Simple Internet Tools For Improving Healthcare

When we think about using IT for improving healthcare, we think about big, expensive projects like electronic medical records and physician order entry systems. But, in fact, e-healthcare doesn't have to be a massive undertaking. I had fascinating conversation with Dr. Danny Sands of Cisco Systems, who talked about some of the ways that doctors and other healthcare providers can stay in touch with patients.Most of his ideas took advantage of simple Internet tools like e-mail, Facebook, Twitter, and patient peer-support communities--nothing fancy.

Sands is both a practicing physician and director at Cisco's Internet business solutions group, a Cisco business unit not involved in any particular product or directly tied into sales, but which works with top customers to solve business problems using novel application of technology.

"There are a lot of opportunities for social networking. In healthcare, we're underutilizing information technology," Sands said. "Even in hospitals, we're underinvesting in information technology compared with most industries that are information intensive. Information technology provides benefits to patients and workflow, but it's been under-utilized. The reason is not so much aversion to technology, but it's not clear what the value proposition is to physicians. It benefits patients and the people paying the bills more than physicians."

Doctors have even been slow to adopt e-mail, a basic tool that's pervasive elsewhere. "In January 1998, I co-authored the first guidelines on e-mail for patient care," Sands said. He encouraged use of Web portals that encrypted messages between doctors and patients, to enhance security. Despite Sand's effort, e-mail hasn't taken off among doctors, who fear (falsely) that they'll be inundated with e-mail from patients. Doctors also don't know how to bill for time spent on e-mail.

Doctors are also resistant to adopting tools like Facebook and Twitter, and some of the reasons are valid. "There is a fear of what it will do to my practice, and how to separate the personal from the professional," Sands said. "Let's suppose I have a Facebook page. Let's suppose you're a patient of mine and you come across my Facebook page and you want to friend me. That may be uncomfortable for me. I may not want to friend you, this is a part of me I may want to hide from you," Sands said. "I don't think we need patients seeing a picture of us with a lampshade on our head."

This is actually an extension of an old, old discussion in healthcare: How much of doctors' personal lives should they bring with them into the practice? "If you go to a doctor and say, 'My knee is bothering me,' the doctor could say, 'I have the same problem.' If you say, 'I'm having problems with my wife,' the doctor could say, 'I've had the same problems with my wife,'" Sands said. Does that humanize the doctor and make it easier to make a connection with, and therefore help, the patient? Or does the personal connection undercut the authority necessary to help the patient?

"Physicians have this mystique that they want to maintain, that they are omniscient, that they know everything about medicine that there is to know, that they don't make mistakes. I don't think that's a bad thing. It is situational. For some patients, it's important to maintain that barrier," Sands said.

Doctors have not rejected social networking entirely, though. Doctors communicate with each other on a site called Sermo. "It's a safe environment where they're not connecting with patients," Sand said.

Authentication is a reason that social networks like Twitter and Facebook have not taken off with doctors. Just as people now impersonate celebrities online, they might also impersonate doctors to get personal information from people, or for other nefarious reasons.

Patient management has rich potential to benefit from online collaboration tools and social networking, Sands said. For example, patients often have a team of specialists working on a case. A patient with diabetes, for example, might have a primary care physician, vascular specialist, dietician, and so forth. Each patient might have an individual portal page, where the healthcare team could share information and the patient could log in to see documents, test results, video chats, and other communications, Sand said.

Doctors could use Facebook and Twitter to distribute health alerts and advice to all their patients, or set up separate accounts for patients with similar conditions. For example, a doctor could set up a single Twitter account and use it to communicate with patients with diabetes. "Maybe I could follow all my diabetic patients, and they could send me informaiton on how they're doing on their diet, how many steps they walked, whether they took their medication," Sands said.

Twitter as it exists today is probably a terrible tool for that kind of thing, but different microblogging services that give users more fine controls over who reads which messages might be quite suitable. Already, there are tools available today that push out pedometer and glucometer readings on Twitter.

Patient support communities are an area that's already growing useful on scoial media. For example, the Association of Cancer Online Resources is a community of cancer patients. "The value of patient support communities is just phenomenal," Sand said. "There are hundreds of cancer specific support communities, helping a quarter of a million cancer patients." He said he referred one patient to ACOR, and the patient said the community literally saved his life. The patient was diagnosed with metastatic kidney cancer. The patient was able to determine, using ACOR, that estimates he'd found elsewhere on the Internet for life expectancy were drastically low, and it told him what to expect from treatments and how to get ready for them.

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