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11:44 pm
December 14, 2009


ezzeldin

Admin

La Crosse, WI

posts 16

 

 

 Bits & Bytes   # 3

 

 

 

 

   e- Patients, Health 2.0 & Participatory Medicine :  or Medicine metamorphosis by the internet in the  era of X-men and  transformers !!

 

First some definitions : 

e-Patients 

 e-Patients (also known as Internet Patient, or Internet-savvy Patient) are health consumers who use the Internet to gather information about a medical condition of particular interest to them. The term encompasses both those who seek online guidance for their own ailments and the friends and family members (e-Caregivers) who go online on their behalf. e-Patients report two effects of their online health research: “better health information and services, and different (but not always better) relationships with their doctors.”    (From  Wikipedia)

  

Participatory Medicine 

Participatory medicine is a cooperative model of healthcare that encourages and expects active involvement by all connected parties (patients, caregivers, healthcare professionals, etc.) as integral to the full continuum of care. The ‘participatory’ concept may also be applied to fitness, nutrition, mental health, end-of-life care, and all issues broadly related to an individual’s health.    ( From Society of Participatory Medicine http://participatorymedicine.org/ )

 

Health 2.0

Health 2.0 is participatory healthcare. Enabled by information, software, and community that we collect or create, we the patients can be effective partners in our own healthcare, and we the people can participate in reshaping the health system itself.  ( From http://www.tedeytan.com)

 

According to Wikipedia: Health 2.0 (as well as the closely related concept of Medicine 2.0) are terms representing the possibilities between health care , eHealth and Web 2.0, and has come into use after a recent spate of articles in newspapers, and by Physicians and Medical Librarians.  A concise definition of Health 2.0 is the use of a specific set of Web tools (blogs, Podcasts, tagging, search, wikis, etc) by actors in health care including doctors, patients, and scientists, using principles of open source and generation of content by users, and the power of networks in order to personalize health care, collaborate, and promote health education.. A possible explanation for the reason that Health has generated its own “2.0″ term are its applications across health care in general, and in particular it potential in public health promotion. One author describes the potential as “limitless.”     

 

 

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Article about e-patients from  Healthcare IT News   ,   Physician Practices & Ambulatory Care Section

 

   The emergence of e-patients

October 16, 2009 | Robert Rowley, MD

Fresh on the heels of the Health 2.0 conference in San Francisco, a renewed spotlight is shining on empowered “e-patients.” The convention was a showcase for a myriad of online and mobile tools which enable patients to engage in their health and their lives in ways not previously feasible.

But who are these “e-patients,” and do they represent a significant segment of the population? A common belief among physicians is that “e-patients” are a minority of motivated people, but do not represent the bulk of the patients being attended. Is this true? A sentinel report describes e-patients, and what the term means, in some detail.

A recent report by the Pew Internet Project describes the rise of the e-patient. A rapidly growing segment of the population is using Internet and other e-tools for access to health information: 61% of the total population, and 83% of the online population, use the Internet for querying about health information. It is widespread across genders and ethnicities: 64% of men and 57% of women; 65% of whites, 51% of blacks, and 44% of Hispanics use the Internet this way. There is a skewing toward upscale and educated users, and towards parents of young children. Over the past few years, e-patients have become high-speed (using broadband 88% of the time), and mobile (using wireless 89% of the time). E-patients are also more likely to use social media, and build online networks of “patients like me” to discuss their health conditions, find out about resources, or simply vent their frustrations or experiences with the delivery system.

As consumers, e-patients have used the Internet to find out about the health delivery system as purchasers of service: 47% have looked up information about doctors; 38% have gotten information about hospitals; 33% about how to lose weight; 27% about health insurance; 12% about how to stay healthy during overseas travel.

Clearly, as technology has evolved and delivered fast, meaningful, mobile and low-cost (or free) tools, patients are becoming “e-patients.” They are engaging the health delivery establishment in a new way, in what can be described as Participatory Medicine.

Is there a direction towards which this development of “e-patients” and Participatory Medicine is heading? Are there platforms that are in a position to enable this direction? Patients, as consumers, are gathering information themselves over the Internet (sometimes from trusted sources, sometimes from questionable sources), and are forming communities among themselves in order to find meaning, support, and experience in making health decisions. Engagement with physicians, and other health care providers, is the logical next step in this evolution. Health professionals, when actively engaged in the networks that patients are creating anyway, can provide context and meaning.

