Telemedicine: Can In-Person Pre-treatment Communication be Expanded by Video Consultation?

Informed consent for radiological or other interventions should give a patient sufficient time to make an informed decision. Currently, patients typically have to be present, in-person, to be briefed about procedures and an extra appointment is often necessary. While in an urban setting this is mostly just a nuisance, in a rural area, similar to ours, it may not be possible at all for patients with limited access to transport. In some countries, teleconsultation via videoconference has proved beneficial in comparable situations.

The full piece can be downloaded below.  

Simplifying Physician Licensing Across State Lines Will Promote the Expansion of Affordable Healthcare Delivered via Telemedicine

Technology has changed the way we live, work and play; its widespread adoption continues growing at a rapid rate, and its improving affordability makes it possible for much of the U.S. population to be connected electronically. The physician demographic is shrinking, and by 2025, physician supply is expected to be in crisis with a shortage of as many as 90,000 doctors. At the same time, wait times to see a physician are increasing, due in large part to growing demand as baby boomers age and chronic diseases become more prevalent. Technological advances in health information technology and video-conferencing make diagnosis, treatment and management of healthcare remotely possible. 

Physician licensure is managed by each individual state medical board, and the constitution gives the state its police power to protect the health, safety and wellbeing of its population. It is both expensive and time consuming and on average it can take four to six months. Promoting widespread use of telemedicine involves better defining what it encompasses within the practice of medicine, thereby allowing for special licensing of practitioners seeking to engage across state lines.  The Veterans Administration, Medicare and Medicaid have developed telehealth programs in order to expand and afford coverage in gap areas, and the federal government is better suited to develop telemedicine licensure guidelines and standardize the process for interstate commerce. Congress has ultimate power to control commerce, as granted by the Constitution, irrespective of the size or volume of the market. As a result, physician licensure for telemedicine should be administered by the federal government, so that simplifying physician licensing across state lines will promote the expansion of affordable healthcare delivered via telemedicine.

The full commentary can be downloaded below.  

Apple Announced Three New Healthcare Studies And Now Is The Time To Ask Hard Questions

On September 10, 2019, Apple announced that it would be launching “three unprecedented medical studies” that will allow Apple Watch users to “contribute to potential medical discoveries and help create the next generation of innovative health products.”

When a much-loved company such as Apple announces an innovative new project, takes on elite university partners and medical organizations, and promises “groundbreaking” new medical research that will “help patients today and … make contributions that will benefit future generations,” it automatically sounds like a positive “disruption” in a flawed industry. The flurry of celebratory press releases from university partners make it seem like we’re finally getting a handle on health data and with the help of our greatest minds. There’s lots of money flying around right now and everyone is excited.

But right now we have the opportunity to ask a question we often throw out in a tongue-in-cheek manner: what could possibly go wrong?

The full Forbes article can be viewed at this link.  

Deprescribing: Practical Ways to Support Person-Centred, Evidence-Based Deprescribing

Deprescribing is complex and multifactorial with multiple approaches described in the literature. Internationally, there are guidelines and tools available to aid clinicians and patients to identify and safely withdraw inappropriate medications, post a shared decision-making medicines optimisation review. The increase in available treatments and use of single disease model guidelines have led to a healthcare system geared towards prescribing, with deprescribing often seen as a separate activity. Deprescribing should be seen as part of prescribing, and is a key element in ensuring patients remain on the most appropriate medications at the correct doses for them. Due to the complex nature of polypharmacy, every patient experience and relationship with medications is unique. The individual’s history must be incorporated into a patient-centred medication review, in order for medicines to remain optimal through changes in circumstance and health. Knowledge of the law and appropriate recording is important to ensure consent is adequately gained and recorded in line with processes followed when initiating a medication. In recent years, with the increase in interested clinicians globally, a number of prominent networks have grown, creating crucial links for both research and sharing of good practice.

The full article can be downloaded below.  

The 3 Causes Of Physician Burnout (And Why There’s No Simple Solution)

Burnout is a big and burgeoning problem in the United States. According to a recent Mayo Clinic report, it affects 28% of the general working population. Among physicians, however, the rate is markedly higher, ranging from 44% to 54% in most studies. 

More concerning are the consequences: Doctors who report burnout symptoms are twice as likely to commit a medical error. They’re also twice as likely as their patients to commit suicide. 

Though the physician “burnout crisis” has left many in the profession battered, bruised and pleading for help, there has been little noticeable improvement in recent years. To understand this strange division—between the urgency of the problem and the lack of effective solutions—I’ve surveyed patients and fellow physicians, scoured the latest research, news coverage and social media commentary. 

Most often, doctors look at burnout as a problem with a single etiology (cause). Instead, burnout has three distinct causes:  

1. The healthcare system 
2. Moral injury 
3. Medical culture 

The majority of physicians who believe burnout is tied to just one cause (particularly to a broken healthcare system) also believe that the solutions are beyond their control. In reality, each of these causes requires attention and action from doctors. Until that happens, the troublesome symptoms of physician burnout will only intensify. 

The full Forbes article can be viewed at this link.  

