Live Conversations

MOOC Summaries - Medicine in Digital Age - Future of Medicine

Live Conversations

“Live Conversations”
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Summaries

  • Live Conversations > Live Conversation #1 > Live Conversation #1
  • Live Conversations > Live Conversation #2 > Live Conversation #2
  • Live Conversations > Live Conversation #3 > Live Conversation #3

Live Conversations > Live Conversation #1 > Live Conversation #1

  • So we’re thrilled to have a live conversation with you all, because we’re really eager to start hearing from you what you’re interested in getting out of the course.
  • We really want to use this opportunity [AUDIO OUT] Send us questions and comments on Twitter and on Facebook as well, and those will all be getting fed into us.
  • We’re really excited about how much conversation there has been already.
  • I’ve just seen there are three people who’ve introduced themselves on the chat from the UK, so that’s really great to see so many people tuning in from across the Atlantic.
  • I think the fact that there are so many different approaches being taken across the country shows there’s a lot of anxiety, and people aren’t really sure what to do this technology.
  • People aren’t sure what to make of it, and some people are embracing it, and some people are really just pushing it away, and very resistant.
  • If you look at what’s happening with mobile health, some third world countries that don’t have these policy restrictions and health privacy restrictions that are really taking off with some of these mobile technologies.
  • SARAH: We’re getting some really good responses, actually, from people on the chat who are really interested in this telemedicine and telehealth field.
  • We’ve got opinions from people in Austria and people in the UK. And Helen has made a really good response, really good point, and has said how, if you’re admitted to A&E or if you’re in a hospice and you have an emergency situation where a new doctor has to come in and be involved in your care, you don’t have a pre-established patient doctor relationship with that physician.
  • SARAH: And Melvin also has chimed in and talked about the situation in the Dominican Republic, and how telemedicine is really popular there because there aren’t enough specialists.
  • So one of the questions this raises is how do we define meaningful communication and meaningful interaction between a doctor and a patient? And I think that’s really the core question that we have to answer differently now.
  • Jay Parkinson, who is the founder of Sherpa, which is a company that provides this sort of asynchronous dialogue between patients and doctors, wrote a really nice post about this.
  • There are times when you really need to get a quick answer and do some good hypothesis testing, like on a telephone call or via video.
  • KIRSTEN OSTHERR: And this is one of the big issues that we talk about some in the course, and that really needs to be addressed right now in digital health, is that designing digital health innovations for the aging population, where there’s huge needs is a whole different thing from designing it for 20-year-olds.
  • Grandmothers- this is really funny- they will sometimes wrench their head to the side and want to have eye contact with me.
  • We’re really interested in where people are chiming in from.
  • If you think about health privacy law, it was really designed at a time when we didn’t have these technologies available to us.
  • SARAH: We’ve also got an interesting question coming in on the streams about someone’s proposing the idea that maybe through telehealth interactions, when you’re speaking to a physician on the phone, there’s a risk that you might downplay your symptoms and say, oh, it’s not really that bad. So they propose the scenario where a patient calls and says they have chest pain, and when the doctor asks more questions, they say, well, actually, it’s not that bad. I wouldn’t go to hospital.
  • Is that something- I think often people talk about telehealth as being way of really reducing pressures on resources like going to hospital and preventing them from doing that.
  • So I think going forward, technology is going to advance such that it will be a lot more like being in close contact in person, right? KIRSTEN OSTHERR: So in that case, the issue may be, OK, what if you’re getting a remote feed on a heart rate, and on how much someone is sweating, and whether they’re moving around and all that stuff? And maybe you want a visual because you want to know, are all those sensors on them or their dog? So that’s a different kind of question, which sort of gets at the same issue in a way.
