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Using the cloud to improve the practice of medicine
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How to Use Technology to Improve the Practice of Medicine
Robert Miller, MDDecember 2016AboutCancer.com
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Are Doctors Happy with the way Medicine is Being Practiced Today?
Medscape survey in 2015 found that 46% of physicians felt burnout (up from 39% in 2012 with other studies ranging from 30 – 65%
Issues cited by doctors included:
Too many bureaucratic tasksToo may hours at workIncome too low for the hoursIncreasing computerizationInability to keep up with current science
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The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic ReviewJournal of the American Medical Informatics Association Volume 12, Issue 5September–October 2005, Pages 505–516
the use of central station desktops for computerized provider order entry (CPOE) was found to be inefficient, increasing the work time 238.4%
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According to the Mayo Clinic, more than half of all physicians are burned out, and On average, doctors spend 158 million hours per year on administrative tasks and 49.2% of their day on EHRs
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Increasing demands for documentation
“I’m from the government and am here to help you.”
PQRSICD10
MACRAMIPSQPP
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What will the government do to “get the hearts of minds of doctors back?”
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QPP (Quality Payment Program)The Quality Payment Program improves Medicare by helping you focus on care quality and the one thing that matters most — making patients healthier. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula. https://qpp.cms.gov
Merit-based Incentive Payment System (MIPS)
You earn a payment adjustment based on evidence-based and practice-specific quality data. You show you provided high quality, efficient care supported by technology by sending in information in the following categories.
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Are Doctors Happy with the way Medicine is Being Practiced Today?
Too many bureaucratic tasksToo may hours at workIncome too low for the hoursIncreasing computerizationInability to keep up with current science
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John Henry (African American folk hero)
‘We’ need to help doctors use computers in a way that:• Faster (time efficient)• Cheaper (cost efficient,
free is best) • Better and Safer Care of
the patient
Used a hammer and was a ‘steel-driving man’ who died trying to prove he could outperform a modern steam drill
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1. How to use technology and the internet to better self educate and remain current.
2. How to use apps, more sophisticated EMR (electronic medical records) or EHR (electronic health records) systems to try to run a more efficient practice (better and safer patient care.)
3. How to use web sites and other social media outlets to better communicate with your patients or colleagues
Computer tips from Dr. Miller
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Best ways to get reliable information from the cloud
• Specialty medical sites (NCCN, Up-to-Date, Pubmed, etc)
• Specialty Journals• Medical sites or apps (Medscape, Epocrates,
etc)• Search (Google or Bing or Wikipedia)• Medical Calculators
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Most Important Web Sites if Your are on Oncologist
• PubMed (Medline) ? • NCCN (National Comprehensive Cancer Network)• UpToDate• Google (need to take advantage of all the free
apps that make doctors more efficient and keep them up to date)
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ncbi.nlm.nih.gov/pubmed
Medline is now called PubMed
MEDLINE (Medical Literature Analysis and Retrieval System Online, or MEDLARS Online) is a bibliographic database of life sciences and biomedical information Compiled by the United States National Library of Medicine (NLM), MEDLINE searchable via PubMed
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How to Use PubMed?
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NCCN.org
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Epidemiology, risk factors and the clinical approach to ER/PR negative, HER2-negative (Triple-negative) breast cancer
All topics are updated as new evidence becomes available and our peer review process is complete.Literature review current through: Oct 2016. | This topic last updated: Aug 10, 2016.
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Is search the quickest way to get useful medical information?
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Triple negative breast cancer
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14,300,300 results from basic google search
But hit the scholar button
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scholar.google.com
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scholar.google.com
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Create an Alert in Google Scholar
Click to learn more
Triple negative breast cancer
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google.com/alerts
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google.com/alerts
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translate.google.com
Are you having trouble breathing?Problémái vannak lélegzik? Hungarian
Ertu í vandræðum með öndun?Icelandic
לנשום מתקשה אתה ?האםHebrew
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When you ‘google’ a name
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Often dozens of high quality video lectures
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If the quality is good you can subscribe to their site
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Subscribe to University You Tube Sites
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The way to survive is with Medical Apps
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Running an Oncology practice with just 4 apps
1. ePSS ( Electronic Preventive Service Selector from the US Preventative Task Force) : update guidance for screening and prevention
2. NCCN (National Comprehensive Cancer Network) constantly updated treatment and testing and follow up
3. Epocrates: to make sure medication orders and safe and appropriate
4. Up to Date: if I need more detailed review of a subject
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What is a chatbot? A messaging application, sometimes referred to as a conversational interface, designed to simplify complex predefined task(s). Chatbots came on the scene in 2011 as business intelligence, artificial intelligence and messaging platforms combined into new forms of responsive technology
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https://www.google.com/intl/en/about/products/assistant/
Pixel with built in google assistant
Google Home
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1. Pick One 2. Train the staff properly 3. Use it
Remember the software works for you and not the other way around.
