It is clear that most stakeholders in the health industry now support President Obama's view that it is essential that we have substantial healthcare reform, and soon. The arguments around the issue are not whether this should happen, but how and when it will occur. An excellent white paper has just been written on how national telemedicine initiatives are essential to that reform. The whole paper, primarily authored by Rashid Bashshur PhD and Gary Shannon PhD, is available for free download at http://www.liebertonline.com/toc/tmj/0/0. I strongly suggest that you read it.
In brief the paper makes the case that the need for reform stems from long-standing problems in our health system, and demonstrates that the central role of telemedicine derives from an ever-expanding body of research-and experience that attests to its merit in addressing these problems.
The paper notes that "despite the fact that the United States spends more on health care than any other country, both in absolute numbers and on a per capita basis, the health status of Americans ranks relatively low when compared with that of people in other developed nations. Moreover, the general discrepancy between expenditures and health status indicators in the U.S. masks significant differentials among segments of the population, based on socio-economic, geographic, cultural, ethnic and other factors."
The consequence of these factors is that we continue to suffer from inequities in access to health care, inefficiencies in the delivery of care, escalating costs and the prevalence of adverse life styles that exacerbate these problems.
I have just spent been on call over the last weekend working in a major Academic Medical Center Emergency Department managing acutely psychotic patients transferred there as a place of last resort because the only local locked inpatient psychiatric facility was closed to admissions because it was full as a result of major financially driven cuts to local outpatient mental health services. This is the sort of concrete evidence that the American healthcare system is broken, inefficient, disorganized and inequitable.
Why is this relevant? Simply because we must improve our system of care, make it more integrated, and start using electronic healthcare more intelligently and more frequently. Electronic health records represent a means to improving the health care system but are only a partial solution to the problems we face. The practice of telemedicine, where patients are treated by videoconferencing or email in real or asynchronous time, incorporating electronic medical records, is a much better way of working, and allows many of the geographical and cultural inequities we face in health care access to be overcome. The white paper argues effectively and strongly for those involved in planning healthcare reform to take a broad view of the use of health information technology, and to think beyond electronic health records to a time where we will be using telemedicine incorporating electronic health records.
Peter Yellowlees MD has recently published "Your Health in the Information Age - how you and your doctor can use the Internet to work together." The book is available at http://www.InformationAgeHealth.com and most online bookstores. An e-Book called "4 simple steps to better health - an insiders look" is available at Smashwords at http://www.smashwords.com/books/view/1271
Monday, June 22, 2009
Thursday, June 4, 2009
Public Health Insurance - a lifesaver for the American Health System
There is much debate around the type of insurance proposals that will be required in the new health system currently being negotiated in Congress. President Obama has just come out in support of a public health plan, which is opposed by private insurers who say that they could not compete with a public health plan that didn't have to make a profit. Supporters of the public plan proposal correctly say that it would give people more choices and create more competition. Opponents argue that private health plans would go out of business, leaving only an entirely government-run health care system.
Of course all sides are exaggerating and taking up extreme positions. They will all in time compromise and hopefully reach some form of agreement. The sad part is that at present they don't seem to be thinking of the person at the center of all this - the patient. It is widely acknowledged that healthcare costs far too much in this country, while at the same time at least 47 million Americans are uninsured. So, from a patients perspective, if you do have health insurance, you are paying way too much for it, and getting poor value, and if you don't have it, then you just continue to suffer. What a dreadful choice.
The goal of overhauling the health care system is to lower costs and extend care to the uninsured. Obama wants a bill on his desk in October. Where can Congress begin to compromise, and why is it that Republicans in particular, believe that public health plans are likely to be so dreadful. They regularly bring up the ogre of "socialized medicine" whenever public plans are discussed, but there is no evidence whatsoever that countries with more federal control over their health systems, especially in Europe, have worse health outcomes that the USA. In fact the contrary is true, health outcomes are much better overall, for a lot less money per capita.
As a physician who has lived and worked in the USA, Australia and Britain, and who has an interest in how health services are organized, I think we could move forward in a relatively simple way as long as we always keep the patient at the center, and don't try and design a health system primarily to protect profit levels for various constituents, whether they be providers, health insurers or pharmaceutical companies.
Firstly we need a public-private partnership philosophy. That means public and private, not just private. America is founded on capitalist principals, where the profit motive is central, and any new approach to healthcare must combine this with the need to develop core public services that may be less likely to ever achieve a profit. Funding for care needs to be provided on the basis of annual or episodic whole of person care, rather than on individual piece rates as at present. The primary importance of this approach is that it will force more resources into the prevention of illness - to wellness promotion - rather than into the treatment of illness that has already commenced. This is an approach that Kaiser Permanente is well known for.
