Health care disruptor Jay Parkinson, MD, just posted a nice demo of the Myca platform for patients and providers, that wowed so many at the Health2.0 conference in March.

The things I liked are the fact that they are demo-ing the platform in the first place - some vendors are reticent to show their user interface publicly. I liked that Jay starts out with the patient experience and flows to the provider experience, not the other way around. I like that the provider experience piece is equally capable of storing a video or IM interaction as much as the in person physician documentation.

The provider user interface looks very slick. I can’t say either way how I might practice with it. I would ask how the practice is able to keep prevention issues a part of every interaction (Jay started the demo by looking at the problem list). I would also be more interested in how flexible the product is over time to support a patient centered practice, as opposed to whether it is there today.

I was really impressed with what I see as the entre of basic tagging - providers being able to tag treatments for each patient. I’m not sure whether they can tag significant test results, too, but this would be very handy (e.g. which chest x-rays are the ones to remember moving forward).

All in all, more innovation is better, and let’s see what the patients think of the care, and let them guide us on what works best - it looks like HelloHealth is set up to do that, which is the most important thing in my mind.

See what you think of the demo yourself.

The Myca Platform

Andrew Soucy, from The Visible Body (note: incorrect URL fixed, 3/17/08), contacted me after the Health 2.0 Conference and asked if I wouldn’t mind looking at this anatomic visualization application. He said

stumbled across your blog this morning, and wanted to see if this might interest you, esp. given your coverage of Health 2.0.

After being at Health 2.0, I admit I have become more interested in new ideas and products, even if I am not endorsing any specific one (I am not). One thing that I really liked that is reflective of the Web2.0 world today is that the company posted a short video on YouTube, which I am pasting in here:

It’s a different way to experience something as opposed to going to the company’s web site - it’s kind of open source, publicly available, and other people can say what they thing of the product right there. I haven’t gotten a chance to use this yet because I am on a Mac running Windows Vista 64 Bit, but I am interested in the idea, and especially the idea that I wouldn’t have to reach for the anatomic atlas as I guide patients through a consultation about what’s going on their bodies.

Way back when, when I did a clerkship at the National Library of Medicine, I was exposed to the Visible Human Project, which you can read about on the National Library of Medicine’s Web Site. At the time, the images from that project comprised 18 Gigabytes of data (I remember this number, because it was so gargantuan). It’s interesting to see that we have come such a long way in being able to visualize our bodies like this.

I came across Susannah Fox’s recent blog entry: (e-patients: Flashback to 2001) where she uploaded a PDF of the American Medical Association’s Press Release of Resolutions for 2001 (you can link to it directly here), which included a resolution to “trust your doctor, not a chat room.”

She said she posted it by the popular demand (of one), but I also was glad she posted it (so increase the count to two, Susannah!), and followed the link to another blog post that was critical of her presentation at the Health 2.0 conference. In that post, the author said, “is Fox actually disagreeing with those who think it wiser to seek advice from physicians than to take seriously medical advice received from anonymous strangers in internet chat rooms?” and I wanted to comment on this as someone sitting in the audience (and who got to catch up with Susannah shortly before she went on stage - ok, so I am disclosing that I am a fan).

I think what Susannah was responding to, and somewhat verified in David Rothman’s post is the binary-ness of the argument, that it’s either your doctor or the Internet, not both. The first question I ask when I wonder about behavior is (in true LEAN tradition) “why?” Why would a patient access information outside of their physician relationship? We can guess at many reasons, including that they don’t have access to a doctor, or the doctor they do have access to has not given them the information they are looking for. At some level, there is a trust issue involved, and if we use the Edelman Trust Barometer as one piece of data, it is that patients are more likely to trust “someone like me” than their doctor. It’s impressive that we’ve come to this.

Rothman goes on to discuss the virtues of Medline Plus as a place to get authoritative information and “I do not believe that online resources collaboratively created by patients will solve the problems and dangers of healthcare misinformation online.” Again, I think it is the “it is or it isn’t” aspect that we have to be careful of. To Rothman’s comment, I would say, “Is that true 100% of the time?” And I thought about this a bit more as I pulled out a study I have been waiting to read for some time:

Williamson IG, Rumsby K, Benge S, Moore M, Smith PW, Cross M, et al. Antibiotics and Topical Nasal Steroid for Treatment of Acute Maxillary Sinusitis: A Randomized Controlled Trial [Internet]. JAMA. 2007 Dec 5;298(21):2487-2496.[cited 2008 Mar 13 ]

The study is, I would say, on the incredible side. It challenges one of the most commonly held notions in primary care, that sinus symptoms should result in antibiotic treatment, and shows that prescribing amoxicillin for the most commonly used criteria to diagnose sinusitis was no better than a placebo (sugar pill). I imagine the signficance of this, considering that the average physician may see at least one case of these symptoms each week and the antibiotic cost yearly is $2.4 billion in the U.S. Not to mention that these antibiotics are now in our water supply.

So I next went to Medline Plus, to the Sinusitis topic, to look for the information that says that antibiotics have no effect on the condition in most cases, and that diagnosis itself is questionable.

