Mobile communication brings doctors and patients closer

SAN FRANCISCO – In the best of all possible worlds, patient care wouldn’t stop outside the four walls of the treatment or exam room. It would eliminate post-treatment problems by effective follow-up. It would encourage compliance by understanding a patient’s “real life.” It would involve primary care in a collegial, collaborative relationship, and bring in the family when appropriate.

We might not live in the best of all possible worlds. But we do live in an increasingly connected world, where technology can bridge the space between “would” and “will,” Dr. Ashish Atreja said at the 2015 AGA Tech Summit.

“The time is ripe” to put smartphone apps, social media, and teleconferencing to work to improve patient outcomes, Dr. Atreja of Mt. Sinai Hospital, New York, said at the meeting, which is sponsored by the AGA Center for GI Innovation and Technology. Not only can these connections improve doctor-patient relationships and clinical outcomes, they stand ready to harness the research power of real-time data.

“We can merge clinical data from the electronic medical record and link to a registry. We can mine data for safety and efficacy. We can even use it to enroll patients in clinical trials that might otherwise take years to build a meaningful cohort.”

When Dr. Atreja says “The future is now,” he means it. Just days ago, Apple launched its new iPhone program, ResearchKit. The app allows users to become part of enormous potential research pools. Within just 36 hours of launch, thousands of users had signed up.

They can enter all kinds of baseline health data – for example, blood pressure, body mass index, and chronic illnesses. They can also complete user-interface activities like finger-tapping the screen, speaking into the phone, and walking with it – all of which can flag potential disease-specific symptoms.

Researchers looking for study subjects can comb through the data and identify subjects who might be interested in participating, then reach out to them.

Digital communication also makes extending care beyond clinic a reality, said Dr. Brennan Spiegel, director of Health Services Research at Cedars-Sinai Hospital, Los Angeles.

“Our patients don’t just exist in the clinic. They are at senior centers. They are at home, at work, at play in parks. These are the places where they experience the psychomedical effects of their illness. And we need to find a way to get to them.”

Patients are not always completely reliable, or even open, during a clinic visit. The physician, therefore, can be working off incomplete information even before embarking on a complex 20-minute interview.

“We need to get a history, do an exam, think about tests, try and understand the emotional context of the illness, assess the patient’s motivation, educate and counsel, and develop a targeted treatment plan. All from behind the laptop that separates us from the patient.”

The patient often leaves with unanswered questions, or simply overwhelmed with information. “But she has a computer. She has smartphone. And so do we. . . so we can still exchange information.”

Is it practical, though, for the physician who already has too few hours in any day to stay glued to a cellphone or laptop for this kind of continuous interaction? The answer is a most decided “No.”

Instead, Dr. Spiegel said, interactive algorithms can be employed to gather real-time patient metrics through voluntary input or automatic monitoring programs, and send what amounts to personally dictated notes to providers through the patients’ electronic medical record.

My GI Health, which Dr. Spiegel co-created, is a good example of this technology.

Patients can access a secure portal and answers basic questions about GI symptoms and medical history. The program translates this into something very much akin to a provider-generated history and presentation document. This can be reviewed before an appointment to facilitate communication. And because the initial information is shared privately, Dr. Spiegel said patients may be more forthcoming than discussing what they perceive as embarrassing topics face-to-face.

The computer-generated notes are impressively accurate. A study published in the American Journal of Gastroenterology in January showed just how impressive.

Blinded physician reviewers compared both computer- and physician-generated histories for 75 GI patients. The reviewers found the computer-created histories consistently superior, even after adjusting for physician and visit type, location, mode of transcription, and demographics. They said the computer histories were more complete, more useful, better organized, more succinct and more comprehensible. All of the computer histories could have been billed at the highest level, compared to 84% of those written by humans.

“That doesn’t mean computers are better than doctors,” Dr. Spiegel said. “We still need ‘us’ … to look at patients face-to-face, to understand the deep, nuanced complexity of their lives and illnesses. But computers are excellent at collecting information and putting that into meaningful context. And we can use this to benefit everyone.”

