Medicine 2.0

Background

A majority of Americans use the Internet to search for health-related information. Many online physician review sites provide patients with information about physicians and allow patients to rate physicians. The goals of this study were to 1) determine the most frequently visited physician-review websites that have user-generated content; 2) evaluate the available information on these websites and the methods used by each site to rate physicians; 3) analyze online ratings of 4999 physician reviews.

Methods

On 10/1/2010 the ten most frequently visited online physician-review sites with user-generated content were identified using Google Trends. Each site was then studied to evaluate the available information (e.g., board certification, years in practice), the types of rating scales (e.g., 1-5, 1-4, 1-100), and dimensions of care (e.g., recommend to a friend, waiting room time) that patients were asked to rate physicians. Data from 4999 physician-reviews without identifiers were analyzed to assess how physicians are rated online.

Results

The 10 most commonly visited websites with user-generated content were: HealthGrades.com, Vitals.com, Yelp.com, YP.com, RevolutionHealth.com, RateMD.com, Angieslist.com, Checkbook.org, Kudzu.com, and ZocDoc.com. A total of 49 different dimensions of care were rated by patients, with a median=4.5 (mean 4.9, SD 2.8, range 1 – 9) questions per site. Depending on the scale used for each physician-review website the average ratings equaled 77 (standard deviation/median/range = 11/76/33-100) for sites using a 100-point scale, 3.84 (0.98/3.8/1-5) for sites using a 5-point scale, and 3.1 (0.72/3/1-4) for sites using a 4-point scale. 62% of the reviews on the 100-point scale were above 75, 58% were rated 4 or 5 on sites with a 5-point scale, and 74% were rated 3 or 4 on sites with a 4-point scale. The patient’s single overall final rating of the physician correlated well with the other more specific dimensions of care rated by patients for the same physician. (Pearson Correlation 0.73, P< 0.001)

Conclusions

Most patients give physicians a favorable rating on online physician review sites. A single overall rating to evaluate physicians may be sufficient to assess a patient’s general opinion of the physician. The optimal content and rating methodology that is useful to patients when visiting online physician-review sites deserves further study.

Research indicates that screening instruments are very often difficult to understand for low SES (Socioeconomic Status), children and immigrant groups. Most screening instruments for common mental disorders feature long sentences and difficult wording. Screening instruments for children are usually answered by their parents, people with low SES or illiterates need to be assisted to answer the questions. Assistance with screening questionnaires may affect and alter the quality of the answer, and, moreover, makes the individual dependent. We have developed an easy-to-understand, web-based (audio-)visual screening instrument, called the Visual Screener for Common Mental Disorders (VS-CMD). It screens for symptoms of depression, anxiety, problem drinking and suicidal tendency and is designed for adults with various education and reading levels. The wording of the questions has been simplified, every question has been supported by an equivalent in voice (read me function), in 5 languages and spoken by a man and a woman. The answers are presented with graphic (cartoon) representation or animation. The VS-CMD is currently being validated. This study will cross-validate the VS-CMD with a battery of self-report measures in the general population. If the results of the present study are favorable, the VS-CMD can be utilized in web-based mental health portals, as screening before a web-based intervention, as an application on a tablet or Smartphone, as a research instrument or as a standalone program on a computer at hospitals or care centers. In this interactive presentation the practical opportunities of the VS-CMD are presented and discussed.

Background

The NYC Green Cart program attempts to infuse low-income neighborhoods with jobs and fresh produce by offering permits for the mobile sale of fruits and vegetables. Because vendors can choose—and change—their vending locations, the Green Cart program poses problems for both program promotion and evaluation. Similar problems have been addressed in the developing world through short message service (sms) text messaging. Our objective is to promote Green Cart vendors and evaluate their geographic distribution and customer volume using text messaging technology.

Methods

An academic physician was partnered with a community-based organization to develop a web-based map (“Locarto”). Vendors can update and consumers and community organizations can determine Green Cart locations on the map via sms text messaging. Locarto outreach workers solicited vendor participation in 2010. Public promotion of the map is beginning in 2011.

Results

This demonstration will discuss the Green Cart program and how Locarto addresses unmet needs through novel use of text message-based mapping. The technology platform, development, and implementation challenges will be discussed. Conclusions

Locarto attempts to provide a web-based text message interface accessible to low-income and low-literacy communities in order to promote economic development and healthy food availability.

