Category: mhealth

IOS, Android and the battle for my #mhealth soul

The preamble story to this discussion is as follows.

My 3 year old son is quite adept at using my Iphone. He was more interested in my phone than the Macy’s Thanksgiving day parade. He was so engrossed in it, I had to physically carry him to the bathroom to take care of business. In that process, he accidently dropped it in the toilet. My phone was toast. I shrieked and cried (on the inside) while I had a  massive digital heart attack.

Now it’s decision time.

My initial instincts were to stick with what I knew and the Apple ecosystem that was flourishing in my home for the past 7 years. My wife has one. My kids use a 2nd generation IPAD  for their activities. I also use a 3rd generation IPAD mini for work and day to day activities. We even have our old Iphone 4’s in our kid’s bedrooms that play music and function as a sound machine for their sleep. We also have Apple TV’s for entertainment purposes. My wife and I also share a Mac desktop. This ecosystem has been working well, but admittedly has given me Apple tunnel vision and a general fear of  trying Android devices.

In addition, my interest in the concept of #mhealth has been growing recently. Specifically I’m appreciating  how remarkable smartphones are and their potential to  be a game changing element in healthcare.

In medical education, mobile devices like a smartphone gives trainees and veteran clinician’s access to real time evidence based information. Social media is a ubiquitous platform for networking, advocacy and expanding medical knowledge. There is a growing capability of technology to collect numerous forms of patient data with the smartphone being the fulcrum that processes that information and connects patients to their clinicians. #Mhealth is and can be so many different things. We are just scratching the surface of its immense potential.

With that in mind,  I’ve started a #mhealth interest group within the Society of General Internal Medicine. We will be meeting for the first time this spring and I look forward to collaborating with people want to explore this area further.

SGIM 2016 Annual Meeting

But it took my precocious son’s butter fingers to make me realize I’m only experiencing  half of the #mhealth world by avoiding Android devices. So with much trepidation but in an effort to be a more complete digital physician, I’m going to jump ship from Apple temporarily. I hope by the time the SGIM meeting rolls around, I’ll have a better perspective on the smartphone #mhealth world.

I’m already noticing a difference. I have so many different phones to chose from…

And what’s KitKat, Jellybean and Lollipop???




Teaching Medicine and Macros

I have the great privilege of being a medical educator. Everyday, I have an incredible time working with  internal medicine residents at their continuity clinic, teaching the art of ambulatory medicine. Our working environment here is academically rich and fulfilling. The name of the legendary Dr. Martin Leibowitz (an iconic figure in ambulatory medicine here) stands outside our conference room as a constant reminder of how medicine is practiced and taught. There is a large oval table at the center of the conference room, constantly surrounded by venerable attendings, interspersed with curious residents, discussing all the difficult cases of the day. There is the constant buzz of organized chaos like a stock exchange that is addictive and keeps things fun and enjoyable.
Although this positive vibe has never changed, the working environment has transformed since I first joined in 2009. The conference table used to be littered with text books like Harrison’s, Netter and a variety of dermatology books. In between the people and books sat  heavy, tattered orange colored paper charts. Some were just a few pages, some hundreds, all documenting a litany of complaints, physical exam findings, test results, insurance documentation, medication lists and well thought out plans by generations past of neophyte doctors. Blue, black, red, green ink on yellow oxidized pages, all fascinating yet often illegible. My intrigue with these historical documents quickly faded, and the burden of having to flip through hundreds of abstruse pages became quite frustrating. The sight of these bright orange charts piled on my desk at the end of the day, became a nauseating reminder of the inefficiencies and dangers of paper documentation. Our electronic medical record (EMR), slated to be released 6 months after my start date, could not come soon enough.
When our EMR era began, it was a cataclysmic event. The process of seeing a patient with the computerized elephant in the room was a culture shock for many attendings and residents. But we integrated slowly, utilizing a light schedule, and a lot of one to one attention for our residents. In 2 years we overcame a lot of the initial technical problems and are on our way to making this a very successful transition. The hardest part of this change for me, had nothing to do with my personal battles with the EMR. Rather, the presence of the EMR created an entire new domain of education I had to provide for my trainees. In addition to medicine, I found myself teaching how to create macros or imbed digital pictures into the electronic record. I’m teaching how to incorporate a myriad of digital tools to better care our aging complex population. It’s become clear that my role as an educator now goes beyond teaching classical medicine. It also involves teaching how medicine will be practiced in the future utilizing technology such as social media and an EMR. As an advocate for the advancement of technology in medical practice, I feel fortunate to have an audience of bright trainees to share my enthusiasm about the future of medicine.
But this technological leap in our practice has had a price. Although the placard of Dr. Leibowitz remains steadfast, the working environment has drastically changed. The conference table often sits empty, replaced by several desktops sitting at the periphery of the room. All the textbooks stand neatly stacked in a corner, collecting dust, as Google images replaces dermatology books, and online resources replaces most texts. The sound of vibrant debate and chart perusal has been replaced by the clicking and clacking of keyboards.
Whereas in the past, 50 % of my encounter time would be spent discussing each case, and the other 50% seeing the patient, my attention is split in three ways now. 33 % each , for patient, trainee and EMR. Now I have less time to get to know and personally connect with each patient. Now there is less time to discuss medicine with my trainees. For new doctors, I wonder if its more important to spend a few extra minutes to discuss how to manage a COPD exacerbation in the outpatient setting, than it is to teach how to multi-click and renew 14 medicines using “E-scribe”. With this whole new domain to teach, given the same time constraints, I’ve had to bring home work quite often, which  is begrudgingly easier now with an electronic record.
Despite these difficulties, I continue to love my role as a medical educator. The day to day issues are minuscule compared to the greater problems in medicine and society. I continue to stay motivated by the idea that my tutelage in medicine and how it interfaces with modern technology will prepare them for a future that will need doctors that are comfortable and successful in the both the real and digital realms.