Practice Fusion is building a platform that will enable this evolution in health care. By building a physician-facing Electronic Health Record (EHR) system that is able to seamlessly share clinical charts between clinicians taking care of the same patient, and by building a patient-facing Personal Health Record (PHR) that is automatically filled and updated real-time by the physician’s EHR, the level of interaction between patients and their clinicians can reach levels not previously witnessed. The consumer-friendly Health Internet, which is still a dream in practicality, is something that the Practice Fusion platform will be able to achieve in the very near future. With widespread adoption of this approach, and with connectivity between many different constituencies and trusted services, the impact on the health of the country can be measurably improved. That is the vision with which we build these tools.

Dr. Rowley is a family practice physician and Practice Fusion’s Chief Medical Officer. Dr. Rowley has a first-hand perspective on the technology needs and challenges faced by healthcare practitioners from his 30 year career in the sector, including experience as a Medical Director with Hill Physicians Medical Group and as a developer of the early EMR system Medical ChartWizard. His family practice in Hayward, CA has functioned without paper charts since 2002.

 

 

Ezzeldin

11:53 pm
December 7, 2009


ezzeldin

Admin

La Crosse, WI

posts 16

 

     

     Bits & Bytes   # 2

Cool Social media and networking have sprawled to entangle medicine and healthcare profession. Facebook, MySpace, twitter and blogs are some of the popular social clubs and get-together media that are attracting more audience every day. Medical schools, hospitals, physicians and other health professionals are competing to send their fly-ships and stations into the cyberspace.

 http://ebennett.org/ is a personal blog by Edward Bennett which cover excellent data and lists regarding hospitals social networking. His last update on November 27, 2009 listed 473 Hospitals total, 218 YouTube Channels, 254 Facebook pages, 356 Twitter Accounts and 57 Blogs.

 

 

Cool The following is a nice article in NEJM that illustrates how this new online media is a great means of communication and connectivity and on the other hand warns about crossing the line of privacy, confidentiality and professionalism.

 

New England Journal of Medicine, Volume 361:649-651  August 13, 2009   Number 7

 

Practicing Medicine in the Age of Facebook

Sachin H. Jain, M.D., M.B.A.

 

In my second week of medical internship, I received a “friend request” on Facebook, the popular social-networking Web site. The name of the requester was familiar: Erica Baxter. Three years earlier, as a medical student, I had participated in the delivery of Ms. Baxter's baby. Now, apparently, she wanted to be back in touch.

Despite certain reservations, I clicked “confirm,” and Ms. Baxter joined my list of Facebook “friends.” I was curious to hear about the progress of her baby girl, but I wondered about the appropriateness of this interaction. Was Ms. Baxter simply a grateful patient interested in sharing news about her child — as a follow-up to our professional interaction — or did she have other motives that weren't apparent to me? In confirming this patient as my “friend” on Facebook, I was merging my professional and personal lives. From my Facebook page, Ms. Baxter could identify and reach anyone in my network of friends, view an extensive collection of personal photographs, read my personal blog, and review notations that others had left on my “wall.” The anxiety I felt about crossing boundaries is an old problem in clinical medicine, but it has taken a different shape as it has migrated to this new medium.

Over the past 5 years, social-networking sites have evolved from a preoccupation of high-school and college students to a mainstream form of social interaction that spans divisions of age, profession, and socioeconomic status. At the hospital where I'm in training, medical students, nurses, residents, fellows, attending physicians, and service chiefs can all be found linked to one another as active members of social-networking sites. The technology facilitates communication, with personal Web pages that permit users to post information about events in their lives, advertise social activities, and share photographs. Users are prompted by Facebook to carve out a digital identity by disclosing their political affiliations, sexual orientation, and relationship status. Those who do so can readily communicate and associate with other users who have similar interests — a feature of these sites that facilitates collective action across spans of geography and time. In the 2008 presidential campaign, the group Doctors for Obama used Facebook to rapidly mobilize thousands of doctors to communicate their views on health policy to the Obama headquarters. This group of physicians continues to have a voice in the Obama administration, largely on the strength of its Facebook-created network of members. Similarly, Facebook networking groups have been created with a focus on specific medical specialties or diseases. Doctors or patients can interact with one another in groups such as “Diabetes Daily” and “I Support Cystic Fibrosis Research and Awareness!,” each of which boasts thousands of Facebook members. Hundreds of thousands of philanthropic dollars can be traced back to initiatives publicized on social-networking sites.