[email protected]

SAN FRANCISCO – In the best of all possible worlds, patient care wouldn’t stop outside the four walls of the treatment or exam room. It would eliminate post-treatment problems by effective follow-up. It would encourage compliance by understanding a patient’s “real life.” It would involve primary care in a collegial, collaborative relationship, and bring in the family when appropriate.

We might not live in the best of all possible worlds. But we do live in an increasingly connected world, where technology can bridge the space between “would” and “will,” Dr. Ashish Atreja said at the 2015 AGA Tech Summit.

“The time is ripe” to put smartphone apps, social media, and teleconferencing to work to improve patient outcomes, Dr. Atreja of Mt. Sinai Hospital, New York, said at the meeting, which is sponsored by the AGA Center for GI Innovation and Technology. Not only can these connections improve doctor-patient relationships and clinical outcomes, they stand ready to harness the research power of real-time data.

“We can merge clinical data from the electronic medical record and link to a registry. We can mine data for safety and efficacy. We can even use it to enroll patients in clinical trials that might otherwise take years to build a meaningful cohort.”

When Dr. Atreja says “The future is now,” he means it. Just days ago, Apple launched its new iPhone program, ResearchKit. The app allows users to become part of enormous potential research pools. Within just 36 hours of launch, thousands of users had signed up.

They can enter all kinds of baseline health data – for example, blood pressure, body mass index, and chronic illnesses. They can also complete user-interface activities like finger-tapping the screen, speaking into the phone, and walking with it – all of which can flag potential disease-specific symptoms.

Researchers looking for study subjects can comb through the data and identify subjects who might be interested in participating, then reach out to them.

Digital communication also makes extending care beyond clinic a reality, said Dr. Brennan Spiegel, director of Health Services Research at Cedars-Sinai Hospital, Los Angeles.

“Our patients don’t just exist in the clinic. They are at senior centers. They are at home, at work, at play in parks. These are the places where they experience the psychomedical effects of their illness. And we need to find a way to get to them.”

Patients are not always completely reliable, or even open, during a clinic visit. The physician, therefore, can be working off incomplete information even before embarking on a complex 20-minute interview.

“We need to get a history, do an exam, think about tests, try and understand the emotional context of the illness, assess the patient’s motivation, educate and counsel, and develop a targeted treatment plan. All from behind the laptop that separates us from the patient.”

The patient often leaves with unanswered questions, or simply overwhelmed with information. “But she has a computer. She has smartphone. And so do we. . . so we can still exchange information.”

Is it practical, though, for the physician who already has too few hours in any day to stay glued to a cellphone or laptop for this kind of continuous interaction? The answer is a most decided “No.”

Instead, Dr. Spiegel said, interactive algorithms can be employed to gather real-time patient metrics through voluntary input or automatic monitoring programs, and send what amounts to personally dictated notes to providers through the patients’ electronic medical record.

My GI Health, which Dr. Spiegel co-created, is a good example of this technology.

Patients can access a secure portal and answers basic questions about GI symptoms and medical history. The program translates this into something very much akin to a provider-generated history and presentation document. This can be reviewed before an appointment to facilitate communication. And because the initial information is shared privately, Dr. Spiegel said patients may be more forthcoming than discussing what they perceive as embarrassing topics face-to-face.

The computer-generated notes are impressively accurate. A study published in the American Journal of Gastroenterology in January showed just how impressive.

Blinded physician reviewers compared both computer- and physician-generated histories for 75 GI patients. The reviewers found the computer-created histories consistently superior, even after adjusting for physician and visit type, location, mode of transcription, and demographics. They said the computer histories were more complete, more useful, better organized, more succinct and more comprehensible. All of the computer histories could have been billed at the highest level, compared to 84% of those written by humans.

“That doesn’t mean computers are better than doctors,” Dr. Spiegel said. “We still need ‘us’ … to look at patients face-to-face, to understand the deep, nuanced complexity of their lives and illnesses. But computers are excellent at collecting information and putting that into meaningful context. And we can use this to benefit everyone.”