  • SARAH: And then they also go on to talk about the scenario where, say someone’s having a stroke, are they really able to communicate effectively over the phone and really explain what’s going on effectively to their physician? But I guess my response to that would be, actually, if they are in a position where they find it difficult to communicate, they’re very unlikely to be able to physically get themselves to a doctor’s office.
  • At same time, I think this is also where the smart home technology is really interesting and promising, especially for the question of aging in place.
  • I mean, we in the United States, and in many countries around the world, have really aging populations.
  • There have been really important successes in connected health that allow people to have kind of a remote ICU situation and things like that.
  • Now the question of what that costs, who pays for it, and how to kind of implement these sorts of changes, I think, is a really big one.
  • You kind of touched on it, which is that Silicon Valley likes to create these apps and health devices for people who are really healthy and have lots of money.
  • We need some of that talent, really, in the health care sector to come up with these unique challenges for keeping the elderly at home.
  • Bryan and I’ve talked a lot, and in other courses that we’ve taught- and we do in this course some, too- about digital literacies and the need for the general public, but also doctors and other health professionals, to really develop new ways of communicating through these kinds of new technology.
  • There’s the question- and this is also where the talk of e-Patients really comes in.
  • So the question of how patients might be able to use new technologies to empower themselves to really kind of understand better their health care and be able to interact effectively with providers, it’s a really critical question.
  • So the digital divide that people used to talk about that was between people who had access to the Internet and people who did not has really changed in the smartphone era.
  • The question of how you make sense of what you find online becomes really absolutely paramount.
  • SARAH: And it’s really active on the forums at the moment, so people should definitely go and share their opinion there, because it’s a very contentious issue.
  • BRYAN VARTABEDIAN: I brought it up in 2009 on my blog, and it really has taken off as a big question, because physicians always assume that participation in- we’re talking about online communication- was just sort of an option.
  • So finding a better balance of those two things in health care dialogue is also really important.
  • A few people have chimed in, including Roger Knight, who asked about- this relates a little bit to the LabCorp thing- that could direct consumer lab testing cause unnecessary drain on resources, testing and tracking? And someone else asked about how the particular setup of telemedicine, of having phone calls, text messages, video calls, all coming in at the same time, what kind of strain is that going to put on medical professionals and filtering the drains on resources? BRYAN VARTABEDIAN: So the direct to consumer lab testing one is really interesting, because the question is who’s going to pay for it.
  • So that’s really where it’s great to hear from all the different people that we have chiming in, because the financial situations on how we take care of our health are very, very different in different parts of the world, which means digital health poses really different challenges.
  • SARAH: And it’s actually a question, or an aim that somebody had. Margaret, on Twitter, said, when we asked about what do you want to get out of the course last week, or whenever we started posing that question, she said she really wanted to get an idea of how to deal with what she calls the tsunami of information that we get from all our different kinds of media.
  • We need ways to harness that and filter it and decide what’s relevant to us, because no one knows, really, how to handle it.
  • So patients who have gone through a treatment process are really better equipped than anyone to help guide other patients through that process.

