ROBOTS, TABLETS & SOCIAL MEDIA: THE IMPACT OF CONSUMER

TECHNOLOGY ON HEALTHCARE

Research PaperJune 2013

2

Contents

3

Tablets

The day you have been dreading all week is finally here. You nervously shift in your seat trying desperately not to panic. The door opens and time seems to slow down as you gaze into cold metallic eyes staring back at you. Your eyes search its face for clues but there is no movement. It opens its mouth to speak: “I’m afraid I have some bad news…”

If this scene paints a scary picture, a robot delivering news to a patient may not be as far-fetched as it sounds. Doctors have been relying on information technology to make decisions about patients for a very long time. But now a robot has been developed that could be a game changer. Watson, created by IBM, can digest information and make recommendations much more quickly, and more intelligently, than perhaps any machine before it – processing up to 60 million pages of text per second. It is so advanced, that it is quite plausible to imagine this robot making serious medical recommendations and delivering test results to patients in real-time just like the scenario given above.

However, robots aren't the only new, potentially threatening thing patients and healthcare practitioners have to deal with. Now the meteoric rise of consumer technology is taking the industry by storm. Fast tablet adoption, the explosion of new apps and an increased prevalence of social media is blurring the boundaries between people and data. This is having a marked effect on the doctor-patient relationship, increasing privacy concerns and is fundamentally changing the way we are communicating about our health.

This report examines how consumer technology is radically transforming healthcare. It looks at the numerous benefits and opportunities it offers, as well as the unease surrounding its place in healthcare. Finally, it evaluates the consequences of technology for the patient-doctor relationship.

The new iPad mini has physicians buzzing with excitement. According to a poll of doctors by Epocrates, one in three physicians planned to buy the iPad Mini even when its existence was just a rumor. And for good reason. The smaller-size means they can carry it to exam rooms and easily slide it into their lab coats. The physicians also get the best of both worlds; the familiar functionality of the first generation iPad with the added benefit of portability. Nonetheless, many healthcare IT leaders are concerned. There is an air of unease around the use of iPads and related mobile technologies in as sensitive an area as healthcare.

It is not hard to see the attraction behind tablets. They change the way information is accumulated and stored, solve bad handwriting and unlike laptops, are considered less intrusive in physician-patient interactions. Recent surveys have indicated roughly 80% of doctors use mobile devices, and between 40% and 50% are using tablets.

Redefining the Patient-Doctor Relationship

The proliferation of gadgets has given clinicians - especially young ones – new ways of diagnosing symptoms and treating patients. More importantly, it has redefined the relationship between doctor and patient. It might be thought that using an iPad creates a distance between doctor and patient. Not so, according to Lennox Hoyte, MD, director of obstetrics and gynecology. Lennox says using the iPad means he’s actually ‘seeing’ his patients, rather than talking to them over his shoulder as he tries to type information into a desktop computer. In other words, it can be argued that using a tablet device, such as the iPad actually increases patient satisfaction rather than decreasing it.

Introduction

4

Integrating iPads into Practicing Medicine

Many doctors are integrating iPads into practicing medicine. St. Mary’s Health Care System is collaborating with the University of Georgia’s College of Education on a year-long study to see how iPads can be used in medical settings on a daily basis. Initial research results show that the majority of iPad users — both physicians and students — have embraced the use of iPads, and that patients have liked being able to see their own x-rays and lab results at their bedside.

Patient education is one reason physicians prefer to use smartphones or the iPad in the exam room. The more the patient understands their disease, the more they’re going to be invested in getting better because they understand why it’s happening to them.

John Cox, CEO of Visible Health, notes that “somewhere around the order of 80% of all information communicated between a physician and a patient is lost when a patient walks out of the room.” With special software, physicians can create personalized diagrams to explain tumors and other injuries without needing to take out a sketch pad and pencil. The diagram can be printed or emailed afterward, or added to the patient’s medical record, ensuring that the patient can retain the information and its context.

It could be argued that the positives of using consumer devices like the iPad in healthcare far outweigh the negatives. Our survey of 111 US IT professionals shows that a whopping 97% believe devices like the iPad have a positive impact on medical practices. Yet there is a caveat, and an important one at that, as 58% still see these devices as a substantial security threat. So why are these devices seen as a threat?

believe devices like the iPad have a positive impact on medical practices

still see these devices as a substantial security threat 58%

97%

Source: IDG Connect

iPads in Healthcare

5

Patient Security and Confidentiality

Firstly, there is the issue of storing unencrypted patient health information on the device. What happens if the tablet gets stolen? In a report conducted by BizTechReports, Panasonic challenges the iPad’s suitability for healthcare, citing security, durability and compliance with Electronic Health Records (EHR) as top-of-mind issues for many of the 100 executives and IT professionals in the healthcare field who participated in the survey.