The public component of the healthcare system would include universal basic health insurance (including catastrophic care insurance) and many emergency and isolated health services, as well as much more public health focus on prevention and health promotion. Public programs should also pick up much of pre/post natal and early child care to ensure all mothers and babies are properly looked after, and probably care of some special populations who cannot afford private health insurance such as the unemployed, some seniors and certain impoverished or geographically isolated groups. These are areas where there will be less competition with private insurers who have typically kept away from them.
The private component would be funded with the aid of tax incentives to encourage most people (or companies) to take out private insurance with aim that at least 80-90% of the population should have private insurance. It is crucial to reach this level of insurance to be confident that we all have "skin in the game" and are financially responsible for at least a good proportion of our healthcare costs, and do not see healthcare as something that is provided by the government for free. The private sector should offer a full range of services from birth to death - with the ability to charge extra for certain "non-essential" services such as cosmetic surgery and other niche areas - but with regulation to prevent people being excluded on grounds of pre-existing conditions.
These ideas are taken from what I consider to be the best parts of the American, British and Australian health systems. No country has a perfect health system. America is the Land of the Free and can afford to choose the best of what other countries have attempted as it debates how to improve its healthcare system. Lets hope that Congress can be creative and not get bogged down in political dogma.
Peter Yellowlees MD has recently published “Your Health in the Information Age – how you and your doctor can use the Internet to work together”. It is 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
Of course all sides are exaggerating and taking up extreme positions. They will all in time compromise and hopefully reach some form of agreement. The sad part is that at present they don't seem to be thinking of the person at the center of all this - the patient. It is widely acknowledged that healthcare costs far too much in this country, while at the same time at least 47 million Americans are uninsured. So, from a patients perspective, if you do have health insurance, you are paying way too much for it, and getting poor value, and if you don't have it, then you just continue to suffer. What a dreadful choice.
The goal of overhauling the health care system is to lower costs and extend care to the uninsured. Obama wants a bill on his desk in October. Where can Congress begin to compromise, and why is it that Republicans in particular, believe that public health plans are likely to be so dreadful. They regularly bring up the ogre of "socialized medicine" whenever public plans are discussed, but there is no evidence whatsoever that countries with more federal control over their health systems, especially in Europe, have worse health outcomes that the USA. In fact the contrary is true, health outcomes are much better overall, for a lot less money per capita.
As a physician who has lived and worked in the USA, Australia and Britain, and who has an interest in how health services are organized, I think we could move forward in a relatively simple way as long as we always keep the patient at the center, and don't try and design a health system primarily to protect profit levels for various constituents, whether they be providers, health insurers or pharmaceutical companies.
Firstly we need a public-private partnership philosophy. That means public and private, not just private. America is founded on capitalist principals, where the profit motive is central, and any new approach to healthcare must combine this with the need to develop core public services that may be less likely to ever achieve a profit. Funding for care needs to be provided on the basis of annual or episodic whole of person care, rather than on individual piece rates as at present. The primary importance of this approach is that it will force more resources into the prevention of illness - to wellness promotion - rather than into the treatment of illness that has already commenced. This is an approach that Kaiser Permanente is well known for.
The public component of the healthcare system would include universal basic health insurance (including catastrophic care insurance) and many emergency and isolated health services, as well as much more public health focus on prevention and health promotion. Public programs should also pick up much of pre/post natal and early child care to ensure all mothers and babies are properly looked after, and probably care of some special populations who cannot afford private health insurance such as the unemployed, some seniors and certain impoverished or geographically isolated groups. These are areas where there will be less competition with private insurers who have typically kept away from them.
The private component would be funded with the aid of tax incentives to encourage most people (or companies) to take out private insurance with aim that at least 80-90% of the population should have private insurance. It is crucial to reach this level of insurance to be confident that we all have "skin in the game" and are financially responsible for at least a good proportion of our healthcare costs, and do not see healthcare as something that is provided by the government for free. The private sector should offer a full range of services from birth to death - with the ability to charge extra for certain "non-essential" services such as cosmetic surgery and other niche areas - but with regulation to prevent people being excluded on grounds of pre-existing conditions.
These ideas are taken from what I consider to be the best parts of the American, British and Australian health systems. No country has a perfect health system. America is the Land of the Free and can afford to choose the best of what other countries have attempted as it debates how to improve its healthcare system. Lets hope that Congress can be creative and not get bogged down in political dogma.
Peter Yellowlees MD has recently published “Your Health in the Information Age – how you and your doctor can use the Internet to work together”. It is 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
Ready to Launch? Swine Flu phase 2?
When will swine flu reappear in the Northern Hemisphere? Next September of October is the most likely time.
Most pandemics go through a well described series of three peaks of infection rate. There is an initial outbreak, that we have just had, followed by several months of relatively little activity as the flu literally travels south to the traditional flu season in the Southern Hemisphere. The flu then returns with its largest peak of activity with the next Northern Hemisphere flu season, traditionally around September and October, before dropping away again. There is usually then a final relatively small outbreak the following flu season during the next spring.