Sinusitis [Internet]. [cited 2008 Mar 13 ]

No such mention. Is this surprising considering that the average piece of research takes 17 years to find its way into medical practice? I won’t go into why that is here; however, the point is that even the most infallible official resources can be fallible. All that this means is that we should always as “why?” and support our patients asking “why?” also. Of interest, I found out about this peer-reviewed study in the blogosphere, not on PubMed or Medline. We should leave the door open to the idea that patients may just help us reflect on better ways to treat them that are less costly and less harmful to themselves and the environment. It’s a continuous spectrum, not a binary switch.

What about American Medical Association 2001?

I also wanted to comment on Susannah’s use of the press release, which is very important and useful. We have to know where we came from so we can move ahead together. The same year that the press release came out, the American Medical Association also published another piece, “Geraghty K. Historical Postmortem, March 2001 (The Telephone). Jama 2001. (link fixed 03/13/08)” In that piece, my profession’s history with the telephone was discussed - it took 80 years for the telephone to become accepted in modern medicine. But it’s accepted now. And one day, the Internet will be, too. We’re really only 8 years into Internet-enabled health care (using my own organization as the example).

What Susannah presented was what it was: American Medical Association 2001. That’s not the same as American Medical Association 2008. Organizations grow and change. I’m confident that the medical profession will grow and change and use the best tools out there to help our patients. We came from barbers, after all. And I’ve never met a physician that wanted to provide bad health care to their patients.

Scribemedia and the organizers of the Health 2.0 Conference have put the videos that they showed from the conference online. They’re terrific.

My favorites : A patient with reflex sympathetic dystrophy:, A patient with multiple sclerosis who can dance every night in Second Life

I think they’re moving from a patient, provider, and health system leader perspective. I especially enjoyed the one about chronic pain. We are taught in residency to support patients with pain by encouraging them to document their symptoms over time. Then we don’t give them tools to do it. Then we wonder why they didn’t document their symptoms. Then we ask them to document their symptoms. In the video I got the sense that bearing witness to one’s own symptoms is therapeutic in and of itself. Would I want this information brought into a consultation with a patient? Is it more important than asking if prescribed drugs were effective? Absolutely. See what you think.

Video will help the patient and consumer voice be heard in ways not thought possible before. Better health care will result.

Quite possibly.

I didn’t catch the iPhone SDK launch right on March 6, but I did watch it a few days later, and it’s very impressive. It is worth a watch, especially with regard to the possibilities in verticals such as health care. I have met many physicians in the past 6 months who have told me, “I will get an iPhone when…” I think the “when” has been answered. Possibilities such as secure physician-patient communication and patient activity monitoring with direct connect to electronic health records are now possible.

It was interesting to see this right after the Health2.0 Conference, to be sure.

Not to mention that the iPhone is now enterprise-worthy….

Apple Developer Connection - iPhone Dev Center - iPhone Developer Program

Health 2.0 is now over, and it was a great experience. I am not the only person in the room that remarked that they felt less innovative than ever in this room of innovators. The patient experience was front and center. I / we need to see that, often.

The post-lunch surprise was a demo of Microsoft’s HealthVault, accompanied by a post-demo comparison of the HealthVault and Google Health product by Missy Krasner. Overall a great discussion. I’m happy that more, rather than less, is happening here.

From my perspective I thought a big splash was made by the new EHR platform that Jay Parkinson, MD, demonstrated, manufactured by Myca. It has a compelling patient portal aspect as well. Interesting to see what happens when people start from scratch and build things the way they want to use them.

Susannah Fox started something this morning by announcing her “7 words” around Health 2.0. It’s the meme of the conference.

Here are Holly Potter’s (National Director of Communications for Kaiser Permanente HealthConnect):

Build Continuity, Eliminate Fragmentation, Create Total Health

I need formulate mine. Feel free to post yours in the comments below.

A few more interesting ideas in Health 2.0: Jay Parkinson, MD, in a video about his practice, invoked the work of Toyota Motor Company (smiley face) as a company that works to remove errors from processes.

The On Call Medical Group, like Jay, go to where the patients are - home or work, their true Gemba. I liked the comment about the fact that going patients’ homes allows physicians to assess patients’ capabilities and work with them collaboratively.

The patient filmed was judged not to have a high likelihood of strep infection, yet a culture was still drawn and antibiotics prescribed.

Panel moderated by David Kibbe, MD, from the American Academy of Family Physicians. Overall, it is great to see physicians interested in the art of medicine and able to equip themselves to do something different.

I figure that of all places in the world where it should be okay to blog live, the Health 2.0 Conference is it. So I’m going to try blogging as I go.

I’m in the morning session and I just saw Susannah Fox, from the Pew Internet and American Life Project, talk about the healthcare internet user.

She pointed out that there are few documented cases of harm that have come from consumers accessing the internet (and by the way, we had a conversation at this table about whether we should talk about people as “patients” or “consumers”).

Susannah closed with 7 words of advice:

Recruit doctors, let e-patients lead, go mobile

We were just introduced to a few interesting web services during a very moving video about patients’ experience with significant conditions.

http://www.i2y.org/
http://www.reliefinsite.com/

There was also an impressive story about the use of SecondLife for a patient living with Multiple Sclerosis. She is able to go dancing every night in this community.

(Who is Melissa Peterman?)

http://www.trusera.com - launching today

David Sobel, MD - “Doctors will be flooded” with this material (potentially). “These sites can help people learn that they are more than about their disease.”