Then of course there is patient confidentiality. The Medical Protection Society is concerned that doctors are accessing patient information in public places with insufficient security. Visibility of screens is risky in public places where any passerby could see patient data. And what about family members sharing the personal tablet device at home? Insufficient password protection or no encryption poses major security concerns.

Finally, how is all this technology impacting, what some might argue, to be the heart of the issue? The traditional relationship between doctor and patient. No matter how much efficiency technology brings us, it cannot substitute for intuition and compassion. With the advent of all this technology, could the core human connection between doctor and patient be lost?

Loss of a Ritual

What happens if the doctor gets distracted by his screen and forgets to check one vital thing: his patient? Physician and Writer Abraham Verghese says that if we shortcut the physical exam and go straight to tests instead of talking to and examining the patient – we are not only overlooking simple diagnoses that can be diagnosed at an early treatable stage – we are losing much more than that. We are losing a ritual. The powers of the human hand to touch, comfort, treat and diagnose.

Growth of Apps

Patients’ not taking their medication is a huge problem in healthcare. According to the National Institute of Health, one in five patients fail to fill in new prescriptions, and half of those being treated for chronic conditions stop their medications after six months. These lapses are resulting in additional treatments and hospital stays that cost as much as $289 billion a year, according to NEHI, a Cambridge (Mass.) health policy group. On top of the expense, missed doses cost an estimated 125,000 U.S. lives a year.

There are lots of reasons patients don’t follow doctors’ orders: The medicine might cost too much or have unpleasant side effects, or patients might not understand why it was prescribed. Some simply forget.

But now the proliferation of mobile apps has made it convenient for doctors to check in on their patients, review vital data, and even prescribe smart phone applications. “The apps will not just help the doctors know what their patient is doing on a daily basis, but they should empower the patient to do something to improve their lives,” said Dr. Clay Marsh, the executive director for Ohio State’s Center for Personalized Health Care.

6

Complications

The growth of mobile devices may be making individuals’ lives easier - but it is causing all sorts of other complications for healthcare organizations. A major concern is about the security, privacy and manageability risks they pose. Doctors are also conflicted between their desire to use their mobile devices and managing the hospital management worries about security.

The influence of mobile devices will only grow more pervasive in coming years. Nick Adams, co-founder and COO of Providence, R.I.-based Care Thread, estimates that there will be 6 billion mHealth devices by 2016, while PriceWaterhouseCoopers projects 10.5 billion by 2017.

New Opportunities, New Dangers

The growth of these healthcare apps opens up new opportunities for medicine. Patients that suffer from chronic medical conditions like depression or diabetes often draw inward. Doctors do not see them until it is too late and the patient ends up in the emergency room. But now there are apps available that can track how often the patient sends text messages or makes calls and how often they move. If their general pattern of behavior deviates from the norm – their doctor can reach out to them.

However, the use of these apps is also marked with concern. Hundreds of new health-related apps are uploaded to the internet daily – and regulators are struggling to keep up with it all. Can healthcare providers trust the accuracy of the data provided by these apps? Many healthcare apps now provide functionalities for patients to monitor their health metrics. They can monitor anything from blood pressure to calories burned. Mobile devices and apps will make that self-monitoring easier.

This puts medical providers in a tricky position. On the one hand, the data’s accuracy and provenance are both unknown, so acting on it could be risky. On the other hand, not acting on it could be a form of negligence. Furthermore, bringing such data into the formal medical record makes it permanent -- health records may not be deleted -- so any bad data could be perpetuated.

One solution that has been suggested is to treat such data informally - like patients’ self-reported conditions and readings. If the patient decides to share the information taken from the mobile app with their doctor – it would be at the doctor’s discretion to decide whether formal tests are needed to confirm the results of the data given by the app.

“The trick will be to keep patients educated about the limitations of their self-monitoring while not discouraging it, says Justin Steinbman, vice president of marketing at GE Health: “After all, it facilitates better conversations.”

Are Patients Even Using These Health Apps?