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Is it possible to teach (train) a doctor how to use EMR/HER Software?
1. They may not have the time (or interest) to commit and participate in training courses or attend up date courses
2. Unless they use the software frequently or exclusively they may not be able to remember or keep straight how to use it properly and efficiently.
Solution: build short help screens, FAQ or videos into the interface so they can refresh their knowledge in real time
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Using the Internet to Educate Patients
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What are patients getting from the internet?
• High percent of patients access the web (60% in 2001 and 80% 2013)
• Medical sites but also blogs and Facebook• Survivorship and patient participation
According to one study, only 43.5% of websites provided accurate information. Most accurate sites were from government organizations (80.1%) The least accurate websites are blogs (30.9%)
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FAKE NEWS
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Doctors need to identify the best patient information sites for their specialty and share these
sites or links with their patients
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Direct patients to society’s web site, for cancer ASCO
http://www.cancer.net/
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http://www.cancer.net/
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nccn.org/patients/
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https://www.cancer.gov
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Are Social Networking Sites a good way to convey medical information to the public?
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There likely will be numerous competing on line physician resource sites in the future
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Are patients satisfied that all of their questions were answered?
Do doctors think the patient and family actually understand and remember what they were told?
1. The patient may be too emotional or upset to even listen to what is said2. They may just not comprehend3. They may not remember what was discussed4. Often the family member who should have been there wasn’t available
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If only you could clone your mini-lectures and teaching sessions with the patients so that they can (at home and on their own schedule)
Re-read the slides and descriptions or
Re-listen to your explanations and have them available to share with other members of their family.
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www.slideshare.net
Slideshare is now part of Linkedin which is now part of Microsoft
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First 5 years
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Last 12 months
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www.slideshare.net
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At the top of your Gmail page look at the upper right corner and click on the box which will show you the attached apps
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https://support.google.com/docs/topic/21008
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google.com/docs/about
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Turn PowerPoints into YouTubes or other Videos
Windows Movie Maker Microsoft PowerPoint
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At the top of your Gmail page look at the upper right corner and click on the box which will show you the attached apps
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At the top of your Gmail page look at the upper right corner and click on the box which will show you the attached apps
Then click on the You Tube
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youtube.com/user/robertmillermd
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Views = 261,216
12,647 hours
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At the top of your Gmail page look at the upper right corner and click on the box which will show you the attached apps
Create a web site
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At the top of your Gmail page look at the upper right corner and click on the box which will show you the attached apps
Then click on the More
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Under Sites you can easily create a simple free web site
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sites.google.com/site/robertmillermd/
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Web Site Software
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www.aboutcancer.comCancer Information
• Basic Cancer Information• General Cancer Statistics• Most Common Cancers
* brain* breast* colon/rectum* gynecologic * lung* prostate
• Other Specific Cancers Radiation or Chemotherapy
• All Other Cancer Topics• Other Topics• Best Web Sites
Advice for Patients
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www.aboutcancer.com/premed.htm
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Favorite Non-Medical Web Sites
aboutcancer.com/best_webs.htm