Live Conversations > Live Conversation #2 > Live Conversation #2

  • So one topic that’s come up a lot in the discussion forums in response to your video, I think, about online engagement, was this question of whether doctors have an obligation to engage online.
  • So what do you think about that? BRYAN VARTABEDIAN: It’s really hot button issue, Kirsten.
  • When you think about- I think in the video I brought the example of vaccines.
  • KIRSTEN OSTHERR: Part of the issue is about which voices get the most airplay in a way, and it sounds like what you’re saying is that physicians, by virtue of your training and by virtue of your interaction with patients, you have a kind of insight into what’s going on with patients and what issues might be causing people concern.
  • KIRSTEN OSTHERR: What do you think about the issue of time? I think a lot of people if they hear you say that would say, well, you know, I can barely see all the patients I need to see complete all the paper work.
  • SARAH DEW: And I think just a little segue on that issue of time.
  • As more and more of these communication channels kind of come about, there are more and more expectations of physicians to keep up with them and participate in them, when in fact, they simply can’t.
  • I think that’s a trend that we might see emerging.
  • The person who kind of sits between perhaps the wearables and the EMR and translates in some way, and I think that’s a topic we’ll get back to later.
  • BRYAN VARTABEDIAN: Well, I don’t think the two are mutually exclusive.
  • So I don’t think the two are mutually exclusive, but it is a good point.
  • And even if you do have that kind of relationship, it’s like thinking about the way we used to think about the traditional mass media- broadcast media.
  • I think that’s one of the big- this is an affordance of the internet, right? The many-to-many communication.
  • What do you think? BRYAN VARTABEDIAN: Well, I mean, with every new technology, there’s a liability that comes with it, too.
  • I think this is clearly the case where the benefits outweigh the risks, and it has to be looked at as a net situation.
  • SARAH DEW: And I think building on the conversation we had last week about telemeds.
  • I think the presumption here is that patients will go away with this information online and diagnose themselves completely independently of the doctor.
  • So early on, I think that that gives us a lot of concern.
  • I always like to think that over time, docs have kind of come to accept this- this idea that the patient shouldn’t go online has sort of passed by the wayside.
  • Now things have evolved and change such that I think patients have a real healthy relationship with that information.
  • I think you’re right in saying that this landscape is changing a lot.
  • So I actually think to encourage more people to go online and share their experiences, we are avoiding some of the dangers of the internet in showing these extreme cases.
  • KIRSTEN OSTHERR: I took mine off because I think sometimes they interfere with signals.
  • I think I’m on my second or third, I can’t remember.
  • I wore this and he said- he would get really upset because he really thinks that these are kind of a gimmick.
  • We have a quote that we have somewhere in the course I think this week.
  • SARAH DEW: I think when you’re talking about it now, I can see converted Fitbit users.
  • The guideline in the UK is against using apps without the CE mark, and I think it’s definitely true that we’re seeing lots of things come onto the market- apps and also these wearables that connect to the apps that actually haven’t really been tested very much.
  • We don’t actually have a clear idea of how useful they are in managing house, and I think that’s something that we really need to make progress on if we’re going to see these be integrated properly into the clinical setting.
  • KIRSTEN OSTHERR: So I think here, we start to see that there are two big areas of development.
  • So I think we’re seeing a split between the consumer facing stuff, which until it is actually integrated in some meaningful way into health care context.
  • SARAH DEW: I think for these more technical, clinical apps that you’re talking about, we need a big infrastructure change to make these have a real tangible impact in the way in which they are involved in health care.
  • So to actually make sure we can take these technologies and bring them to patients quickly, we need to change the whole infrastructure that’s involved in creating and testing reliable technologies.
  • I think it’s way too soon to say yet whether or not this will deliver on the promise, and it does remain true that you have to have a smartphone of some kind.
  • SARAH DEW: But when you say that, it suggests that we’re making this much more open access, and I think on that point, I’d probably have to disagree.
  • I think by relying on the smartphone, we’d be eliminating some of those populations that most need to be taken care of.
  • KIRSTEN OSTHERR: OK, but I think that actually those populations you’re describing are already being left out of research.
  • SARAH DEW: I think it’s something you talked about in one to your lectures- I think perhaps in week four, we talk a little bit about looking to the future and what happens next.
  • I think Eric Topol, who’s one of our lecturers who we interview I think in week three- KIRSTEN OSTHERR: [INAUDIBLE].
  • So I think this is an area that we’re going to see really exploding over the coming years, and it’s something we talk about a bit in week four.

