pick up diagnostic cues from patients’ faces. We know what someone physically looks like when they are depressed but we can’t physiologically describe it. We know their brow is furrowed, their mouth drawn, their skin looks dry and pasty and that they are tearful and their face moves slowly. Soon we will be able to mathematically measure and model our facial features by converting a video to digital data. So if we can digitally measure depression, and other moods, using facial recognition software, why not measure narcissism in the same way? Then we could more easily pick a narcissist in the real-life world, as well as in the virtual environment.
How would we do this? If we were to model syntax and language content in sentences, we would likely find narcissists using terms like "me" and "I" much more frequently than others. Equally they would be dismissive of others, patronizing and self-centered, and this could be modeled in their speech. We could examine the facial features and physical attributes given to avatars in virtual worlds like Second Life and would expect to find, for instance, that avatars owned by narcissists were consistently more handsome, taller, more powerful and more dramatic than avatars owned by others. These avatars might be more destructive and bullying, engaging in harmful and power-hungry behaviors. Interestingly the existence of the "Cyber Narcissist" has been postulated and described on a number of websites and blogs - an extension of the real world narcissist who can easily promote themselves and fend off criticism by adopting any number of nicknames and aliases in anonymous sections of the internet. So maybe we can start to identify narcissists in the online world - even though they are all likely to be extensions of their real-life narcissistic alter egos.
But what about narcissistic inanimate objects?
Far fetched as it sounds it is already possible for information to be electrically passed along a line of people holding hands with terminals attached to the legs of the person at each end of the line! This sounds weird but we all know we transmit electricity and must wear rubber shoes when repairing electrical equipment. It is therefore logical, even if it seems unreal right now, that we could literally be a part of the information system! This is called “affective computing” - computing with feelings. Researchers are looking at how to transmit smells, or signals identifying smells, over the Internet – this is perhaps somewhat easier as it is possible to have digital signals transmitted that encode for specific smells, and release them, from one end of a line to another. The term “natural interfacing” is used by scientists who are studying the mechanics of how to allow humans to interact via computers in a way similar to talking to each other – without a need for a keyboard, pad or stylus. The ultimate goal for these researchers is to design systems that can interact directly with our minds – allowing sounds and ideas to be transmitted straight into our brains, allowing us to merge seamlessly with machines. In this view of the future people will have wearable mini-computers that understand the rhythm, inflection, tone and emphasis of speech, and that can respond in a human sounding manner – very different from the mechanical sounding computer speech we have now.
So maybe it will one day be possible to have a narcissistic computer. Or a narcissistic cell phone. Perhaps the iPhone of today, already the trendy attachment of many narcissists who proudly demonstrate their latest software application with only the slightest encouragement, is a forerunner of the narcissistic electrical device of the future. Will it eventually show its feelings by changing color, automatically turn on music to drown out people it doesn't want to hear, and constantly remind its owner how clever, skillful and attractive they are by reinforcing their most intimate thoughts and feelings
Such technology is not in the realms of fantasy. Suicidal depression is as much an emergency as heart failure and hopefully in the future it will be monitored just like diabetes, heart disease and asthma. Undoubtedly lives will be saved. But will this also apply to narcissism, and will there really be narcissistic machines that mirror their owners thoughts and feelings. For that we will have to wait a while, and in the meantime we must read about real-live narcissism, and try to remain modest about any possible upcoming scientific breakthroughs in this field.
This article is based on excerpts from the recently published book “Your Health in the Information Age – how you and your doctor can use the Internet to work together” by Peter Yellowlees MD. Available at www.InformationAgeHealth.com and most online bookstores. A shortened version of the book, available as an e-Book for download to iPhones, Blackberry's, PDA's and other mobile devices called "4 simple steps to better health - an insiders look" is available at Smashwords at www.smashwords.com/books/view/1271
Our faces show our emotions. They are the window of our feelings. Physicians are trained to both consciously and unconsciously pick up diagnostic cues from patients’ faces. We know what someone physically looks like when they are depressed but we can’t physiologically describe it. We know their brow is furrowed, their mouth drawn, their skin looks dry and pasty and that they are tearful and their face moves slowly. Soon we will be able to mathematically measure and model our facial features by converting a video to digital data. So if we can digitally measure depression, and other moods, using facial recognition software, why not measure narcissism in the same way? Then we could more easily pick a narcissist in the real-life world, as well as in the virtual environment.