Art/Culture: IMDB American ArtTimeline Art#1 Art #2 Art#3 Art#4 Art#5 British DigLib EarlyAmerican freeTV Halta Hermitage , Louvre Met Moom MovieRvw Museum museum-2 NatGal philosphyPhotoSynth TED, Vatican webmuseum wotartistBusiness: ABC Bus Week CBS Forbes Fox Google/Finance MarketWatch data Money MSN NYT options USA WashPost WSJ YahooFinanceEconomics: BEA BigCharts chart chart chart econo EconMagic E21, FedStats FedResrve FedData Library SEC Education: AcademicEarth Alison Coursera edX Kahn MIT Classes OpenCourse OpenStax Udacity Udemy WebcastBerkely Yale Government: archives constitution FedLaw FirstGov GPO LegalInfo LibCongress Images History: countries hyperhistory list Nobel world world_maps world maps, maps, maps, Literature: Bartleby Books on Line Books CliffsNotes Free Lib FreeBookNotes Gradesaver, Grammar Guten LitClassics Lit_Ency NYBookRvw ReadPrint VisuwordsPoetry #1 #3 #4 #5 #6 #7 #8 #9 SparkNotes writers Magazines: AmerConserv. Atlantic Claremont Commentary Foreign Harpers Nation Life NatInterest Nat Rvw New Repub Newsweek New Yorker Reason Skeptic Slate Spectator Standard The Week Time US News&World Vanity Fair Wired Misc: comics comics daily motion Edge Epicurious Fora.TV funny hulu Kayak MovieClips supdelux toplinks world time VimeoMusic:Accuradio, AOL Radio, Baroque, classical composers, Grooveshark, Jango, last.fm, MusicCovery, Pandora, Slacker, SongzaNews: ABC BBC Boing Boston Globe CBS Chic Trib CNN CSM DailyBeast Fox GoogleNews Int Harold IWatch LATimes MSNBC News News newspapers NewsMax NYTimes NPR Onion PBS PBS-NewsPew Politico ProPublica StPetTimes TampaTrib USA WashPost Wired YahooNews Quote: Bartlett quote_list Brainy quotes QuoteLand QuotePage Reference: About CIA Citizen. countries dictionary dict.com encyopedia Wikipedia. info InternetArchive IntPubLib ITools LybIndex Lycos map map map mind NatMap presidents refdesk reference.com Research yahoo yellow pages yellowbook wisenut WorldStatsScience: Discovery News edX Eureka HowStuffWorks MIT News NewSci Physics SciDaily ScientificAmerican ScienCentral SmithsonianSearch: Answers Ask Bing, Clusty Dogpile, Google Infospace Medica MrSapo wolfram Sports: BBref Rays schedule ESPN MLB NFL SIThink Tanks/Politics: AmerEntInst. AmProg, Brookings Cato CFR, Counterpunch CSIS, Drudge, Fair Global Heritage Huffington, Independent Intell Squared Pew Polls Rand Urban Znet
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aboutcancer.com/you_tube_videos.htm
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How will the internet and AI change medicine?
Patients and researchers will continue to produce massive quantities of health data that only super computers will be able to make sense of in a timely manner.
Who ever controls and knows how to mine big data will have the power to control health care in the future.
Patients will be more and more comfortable accessing this data from virtual assistants without the cost and delay involved with seeing a physician.
Doctors of the future will need to reinvent themselves to remain a relevant part of the future health care delivery system.
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Will doctors become obsolete?
1. They should use technology and the internet to better self educate and remain current.2. They should use apps, more sophisticated EMR/EHR (electronic medical or health records)
systems to try to run a more efficient practice with safer and better care.3. They can use web sites and other social media outlets to better communicate with their
patients (you need to score well on patient satisfaction surveys.)4. They can use ‘telemedicine or telehealth’ software to try to reach patients more effectively
and efficiently. (May be better than becoming an Uber driver!)
But…. many physicians may be replaced by increasingly sophisticated soft ware and AI programs and patients may turn to digital assistants and robotics for the majority of their care in the not too distant future!
See video here: aboutcancer.com/future_of_medicine
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How to Avoid ObsolescenceIn the past college graduates had to “find a job” now they have to “create or invent a job”, Thomas Friedman
Doctors need to move up the “intellectual food chain.” Need to move forward with the understanding that health care is now information technology and they to need to become experts in medical informatics. You should be better than your patient in accessing medical information from the internet!
At the same time they need to be retro in the sense of returning to the traditional role of physician as teacher or guide. They need to emphasize their role as a patient ombudsman and someone who can translate or interpret the increasingly complex medical options and present it to the patient and
family in a way that is both compassionate and understandable.
Virgil guiding Dante
If you have a terrible bedside manner, then fix it!
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You should at least be as capable as your patients in accessing medical information
New job description: “I’m an expert in medical information technology.”
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What do patients want from their doctor when can google the information themselves?
1. Validate the information (“Is this accurate and current?”)2. Translate the information (“Am I understanding this
correctly?”)3. Buffer them from some information (“There are some
things I won’t want to see, so don’t tell me everything!”)
www.aboutcancer.com