[email protected]

SAN FRANCISCO – In the best of all possible worlds, patient care wouldn’t stop outside the four walls of the treatment or exam room. It would eliminate post-treatment problems by effective follow-up. It would encourage compliance by understanding a patient’s “real life.” It would involve primary care in a collegial, collaborative relationship, and bring in the family when appropriate.

We might not live in the best of all possible worlds. But we do live in an increasingly connected world, where technology can bridge the space between “would” and “will,” Dr. Ashish Atreja said at the 2015 AGA Tech Summit.

“The time is ripe” to put smartphone apps, social media, and teleconferencing to work to improve patient outcomes, Dr. Atreja of Mt. Sinai Hospital, New York, said at the meeting, which is sponsored by the AGA Center for GI Innovation and Technology. Not only can these connections improve doctor-patient relationships and clinical outcomes, they stand ready to harness the research power of real-time data.

“We can merge clinical data from the electronic medical record and link to a registry. We can mine data for safety and efficacy. We can even use it to enroll patients in clinical trials that might otherwise take years to build a meaningful cohort.”

When Dr. Atreja says “The future is now,” he means it. Just days ago, Apple launched its new iPhone program, ResearchKit. The app allows users to become part of enormous potential research pools. Within just 36 hours of launch, thousands of users had signed up.

They can enter all kinds of baseline health data – for example, blood pressure, body mass index, and chronic illnesses. They can also complete user-interface activities like finger-tapping the screen, speaking into the phone, and walking with it – all of which can flag potential disease-specific symptoms.

Researchers looking for study subjects can comb through the data and identify subjects who might be interested in participating, then reach out to them.

Digital communication also makes extending care beyond clinic a reality, said Dr. Brennan Spiegel, director of Health Services Research at Cedars-Sinai Hospital, Los Angeles.

“Our patients don’t just exist in the clinic. They are at senior centers. They are at home, at work, at play in parks. These are the places where they experience the psychomedical effects of their illness. And we need to find a way to get to them.”

Patients are not always completely reliable, or even open, during a clinic visit. The physician, therefore, can be working off incomplete information even before embarking on a complex 20-minute interview.

“We need to get a history, do an exam, think about tests, try and understand the emotional context of the illness, assess the patient’s motivation, educate and counsel, and develop a targeted treatment plan. All from behind the laptop that separates us from the patient.”

The patient often leaves with unanswered questions, or simply overwhelmed with information. “But she has a computer. She has smartphone. And so do we. . . so we can still exchange information.”

Is it practical, though, for the physician who already has too few hours in any day to stay glued to a cellphone or laptop for this kind of continuous interaction? The answer is a most decided “No.”

Instead, Dr. Spiegel said, interactive algorithms can be employed to gather real-time patient metrics through voluntary input or automatic monitoring programs, and send what amounts to personally dictated notes to providers through the patients’ electronic medical record.

My GI Health, which Dr. Spiegel co-created, is a good example of this technology.

Patients can access a secure portal and answers basic questions about GI symptoms and medical history. The program translates this into something very much akin to a provider-generated history and presentation document. This can be reviewed before an appointment to facilitate communication. And because the initial information is shared privately, Dr. Spiegel said patients may be more forthcoming than discussing what they perceive as embarrassing topics face-to-face.

The computer-generated notes are impressively accurate. A study published in the American Journal of Gastroenterology in January showed just how impressive.

Blinded physician reviewers compared both computer- and physician-generated histories for 75 GI patients. The reviewers found the computer-created histories consistently superior, even after adjusting for physician and visit type, location, mode of transcription, and demographics. They said the computer histories were more complete, more useful, better organized, more succinct and more comprehensible. All of the computer histories could have been billed at the highest level, compared to 84% of those written by humans.

“That doesn’t mean computers are better than doctors,” Dr. Spiegel said. “We still need ‘us’ … to look at patients face-to-face, to understand the deep, nuanced complexity of their lives and illnesses. But computers are excellent at collecting information and putting that into meaningful context. And we can use this to benefit everyone.”

[email protected]