Live Conversations > Live Conversation #3 > Live Conversation #3

  • So what do you think about this? What stands out to you? BRYAN VARTABEDIAN: I think it’s amazing.
  • We’ve empowered people to think differently about the doctor-patient encounter.
  • I don’t think we can underestimate the importance of even just providing broadband access for these patients, where in this part of the world may be a huge thing.
  • So I think it’s always- I know I’ve seen you write on your blog before about the fascination with shiny new objects in tech development, right? Like, it’s so much easier to be entranced by some new technology and see it as the thing that will solve our problems, when in fact what he’s pointing out is that just making internet access available may be more powerful than anything else.
  • ERIC KOK: I think that internet access in different countries can allow people to access information that you wouldn’t normally get, unless you actually went to a doctor, which some people unfortunately don’t have the ability to do so.
  • So it opens up this new door of ways they can treat themselves and ways they can actually be more aware of how to live healthily, I think.
  • I also do think that the Robert Wood Johnson Flip the Clinic project, if you haven’t heard about this before, you should just look for it online.
  • Why couldn’t we flip the clinic too? Why couldn’t we think about how to actually make the medical encounter different, and ideally better, by thinking differently about what goes on in the clinic and what goes on outside the clinic, before or after.
  • So then that gets us back to thinking about what makes conversation? What makes communication meaningful? And that’s really, I think, the core question to ask when you’re thinking about any new technology that might be changing the way you do communication.
  • This might also guide us in the future in thinking about other things we might want to discuss further in a future course.
  • I think Steve’s going to put it up on the screen there.
  • I guess I was just inspired us seeing this, because I was thinking about the Texas State Board here in Texas recently voted to disallow the use of telehealth without having a face to face encounter initially.
  • Here in the United States and in developed countries, I think we tend to see telehealth as something that can interfere with something that we already have.
  • In other parts of the world, where there’s no access to physicians, I think telehealth can provide the solution, rather than being the problem.
  • KIRSTEN OSTHERR: No, I think it’s really important to remember that the perspective that we may have, where there are many resources, actually is not universally applicable.
  • I think we sort of underestimate the importance of the experience or the user experience in terms of interface and with physicians and their charts.
  • I think certainly we have a long way to go with regard to physicians accepting electronic health records.
  • I think that in my interview or one of our interviews with Roni Zeiger, he makes reference to looking forward to a more graceful age of the EHR, or something like that.
  • I think that we hear from a lot of people that they would love to reinvent that experience.
  • BRYAN VARTABEDIAN: Yeah, you know, the market, I think, is dominated by some legacy organizations that make it hard for innovation disruption to happen with the EHR experience, which is unfortunate but maybe that’ll change.
  • It’s also a question of motivation, to some degree, right? So I think that this really needs to be pushed by the market.
  • If organizations that have been using this stuff are not pressured to make any change and financially there’s no pressure to do so, then why are they going to? BRYAN VARTABEDIAN: I think that change is coming.
  • So I think the change may come from the periphery.
  • BRYAN VARTABEDIAN: I think there’s a couple things.
  • I think what’s most interesting to me is the way that these young doctors came together to pile together pictures without using words, because it was something that can translate across language barriers.
  • I was questioning online whether this was really kind of a movement or was it just sort of a phenomena everybody’s getting together, or what? KIRSTEN OSTHERR: And I think your point about using photo sharing as an act of solidarity is really interesting.
  • I think I called it a digitally mediated pig pile of whining.
  • I think that in some ways this phenomenon brings that up.
  • KIRSTEN OSTHERR: So I think it was Dr. Alan Greene who first proposed this idea that both doctors and patients should have a kind of digital engagement code of responsibility or something like this.
  • Part of the idea was doctors may need to think about how they engage online.
  • So this brings us to another topic that I think we wanted to address here, which is about, again, the question about engaging.
  • I think you suggested that it’s possible that in this day and age, failure to engage in public could be construed as negligence.
  • BRYAN VARTABEDIAN: I think in one of my videos- I’ve suggested this in the past.
  • We had one of our students who got upset by this, I think is reported as a surgeon and didn’t like that.
  • So we had a nice exchange on the comments under week one, which I think you can go and check out.
  • My assertion is really one that raises this question and raises the whole idea of thinking anew about our responsibility out in public.
  • KIRSTEN OSTHERR: So I think one of the things about public dialogue- so you even saying this is an act of public dialogue, right? And it’s getting people talking about the new kinds of ethical issues that arise in the digital age that are not covered by the Hippocratic oath.
  • When we really think about the Hippocratic oath, it initially told doctors to keep information from patients as much as possible to avoid upsetting them.
  • BRYAN VARTABEDIAN: And Doctor- I forget the doctor’s name who made the comment, but I think to his point, what we do with a patient in real life, and our responsibilities to that patient, certainly in a surgical theater, is very different than our responsibilities out in public, commenting and correcting the [INAUDIBLE].
  • So improvisation- and I think that’s a really important way to just think about this question, about the relationship between technology and humans.

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