The number of apps available to help patients live healthy lifestyles has grown considerably over the last few years. But how many patients actually use these health monitoring apps? Not as many as you might think. According to some recent stats, only 7% of patients use mobile technology to monitor their health. But according to Michael Esquivel, a health and information technology attorney, this is not that surprising.

“People are buying these things, and they are using them. But unless that data is actionable and meaningful and it actually helps improve your health in some manner … then the mere collection of data is a novelty that will wear off,” he said. “There's growing recognition among developers that the apps must do more to keep patients engaged, and the apps are starting to evolve as a result.”

7

Social Media

Social media sites such as Facebook and Twitter offer a mix of challenges and opportunities. According to the Pfizer survey of 485 doctors, one quarter of doctors said they use social media in a professional capacity every day, including searching for medical information. 61% of doctors surveyed said they turn to social media to search for medical information at least once a week, and 46% share medical information via social media on a weekly basis. What about their attitudes towards social media in general? 58% said social media is a good way to get current information, 58% stated that social media enabled them to care for patients more effectively, and 60% said it helped them deliver a higher quality of care to patients.

Social media use: Attitudes towards social media:

of doctors surveyed said they turn to social media to search for medical information at least once a week

share medical information via social media on a weekly basis

said social media is a good way to get current information

stated that social media enabled them to care for patients more effectively

said it helped them deliver a higher quality of care to patients

61%

46%

58%

60%

58%

A B C D E

C

A

B

D

E

Of course, being able to share medical information and engage with patients offers many advantages. The updates are in real-time and patients also find it easier to communicate with their doctors this way, as most use some form of social media to communicate with their circle of friends anyway.

But the problem starts when trying to protect patient privacy and maintaining appropriate boundaries between professional and social relationships. For instance, what if your patient tries to ‘friend’ you on Facebook? In an article posted by the Guardian, it was found that increasing numbers of patients are making amorous advances to doctors through Facebook, Twitter and text messages in order to strike up a relationship. Patients are increasingly using social media rather than letters or flowers to make their feelings clear, such as following a doctor on Twitter, "poking" them on Facebook or flirting with them online. In guidance issued in July on use of social media, the BMA advised doctors and medical students not to accept Facebook requests from current or ex-patients because of the “difficult ethical issues” and also to adopt “conservative privacy settings” on their Facebook pages.

Source: Pfizer

8

Online Professionalism

This isn’t the only dilemma social media presents doctors with. What about taking care of the doctor’s ‘image’? Doctors clearly have to represent a professional image to their patients at all times. But they are also only human with regular social lives like the rest of us. Is it really so wrong of them to post a few pictures of them acting silly with their friends?

But here is where it gets very tricky. For instance, is it ok to come across a picture of your doctor drinking at an office party? Maybe this could count as acceptable. After all, a doctor after a hard day’s work is allowed to have some down-time too. But wait a minute. What if your doctor is wearing scrubs in that photo. Would that make you think he’s drinking on the job? More crucially, would it make you reassess your opinion of the doctor all together?

So what pictures are appropriate and what aren’t? It might be fair to say that a good degree of common sense should be involved; however a lot of people want specifics. A survey published recently, makes it clear that some things posted online will almost always get doctors in trouble. More than 80% of the boards that responded said a doctor posting a clearly misleading claim on his website - something like ‘I can cure your cancer – guaranteed!’ – would be cause for an investigation. Perhaps it is fair to say that doctors will not be judged for what they do in their personal life so long as they are careful about what they decide to share on a social media site. Perhaps in seeing an inappropriate photo it is not the doctor’s capability that will be called into question but the doctor’s common sense for creating the post to begin with.

Recommendations from The American College of Physicians and the Federation of State Medical Boards on the usage of social media in healthcare, April 2013:

• Physicians should keep their professional and personal personas separate. Physicians should not “friend” or contact patients through personal social media

• Physicians should not use text messaging for medical interactions even with an established patient except with extreme caution and consent by the patient

• Email or other electronic communications should only be used by physicians within an established patient-physician relationship and with patient consent

• Situations in which a physician is approached through electronic means for clinical advice in the absence of a patient-physician relationship should be handled with judgment and usually should be addressed with encouragement that the individual schedule an office visit or, in the case of an urgent matter, go to the nearest emergency department

• Establishing a professional profile so that it “appears” first during a search, instead of a physician ranking site, can provide some measure of control that the information read by patients prior to the initial encounter or thereafter is accurate

• Many trainees may inadvertently harm their future careers by not responsibly posting material or actively policing their online content. Educational programs stressing a proactive approach to digital image (online reputation) are good forums to introduce these potential repercussions

Patient Privacy

Doctors and other healthcare professionals not only have to worry about ‘protecting their own image’ but also ensuring that their posts online are not traceable back to the patient. This is the very issue that one doctor faced when she complained about a patient on her Facebook page. The post talked about a patient that continually showed up late to her scheduled appointments. A screenshot was taken of the doctor’s status and many commentators were outraged with the doctor’s post – despite the fact that the hospital later determined that no patient privacy laws were broken. Although no privacy laws were actually broken – it was maintained that an ethical professional line had been breached.