In the U.S., it is estimated that at least 500,000 patients a year suffer from cardiac arrest requiring resuscitation. Patient outcomes depend greatly on the quality of the resuscitation effort and well-executed resuscitation requires a coordinated team effort led by an effective team leader. Advanced Cardiovascular Life Support (ACLS) is a set of skills used by healthcare professionals to help patients experiencing life-threatening events. With over 4 million physicians, nurses, paramedics and other healthcare professionals in the rapidly growing U.S. healthcare industry, there is need for effective and efficient ACLS training. Current training methods do not provide the necessary practice to become competent or comfortable with these skills. In addition, there are no effective yet scalable methods to maintain and track competency between the standard biannual ACLS training classes. Annually in the U.S., an estimated $100M is spent on training classes while another $260M is incurred in lost revenues and additional work coverage costs. Current Conditions and Competition Traditional training methods cram large amounts of complex material in 1-2 days without follow up. Studies have shown that they fail to adequately teach and maintain ACLS skills, with retention limited to 3-6 months, far short of the 2-year “recertification” cycle in use today. They also fail to establish consistency among various training centers, teach team dynamics, or track ongoing ACLS competency. Physical simulation labs improve performance and retention and are therefore gaining in popularity. However they suffer from critical issues including extremely high cost, geographic and time limitation of resources, and varying simulation quality. Similarly, the few currently available computer-based ACLS simulators are deficient in many aspects including low levels of realism, lack of team management training, and low “replay value” (due to limited numbers of scripted scenarios). The Solution SimCode ACLS™ is a web-based training system which uses Rich Internet Application technology and the “Software-as-a-Service” model to provide a highly-scalable and cost-effective training solution which addresses the issues that plague other training modalities. This system can also achieve the following critical goals: 1) to provide consistent, real-time, high-fidelity ACLS simulation training anywhere and anytime; 2) to foster development of team management skills; 3) to facilitate centralized storage of simulation performance data; 4) to enable users and supervisors to easily review performance history and track simulation competency; and 5) to facilitate rapid distribution of updates to ACLS protocols and system improvements to ACLS providers. Current Stage of Development The SimCode ACLS™ simulator component has been commercialized and used by individuals around the world, as well as several US institutions. Over the past year, our company has been invited to present it at several conferences including the 11th International Meeting on Simulation in HealthCare, the international 2010 American Society of Anesthesiologists Annual Meeting, and national 33rd Annual Meeting of the Society of General Internal Medicine. The system is under constant evolution based on the advances in resuscitation and digital education research as well as internal and external feedback. In addition, we are currently developing a novel learning component targeted for novices.

The Health InnoVation Exchange (HIVE – www.hive.org.nz) is a social networking platform designed to support and foster innovation in the New Zealand healthcare sector. The HIVE is funded by New Zealand Ministry of Health (MoH) and is operated by the team at the National Institute for Health Innovation (NIHI) at the University of Auckland. Based on the Drupal Open Source platform, the HIVE brings together clinicians, health IT professionals, government officials, academic researchers and the health technology industry. The key to bringing together the disparate user groups targeted by the HIVE is a careful effort to cater to each group and offer a neutral ground for discussion: The homepage blog, created by the community and curated by Dr Chris Paton, targets the Health Innovation industry and technical workforce – such as IT managers for hospitals and CEOs of Health IT companies. Clinicians are drawn in by the HIVE e-Learning platform, used for Post-Graduate clinical courses at the University of Auckland. During their studies, clinicians can use the HIVE to communicate with other students and teachers, and hold discussions in private forums specifically set up for their courses. Senior government officials are brought into the discussions through a series of coordinated consultation efforts. For example, the Chair of the NZ Health IT Board at the NZ Ministry of Health used the HIVE to facilitate discussion about a new “Health IT Plan” for the country. In another example, the Ministry of Research, Science and Technology (MoRST) used the site to promote a range of videos it produced to support a new multi-million dollar grant scheme to foster innovation in the NZ health sector. As these communities begin to discuss and form networks, they can use the HIVE to track their new connections by “friending” and posting private messages to each other. Fostering innovation in the health sector requires a careful building of trust across a range of different and difficult to access groups. The HIVE appears to be successfully achieving its objective of using a social media platform to build trust and to allow new innovation to flourish.

One of the most fundamental rights is the right to be fully engaged in one's well-being, especially in moments of crisis when a life is at stake. My experience with moving my data from my hospital's PHR to Google Health gives us all good reason to be deeply concerned about how well the healthcare industry manages data quality. (And I mean YOUR data not "patients'" in the abstract. This is personal.)

I want to be able to audit my medical records, annotate them, export them easily for sharing with other providers, and any other innovation we can dream up that will help fulfill the promise of Participatory Medicine, in which doctors and patients engage in a thriving collaboration, each supporting the other.

This talk will cover real-world examples of how inability to do this has cause harm and how ability to do it has improved outcomes.

I'm serious about this. "Patient" is not a third-person word. We're talking about policy issues that will affect you, your parents, your spouse, you children. Let's work together. Patients can help.