Nonlinear Systems in Healthcare Towards Intelligent Disease Prediction

Healthcare is one of the key fields that works quite strongly with advanced analytical techniques for prediction of diseases and risks. Data being the most important asset in recent times, a huge amount of health data is being collected, thanks to the recent advancements of IoT, smart healthcare, etc. But the focal objective lies in making sense of that data and to obtain knowledge, using intelligent analytics. Nonlinear systems find use specifically in this field, working closely with health data. Using advanced methods of machine learning and computational intelligence, nonlinear analysis performs a key role in analyzing the enormous amount of data, aimed at finding important patterns and predicting diseases. Especially in the field of smart healthcare, this chapter explores some aspects of nonlinear systems in predictive analytics, providing a holistic view of the field as well as some examples to illustrate such intelligent systems toward disease prediction.

The full piece can be downloaded below.  

The personalized medicine challenge: shifting to population health through real-world data

Personalized medicine (PM) is an initiative aimed at optimizing a person’s health through targeted, precise care. The field of precision health has rapidly blossomed, fed by the fertile, data-rich healthcare environment and the hype surrounding artificial intelligence (AI) and big data analytics (BDA). The ability to sequence and analyze large amounts of omics data (e.g., genomics, proteomics), enhanced by AI algorithms, has encouraged the growth of targeted therapies (Jameson and Longo 2015). Enormous databases are now fed by real-world data (RWD), automatically generated healthcare data based on records of routine medical encounters. These databases inform analyses from drug discovery to disease relapse prediction (Mc Cord et al. 2018).

The full editorial can be downloaded below.  

The Association Between Willingness of Frontline Care Providers’ to Adaptively Use of Telehealth Technology and Virtual Service Performance in Provider-to-Provider Communication: Quantitative Study

Telehealth technology can create a disruptive communication environment for frontline care providers who mediate virtual communication with specialists in electronic consultations. As providers are dealing with various technology features when communicating with specialists, their flexible attitude and behaviors to use various telehealth-related technology features can change the outcome of virtual care service.

The objective of this study is to examine frontline care providers’ technology adaptation behaviors in the electronic consultation context. From the perspective of frontline care providers, we reapply and retest a theoretical model, reflecting a mechanism through which technology users’ personal characteristics and technology adaptation behavior enhance virtual service performance, which is an important performance enabler in this online meeting context. In provider-to-provider communication, particularly, we explore the association among providers’ information technology (IT)–related personal characteristics, adaptive telehealth technology use, and virtual service performance.

An online survey was administered to collect individual providers’ personal traits, IT adaptation, and perception on virtual service performance. Partial least squares-structural equation modeling was used to estimate our predictive model of personal traits—IT adaptation, such as exploitative use (use the telehealth technology in a standard way), and exploratory use (use the telehealth technology as innovative way)—and virtual service performance.

We collected 147 responses from graduate nursing students who were training to be nurse practitioners in their master’s program, resulting in 121 valid responses from the cross-section online survey. Our theoretical model explained 60.0% of the variance in exploitative use of telehealth technology, 44% of the variance in exploratory use of telehealth technology, and 66% of the variance in virtual service performance. We found that exploitative IT use is an important driver to increase virtual service performance (β=0.762, P<.001), and personal characteristics such as habit are positively associated with both exploitative (β=0.293, P=.008) and exploratory use behaviors (β=0.414, P=.006), while computer self-efficacy is positively associated with exploitative use of telehealth technology (β=0.311, P=.047).

This study discusses the unique role of frontline care providers in a virtual care service context and highlights the importance of their telehealth adaptation behavior in provider-to-provider communication. We showed that providers perceive that telehealth technologies should function as intended, otherwise it may create frustration or avoidance of the telehealth technology. Moreover, providers’ habitual use of various technologies in daily lives also motivates them to adaptively use telehealth technology for improving virtual care service. Understanding providers’ technology habit and adaptation can inform health care policy and further provide a better view of the design of telehealth technology for online communication.

The full article can be downloaded below.  

Artificial intelligence in medicine raises legal and ethical concerns

The use of artificial intelligence in medicine is generating great excitement and hope for treatment advances.

AI generally refers to computers’ ability to mimic human intelligence and to learn. For example, by using machine learning, scientists are working to develop algorithms that will help them make decisions about cancer treatment. They hope that computers will be able to analyze radiological images and discern which cancerous tumors will respond well to chemotherapy and which will not.

But AI in medicine also raises significant legal and ethical challenges. Several of these are concerns about privacy, discrimination, psychological harm and the physician-patient relationship. In a forthcoming article, I argue that policymakers should establish a number of safeguards around AI, much as they did when genetic testing became commonplace.

The full article from The Conversation can be viewed at this link.  

Personalized Medicine: The Trend That's Sweeping Health Care

From cloud-based medical imaging platforms to artificial intelligence-powered diagnostics, health care continues to be the epicenter of digital innovations that are geared toward boosting patient care. Personalized medicine is another new wave sweeping health care with the dual objectives of achieving more meaningful patient-to-doctor relations and lowering costs. The lynchpin of this concept is leveraging all clinical, genetic and environmental information of the patient to understand and treat diseases in a more holistic manner.

The full Forbes article can be viewed at this link.