9

Physician-only Social Networks the Answer?

With the plethora of problems that comes with using social media to engage with patients, perhaps doctors are better off avoiding social media all together? The waters are too murky; what one person thinks is appropriate might be completely inappropriate to another. But there could be a middle-ground. In recent times, there has been a proliferation of physician-only networks which provide a secure platform for physicians to share and engage with physicians. Doximity, an online social network for physicians has been dubbed as ‘a secure Facebook for doctors’. The site gives a chance for physicians to collaborate, share lab reports and ‘securely communicate about things that matter’. The goal is helping doctors provide better health care.

There is no doubt that the use of social networks in healthcare offers many advantages. But as with most things, a degree of caution is required, particularly when dealing with sensitive data. Maybe Dr. Alex Blau has the right idea when he says, “The general wisdom is don't say anything you wouldn't say in a crowded elevator.”

Robots - The Future of Healthcare?Robot Watson may have appeared on the popular game show Jeopardy, famously beating two human contestants. But this robot created by IBM has a purpose much bigger than that. The goal is for Watson to help train physicians – so that one day it can be deployed to hospitals to help doctors with diagnoses. Sounds like great potential seeing as about one-third of doctor errors appear to be products of misdiagnosis. As humans we are prone to ‘anchoring bias’ – but Watson is here to change all that. According to reports, it can digest information and make recommendations more quickly, and more intelligently than any machine before it.

About 80% of all information is “unstructured.” In medicine, this consists of physician’s notes, research published in peer-reviewed medical and science journals, and even comment threads from online communities. Watson can make sense of all this information – and learn over time. The more Watson spends time sitting in on patient examinations, the better it will become at figuring out medical problems and helping with diagnoses. If all goes according to IBM’s plan, Watson could be a game-changer – a technological breakthrough for healthcare that has long seen the deadly effects of mistakes made by doctors in patient diagnoses.

But the question remains the same – does a robot have a place in healthcare? Yes it can help with patient diagnoses and faster decision-making. It can fill in for the gaps where we as humans fall short. But as most doctors will tell you, healthcare is more than just making cold, calculated diagnoses based on algorithms. Healthcare professionals don’t just simply treat the patient. They build up trust and rapport with the patient. It might not be appropriate for a robot to deal with a cancer patient.

There is no doubt that Watson could prove to be a clever companion for doctors – and if it will improve the quality of patient diagnoses – than that can only be a good thing. But it still raises some uncomfortable questions. For instance, how will Watson compete with a doctor that has 20/30 years of medical experience? Will the doctor have to bow down simply because Watson has greater analytical skills? It is entirely possible, that eventually Watson will be able to override and challenge the very thoughts and practices of physicians who helped shape Watson in the first place.

10

ConclusionFrom the use of social media to the use of apps to make health diagnoses; there is no doubt that consumer technology is cementing its position within healthcare. Doctors can now communicate with their patients through social media, collaborate with each other, and find new ways of diagnosing patients. Through the development of robot Watson, it might even be possible for doctors to consult robots on medical treatments.

Overall, the aim of these technological advancements is to improve the quality of patient care – but has this been achieved with what we have seen so far? Technology offers significant opportunities to improve medical processes but it is no substitute for human compassion. Furthermore, the impact of these gadgets 20 years down the track is difficult to ascertain. Gadgets aside, the healthcare profession is driven by real people with real health problems… and that is something no robot can understand.

About IDG Connect

IDG Connect, a division of International Data Group (IDG), the world’s largest technology media company, produces, publishes and distributes local IT and business information on behalf of a truly global client base. Established in 2005, we have a fully nurtured audience of 2.6 million professional decision-makers from 130 countries, and an extended reach of 38 million names. This lets us conduct research, create independent analysis and opinion articles, and drive long-term engagement between professionals and B2B marketers worldwide. For more information visit www.idgconnect.com