Pandemic flu literally spreads around the world, from north to south, and currently continues to be a threat south of the equator, where countries are entering the winter months and their traditional flu season, according to Dr Christian Sandrock, a UC Davis infectious diseases expert on the effect of this virus.
According to the CDC South America has had more than 600 cases, including one death in Chile, while Australia has reported more than 500.
Overall swine flu has hit more than 60 countries, with the United States reporting the most cases — more than 11,400, including at least 19 deaths, according to the CDC, compared with just over 5,700 in Mexico.
The good news is that the swine flu does not seem to be particularly dangerous to humans, although it spreads easily, it kills in relatively small numbers and is not a very potent form of flu. This does not mean that it can be ignored because with the likely impending outbreak next autumn many patients with chronic diseases, and young children, will be at increased risk of infection and potentially fatal consequences.
What should we be doing? Apart from all the obvious things like good hygiene, avoiding contamination and reducing infection spread by self-isolation of those who are infected, this is a classic example of how we can use health informatics and information technology for the greater public good.
If we had universal electronic records, and good public health reporting systems, we would be able to both identify outbreaks earlier, and treat those with infections more rapidly, as well as possibly follow up clusters of outbreaks to prevent further spread. Have a look at the CDC home page and study their swine flu influenza surveillance systems and see the large amount of data that is able to be collected now, without universal electronic records. The data is already impressive but to collect it is difficult because it involves amalgamating so many different data sources, few of which are complete, so the data itself is still not as good as it could be. And it is not available in real time.
The Obama administration is planning a comprehensive implementation of electronic medical records nationwide within the next five years. A very positive added value effect of this important initiative will be the production of more data, much of it in real time, to combat major pandemics such as swine flu, as well as a number of other substantial public health threats such as bioterrorism. The secondary use of electronic health record data for these sorts of purposes should greatly encourage all doctors and health systems to implement electronic health records, and to make sure that they are able to exchange key health information with important national bodies like the CDC.
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 http://www.InformationAgeHealth.com and most online bookstores. An e-Book called "4 simple steps to better health - an insiders look" is available at Smashwords at http://www.smashwords.com/books/view/1271
Most pandemics go through a well described series of three peaks of infection rate. There is an initial outbreak, that we have just had, followed by several months of relatively little activity as the flu literally travels south to the traditional flu season in the Southern Hemisphere. The flu then returns with its largest peak of activity with the next Northern Hemisphere flu season, traditionally around September and October, before dropping away again. There is usually then a final relatively small outbreak the following flu season during the next spring.
Pandemic flu literally spreads around the world, from north to south, and currently continues to be a threat south of the equator, where countries are entering the winter months and their traditional flu season, according to Dr Christian Sandrock, a UC Davis infectious diseases expert on the effect of this virus.
According to the CDC South America has had more than 600 cases, including one death in Chile, while Australia has reported more than 500.
Overall swine flu has hit more than 60 countries, with the United States reporting the most cases — more than 11,400, including at least 19 deaths, according to the CDC, compared with just over 5,700 in Mexico.
The good news is that the swine flu does not seem to be particularly dangerous to humans, although it spreads easily, it kills in relatively small numbers and is not a very potent form of flu. This does not mean that it can be ignored because with the likely impending outbreak next autumn many patients with chronic diseases, and young children, will be at increased risk of infection and potentially fatal consequences.
What should we be doing? Apart from all the obvious things like good hygiene, avoiding contamination and reducing infection spread by self-isolation of those who are infected, this is a classic example of how we can use health informatics and information technology for the greater public good.
If we had universal electronic records, and good public health reporting systems, we would be able to both identify outbreaks earlier, and treat those with infections more rapidly, as well as possibly follow up clusters of outbreaks to prevent further spread. Have a look at the CDC home page and study their swine flu influenza surveillance systems and see the large amount of data that is able to be collected now, without universal electronic records. The data is already impressive but to collect it is difficult because it involves amalgamating so many different data sources, few of which are complete, so the data itself is still not as good as it could be. And it is not available in real time.
The Obama administration is planning a comprehensive implementation of electronic medical records nationwide within the next five years. A very positive added value effect of this important initiative will be the production of more data, much of it in real time, to combat major pandemics such as swine flu, as well as a number of other substantial public health threats such as bioterrorism. The secondary use of electronic health record data for these sorts of purposes should greatly encourage all doctors and health systems to implement electronic health records, and to make sure that they are able to exchange key health information with important national bodies like the CDC.
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 http://www.InformationAgeHealth.com and most online bookstores. An e-Book called "4 simple steps to better health - an insiders look" is available at Smashwords at http://www.smashwords.com/books/view/1271
Wednesday, May 27, 2009
ATM Healthcare? The way of the future?
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
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
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
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