How would we do this? If we were to model syntax and language content in sentences, we would likely find narcissists using terms like "me" and "I" much more frequently than others. Equally they would be dismissive of others, patronizing and self-centered, and this could be modeled in their speech. We could examine the facial features and physical attributes given to avatars in virtual worlds like Second Life and would expect to find, for instance, that avatars owned by narcissists were consistently more handsome, taller, more powerful and more dramatic than avatars owned by others. These avatars might be more destructive and bullying, engaging in harmful and power-hungry behaviors. Interestingly the existence of the "Cyber Narcissist" has been postulated and described on a number of websites and blogs - an extension of the real world narcissist who can easily promote themselves and fend off criticism by adopting any number of nicknames and aliases in anonymous sections of the internet. So maybe we can start to identify narcissists in the online world - even though they are all likely to be extensions of their real-life narcissistic alter egos.
But what about narcissistic inanimate objects?
Far fetched as it sounds it is already possible for information to be electrically passed along a line of people holding hands with terminals attached to the legs of the person at each end of the line! This sounds weird but we all know we transmit electricity and must wear rubber shoes when repairing electrical equipment. It is therefore logical, even if it seems unreal right now, that we could literally be a part of the information system! This is called “affective computing” - computing with feelings. Researchers are looking at how to transmit smells, or signals identifying smells, over the Internet – this is perhaps somewhat easier as it is possible to have digital signals transmitted that encode for specific smells, and release them, from one end of a line to another. The term “natural interfacing” is used by scientists who are studying the mechanics of how to allow humans to interact via computers in a way similar to talking to each other – without a need for a keyboard, pad or stylus. The ultimate goal for these researchers is to design systems that can interact directly with our minds – allowing sounds and ideas to be transmitted straight into our brains, allowing us to merge seamlessly with machines. In this view of the future people will have wearable mini-computers that understand the rhythm, inflection, tone and emphasis of speech, and that can respond in a human sounding manner – very different from the mechanical sounding computer speech we have now.
So maybe it will one day be possible to have a narcissistic computer. Or a narcissistic cell phone. Perhaps the iPhone of today, already the trendy attachment of many narcissists who proudly demonstrate their latest software application with only the slightest encouragement, is a forerunner of the narcissistic electrical device of the future. Will it eventually show its feelings by changing color, automatically turn on music to drown out people it doesn't want to hear, and constantly remind its owner how clever, skillful and attractive they are by reinforcing their most intimate thoughts and feelings
Such technology is not in the realms of fantasy. Suicidal depression is as much an emergency as heart failure and hopefully in the future it will be monitored just like diabetes, heart disease and asthma. Undoubtedly lives will be saved. But will this also apply to narcissism, and will there really be narcissistic machines that mirror their owners thoughts and feelings. For that we will have to wait a while, and in the meantime we must read about real-live narcissism, and try to remain modest about any possible upcoming scientific breakthroughs in this field.
This article is based on excerpts from the recently published book “Your Health in the Information Age – how you and your doctor can use the Internet to work together” by Peter Yellowlees MD. Available at www.InformationAgeHealth.com and most online bookstores. A shortened version of the book, available as an e-Book for download to iPhones, Blackberry's, PDA's and other mobile devices called "4 simple steps to better health - an insiders look" is available at Smashwords at www.smashwords.com/books/view/1271
Friday, May 1, 2009
Pandemic Flu - Physical and Psychological Responses
The possibility of a pandemic flu is upon us. A great deal of information is available from the Centers for Disease Control and the World Health Organisation. I, with my colleagues, Kathleen Ayers PhD, Christian Sandrock MD and Warner Hudson MD, recently produced a series of 6 videos on pandemic flu which are highlighted on the UC Davis Continuing Medical Education website - www.ucdmc.ucdavis.edu/cme/ The objectives of these modules, which have a focus on public health and mental health responses to pandemic flu, include the following:
- Understand different outcomes from different influenza pandemics
- Understand differences among types of influenza viruses
- Understand antigenic drift and antigenic shift
- Understand basic disaster mental health (DMH) principles and the methods, strategies, and best practices for delivering DMH services
- Recognize typical reactions to pandemic disasters and their time scope
- Understand differences between disaster mental health services and other clinical interventions
- Understand assessment processes following a pandemic disaster
It is crucial that we manage this situation without panic and inappropriate fear, are practical and pragmatic, and most importantly use simple precautions such as handwashing.
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