By creating a new environment for individual and group interaction, social-networking sites also create new challenges for those who work in clinical settings. Take, for example, the MICU nurse who blogs about her experiences in dealing with a difficult patient, forgetting that one of the patient's family members — a recent addition to her network of friends — has access to her blog. Or the dermatology resident who is asked on a date by a clinic patient after he learns from her online profile that she is single — information that he would have hesitated to draw out of her in person. Or the medical attending whose clinical judgment is questioned because of photographs posted online, showing him in progressive stages of apparent inebriation at a department holiday party. Although many Web sites allow users to choose higher privacy settings and to control which personal content is available to whom, it is clear that there is no longer a professional remove between many clinicians and their patients.

Physicians, medical centers, and medical schools are trying to keep pace with the potential effects of such networking on clinical practice. In an e-mail to students and faculty of Harvard Medical School, Dean for Medical Education Jules Dienstag wrote: “Caution is recommended . . . in using social networking sites such as Facebook or MySpace. Items that represent unprofessional behavior that are posted by you on such networking sites reflect poorly on you and the medical profession. Such items may become public and could subject you to unintended exposure and consequences.” At the Drexel University College of Medicine, medical students are warned about the possibility that information placed on social-networking sites might influence the fate of their applications for postgraduate training: “Programs/employers are increasingly gaining access to social networking sites such as Facebook and MySpace to see what they can learn about candidates.” Although legal questions surrounding the relationship between clinical medicine and social networking are as yet undefined, there are obvious concerns for individuals and institutions, since their Internet presence makes clinicians' attitudes and activities increasingly visible.

The issues raised by access to online media are in many ways similar to issues that physicians and medical institutions have dealt with for generations. Physicians, after all, are members of real-life communities and might be observed in public behaving in ways that are discordant with their professional personas. During medical training, the importance of maintaining professional distance — however much one desires to have a close, meaningful relationship with one's patients — is taught by educators and reinforced by the use of beepers and paging services meant to shield physicians from their patients. What is different about the online arena is the potential size of the community and the still-evolving rules of etiquette.

After becoming my Facebook friend and exchanging a few friendly e-mails, Ms. Baxter divulged the reason she had gotten back in touch. Having tired of her job as a fitness instructor, she had decided to apply to medical school and wanted some advice. Relieved to be back in a semiprofessional realm, I began a correspondence with her and shared a few thoughts and suggestions. Among other things, I recommended that she carefully consider her online identity.

The name and identifying characteristics of the patient have been changed to protect her privacy.

No potential conflict of interest relevant to this article was reported.


Source Information : From Harvard Business School and the Department of Medicine at Brigham and Women's Hospital — both in Boston.

 

Ezzeldin

11:58 pm
November 14, 2009


ezzeldin

Admin

La Crosse, WI

posts 16

                                                                           

         Bits & Bytes   # 1

                                                                                  

Last month was the 40th anniversary of the internet. October 29th  1969 witnessed the first time to esatblish computer network connection between two Interface Message Processors (IMP) located at Leonard Kleinrock’s lab at UCLA and Douglas Engelbart’s lab at Stanford Research Institute (SRI), creating what is now known as the Internet. http://www.computerhistory.org…..et_history

Since then the internet has revolutionized the human life leading to dramatic changes in communication, social life, politics, education and health.

Unfortunately the internet is not immune from side effects and ailments, researchers and doctors increasingly discovering emergent infectious diseases related to its use and abuse, if I have to mention some: googlemania, twitterosis, hyperfacebookemia and least but not last cyperchondria.

 …………………………………………………………………………………………………………………………..                                      

A glut of Google can give you a virtual fever

 

Carolyn Butler

Washington Post Staff Writer
Tuesday, November 10, 2009

It always starts out innocently enough — for example, with an eye twitch. It's just a little tic, but it keeps coming and going over the course of a few weeks, and so I decide to do a little medical investigation online. I plug “recurrent eye twitch” into my friendly search engine and, after several hours poring over a range of health-related Web sites — skimming over likely explanations such as fatigue, stress and too much caffeine in favor of dozens of worst-case scenarios, and growing increasingly panicky all the while — I am utterly convinced that I have multiple sclerosis, at the very least, and quite possibly Lou Gehrig's disease.

