At this year’s NASPGHAN meeting, the keynote lecture was given by Brennan Spiegel. (Brennan Spiegel, MD (@BrennanSpiegel) | Twitter) This was a great talk!
This blog entry has abbreviated/summarized the presentation. Though not intentional, some important material is likely to have been omitted; in addition, transcription errors are possible as well.
Challenges in healthcare:
- Time with patient is limited/poorly-timed in comparison to health care needs.
- Care is reactive rather than proactive.
- Care is expensive.
We spend all our time within walls of our clinic/hospital, but patients spend 99% time outside
How do we tailor care to the individual and make it more cost-effective? How do we get there? Potential/Emerging Tools:
- Patient provider portals (including mobile)
- Social media
- Wireless biosensors
Key question for patients: What is the most important goal for you/your family today?
How to improve communication with family? Electronic medical records often designed for billing rather than educating
MyGiHealth website/soon-to-be-app. Here’s a link to YouTube video introduction.
- HISTORY: Trained computer to interview patient re: abdominal pain –where, timing, risk factors for H pylori, etc.
- Symptoms and severity: constipation, abdominal pain, gas/bloating, heartburn, diarrhea, dysphagia, incontinence, nausea/vomiting (Promise scales –percentiles).
- Computer history looked better than history by physician (example below with fictional patient). If history obtained prior to physician coming into room, this would allow physician more time to communicate with patient rather than documenting (Related post: Aptly titled “The Cost of Technology” | gutsandgrowth)
- Man vs Machine (Spiegel in press Am J Gastro 2014). History performed well with regard to billing complexity and completeness.
- THIS IS COOL!
- Physician still needed to analyze information and make diagnosis/treatment plan.
- Also website/app with EDUCATION applicable to patient.
Obtaining information outside the confines of the office can help overcome Hawthorne effect. (Related blog post: Checklists -Helpful? Overhyped? Hawthorne Effect …). Passive vs Active monitoring.
Twitter: “What you say on twitter may be seen by everyone all over the word instantly”
- Tool for epidemiologic data.
- Recruiting for clinical studies
- Measure consumer sentiment
- Educate patients/providers
- Forge patient affinity groups
- Monitor patients for clinical practice
- Help to manage and direct care
Mayo clinic is studying the impact of social media.
Example of patients initiating research. “Spontaneous Coronary Artery Dissection: A Disease-Specific Social Networking Community-Initiated Study” Lead author: Marysia Tweet
- “91% of people keep their phone within 3 feet of themselves 24 hours a day.”
- Can be used to track intake of food, air quality, movements etc
- Current sensors: Fit bit, amigo (?sp), shine (?sp), Zeo (for sleep) others.
- Fitbit: Calories, distance, active time, sleep time
- More advanced sensors for athletes. Stride dynamics can predict marathon winner at mile 16!
- Wireless sleep (eg. Zeo) monitor equivalent to formal sleep study
- Q Sensor –can measure stress: physical ,cognitive, emotional (watching horror movie)
- Hapi fork –can tell if you are eating too fast (correlated with BMI)
- Proteus –monitors intake
- Propeller –monitors MDI use for asthma (FDA approved)
- AbStats Digestion Sensor –adheres to abdomen and can provide neurogastroenterology data. Green light –will tolerate feeds, Yellow light –will tolerate clears
75,000 health apps available at this time.
Recommended Reading by Dr. Spiegel: The Creative Destruction of Medicine by Eric Topol. The Creative Destruction of Medicine: How the Digital …