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Take Two Apps and Call Me in the Morning

An Ever Increasing Array of Gadgets and Widgets Is Changing the Doctor-Patient Relationship

January/February 2013

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Instant Access, Constant Communication

Some changes in health care seem to carry obvious benefits, at least on the surface. For example, EHRs provide instant access to patient information that is available 24 hours a day, seven days a week. Physicians can more easily gain access to a comprehensive medical history for a patient than ever before -- sometimes even if they've never seen that patient in that clinic. But even this benefit holds challenges. Dr. Keith Henry, Professor of Medicine at the University of Minnesota, says that the amount of time he spends in the medical records system actually reduces his face-to-face time with patients. "My patient interactions are depersonalized because I have to pay attention to the computer," Henry explained. "People already complain that they don't get enough time with their doctors." As director of HIV research at Hennepin County Medical Center in Minneapolis, Dr. Henry has been involved in caring for HIV patients since the early 1980s. He has seen the impact of technological changes in the health care industry firsthand and speaks from experience about both the benefits and the costs of electronic systems.

Another benefit of technological advances in health care comes from the ability to communicate across distances with greater ease. Most patients no longer rely on a single physician system, often seeing multiple providers at different clinics. To provide integrated health care, these providers need to stay in touch, which eHealth makes more possible than ever before. Providers can use secure data transfer software to ask for a review of patient information by a colleague. They can touch base by email or receive a health summary before a patient's appointment. Keeping these lines of communication open and accessible provides great benefits for patients, because their providers can stay up to date with their treatment progress, even outside of their own practice. Time is finite, however, and constant connection brings its own issues. In Dr. Henry's practice, he's finding that he spends more and more time using electronic communication, and less time talking with colleagues as well as patients. "You're always basically connected," he explained. "It's very hard to get away for a break or free time."

The changes brought by technology are permanent; there won't be any backwards movement without a serious change in circumstances. The transition from paper to electronic records isn't temporary. EHRs are here to stay. The Federal government has mandated that EHRs must be available for "meaningful use" by 2014. Patients should receive better care since EHRs can be accessed by multiple clinics and providers within any given system. Patients can also become more informed by having access to their medical records online. Unfortunately, there's no mandate that requires communication across different systems, and this can reduce how effective they are for a health care provider.

In Minneapolis and St. Paul, there's been a movement to integrate the medical systems across most of the hospitals there. "When patients come see me, I can more often than not get into their records elsewhere. I can see their labs or x-rays and see what needs to be done," said Henry. But even the benefit of quick online communication can eat up time that could be spent with patients instead. It comes down to finding the balance between face time and time online for physicians in the clinic and at home after hours. This balance is challenged by many of the rules and regulations in the health care industry.


Aways Room to Grow

The patient-doctor relationship is continuously evolving. How does technology affect the pace of that evolution? The relationship will be enhanced, hindered, or unaffected, depending on region, resources, and the way that technology is being used. Different people face different challenges and only through strategic application can technology be useful for any individual. With mindful development and careful research, technical advances can be powerful resources that have the potential to take us further into useful health care for both patient and provider. 


Finding the Appropriate App

HealthyWithHIV.com
HealthyWithHIV.com offers My Positive Agenda, downloadable software for both PC and Mac, with mobile apps for iPhone and Android. The software allows HIV-positive people to track their health, symptoms, CD4 counts, current viral load, and medications. Information can be printed and shared with medical providers. It also has medication reminders. The software offers an educational component to help patients learn more about HIV therapy, the virus, other resources, and other conditions that might affect people with HIV.

My Health Matters
Created by Merck & Co, Inc., this is an app designed for iPhone, iPod touch, and iPad. It helps people with HIV track symptoms and set reminders for medications. The app can create reports to display the symptoms a patient has experienced and email the reports to their health care providers. The medication reminders also keep track of when medications have been taken. These reminders are customizable so the patient can enter the name of the medication they are taking.

The NIH AIDSinfo Glossary of HIV/AIDS-Related Terms
This app for iPhone, iPad and iPod Touch contains both English and Spanish definitions of more than 700 HIV/AIDS-related terms. It is offered as part of aidsinfo.nih.gov.

Airstrip
Physicians can use this app to securely route information from monitoring systems in the hospital, various bedside devices, and EHRs to the provider's mobile device. Compatible with many smartphones and tablets.

Mobile MIM
This mobile app provides access to diagnostic imaging for clinicians. It's available for iPad, iPhone, and iPod touch, and can access images such as x-rays and ultrasounds. The app allows physicians to have images on hand for consultations with patients and colleagues while on the go. Mobile MIM also offers cross-platform, secure, cloud-based image data storage. All personal health information is encrypted for transfer and storage and the system is compliant with the Health Information Portability and Accountability Act (HIPAA). Cloud-based storage is essentially like storing files on the Internet, instead of on your computer's hard drive, so it can reach across institutions and physical limitations. Mobile MIM can also be used to collect images or data for clinical trials. People without Mobile MIM can view data using desktop software downloaded from MIMSoftware.com.

Fooducate
This consumer-focused set of apps helps users navigate nutritional health. These apps aim to act as a personal grocery advisor, so people can make healthy food choices when shopping. The basic app is free for iPhone and Android, with paid versions available for people who have certain food allergies or diabetes and need more in-depth information. They also offer a daily educational tip. The group behind the technology is composed of parents, dietitians, and technology specialists. The app allows you to scan a product barcode, see the good and bad highlights for the product, compare it with other products, and also learn more about food and nutrition. It also works on iPod touch and iPad.

iTriage Health
Founded by two emergency medicine physicians whose vision is to "help the world make better health care decisions," with a focus on helping the patient move from symptom to provider. Their apps for Android and iPhone are oriented to answer the questions "What could be wrong?" and "Where should I go for treatment?" When hospital emergency rooms participate in the ER Check-in feature, patients can use their smartphones to let the emergency department know that they are on their way to the hospital. This can save valuable time and allow the hospital staff to prepare for their medical needs even before they arrive on site.

WebMD
One of the most popular resources online is WebMD. The site is well known for providing credible medical news and reference material and is reviewed by an independent Medical Review Board for accuracy. WebMD offers a number of mHealth options. WebMD Pain Coach for iPhone is helpful for people living with chronic pain, offering tips, articles, and symptom/treatment trackers, among other features. iPad users can get WebMD the Magazine on their iPad for free. The basic WebMD app has a symptom checker, drug and treatment information section, basic first aid information, and allows the user to check local health listings. Available for iPhone, iPad, and Android. Medscape, a medical resource often used by students, nurses, and health care professionals for clinical information, is available for iPhone, Android, Blackberry, iPad, and the Kindle Fire. TheHeart.org is available as an app for the latest information and developments in cardiology and cardiovascular research.

DocbookMD
DocbookMD is a physician-oriented mHealth communication platform that is HIPAA-compliant and available for both smartphones and tablets. It has a secure network that allows providers to share confidential patient information with their colleagues for collaboration and analysis. It has been developed by physicians and is growing in size, although still small and only available in 28 states. One way data is secured is by keeping patient details and images on DocbookMD servers and not on the mobile devices. Its encryption exceeds current HIPAA requirements, and devices can be remotely disabled if lost or stolen.


Bran LeFae has worked as a technician in cancer and HIV research, and in research administration. She is co-owner of Bramblethorn Studios.


Got a comment on this article? Write to us at publications@tpan.com.
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This article was provided by Positively Aware. It is a part of the publication Positively Aware. Visit Positively Aware's website to find out more about the publication.
 
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HIV Medications: When to Start and What to Take -- A Guide From TheBody.com
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