But what really ails me? Cyberchondria, loosely defined as the baseless fueling of fears and anxiety about common health symptoms due to Internet research, or, as I like to think of it, Googling oneself into a state of absolute, clinical hysteria over every last pain, itch and strange freckle on your body.

Apparently, I'm not alone. Last year, Microsoft researchers Eric Horvitz and Ryen White documented the growing trend in “Cyberchondria: Studies of the Escalation of Medical Concerns in Web Search,” which included a survey of 515 Microsoft employees and Web-search tracking of hundreds of thousands of consenting Windows Live toolbar users.

The report showed that about 2 percent of all the Windows Live searches were health-related. Of the 250,000 or so users who engaged in at least one such query during the study, roughly one-third “escalated” their subsequent Web surfing to focus on far more serious — and much less common — conditions. In addition, the employee survey showed that this type of escalation interrupted the everyday life of more than half the respondents at least once.

Of course, it's important to acknowledge that there is a lot of high-quality health content on the Internet that has helped a lot of people, both on respected, vetted Web sites such as WebMD and Medstory, and also within the myriad online support groups for particular illnesses, where people can seek information, encouragement or a shoulder to cry on. In addition, Horvitz and White's follow-up study found that while two in five people report that surfing the Web for health-related information has made them feel more nervous about a perceived medical condition, just over half of folks say that it reduces anxiety.

The problems arise when people turn to a broad Web search to diagnose their ills, says Horvitz, whose professional credentials include an MD degree.

“People have come to look at search engines as question-answering systems,” he explains. “We now see [the Internet] as a general oracle, in our pockets and desktops, that we can just ask questions to, and people think it's going to answer all questions in a quality manner; therefore, people turn to the system and say, 'Diagnose me; here are the symptoms.' ”

Horvitz notes that medical diagnostics requires taking in sets of symptoms, reflecting, having an interactive dialogue with a patient and then converging on a list of likely conditions. “It's a relatively sophisticated task that's quite different than information retrieval, which is what search engines are good at. They do not have a good sense for how to reason under uncertainty, or for probabilities. . . . The Web is really great at finding out who played the role of Gilligan on 'Gilligan's Island,' but not so good at weighing the evidence to give you good information about concerning and unconcerning health situations.”

Instead, Web search rankings are often based on such things as relevance and click-through rates, which skew the results you see. For example, Horvitz and White use the example of headaches, which are just as likely to be associated with “brain tumor” as “caffeine withdrawal” in search, although the annual U.S. incidence rate of brain tumors is about 1 in 10,000, and missing your daily cup of java is one of the most likely explanations for a common headache. Yet the research also shows that the vast majority of people have interpreted the ranking of search results as a list of likely ailments, in order of probable diagnoses.

Clearly, psychology is just as much at play as technology. Stephen Josephson, a clinical associate professor of psychology at Weill Cornell Medical College in New York, says that a lot of the health concerns people have fall broadly under the category of anxiety, which can prompt compulsive behaviors such as constantly cruising the Web for information. He explains that it's well-proven that people are prone to selectively attend to negative information — like the fact that a mole might be melanoma — and to ignore the actual low prevalence of dire diseases,

“It's a paradox: The more you read in an attempt to reduce your fear, the more you try to figure things out, the more anxiety peaks. Very few people know how to navigate the Internet and evaluate information when they're anxious, and yet that's when they tend to go online.”

Microsoft's Horvitz says the challenge for the Web is to improve health content so it more accurately reflects probability and likelihoods, and to adapt search engines to factor in many more complexities, such as family history, to be able to properly diagnose an ailment and then intervene when people are escalating inappropriately. Take, for example, someone younger than 35 with no family history of cardiac trouble who plugs “chest pain” into a search. Right now “heart attack” will pop up the most frequently, about 37 percent of the time, says Horvitz. “But if the system just knew their age and family history, it would say, 'Just take it easy; don't run to the hospital,' ” because it would be extremely unusual for a young person with no history to be having a heart attack.

In the meantime, fellow cyberchondriacs, try to keep everything in perspective and seek out credible information. The Medical Library Association has some great tips for evaluating health research online.

Oh, and about that twitch? Eventually I asked my doctor about it, and he helped me figure out that I'm actually allergic to a new eye cream I bought to stave off the effects of aging — not in need of pricey and invasive tests for a rare tropical disease.



 


 

Ezzeldin

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