UpToDate and beyond

The internet and patient care

“Behind the headlines from NHS Choices” http://

www.nhs.uk/news/Pages/NewsArticles.aspx

Some tools• Webinars• Online conferencing• Podcasts• YouTube: patient information and CPD • SlideShare• MOOCs (Massive Open Online Courses)

Virtual MDTs – will they work?

www.mooc-list.com

https://www.edx.org/

Social media ban - exceptions needed

Clinical uses/opportunities

• Patient/clinician education and information• Remote monitoring of chronic conditions• Patient and family/care-giver support• Post-discharge psychosocial support• The Electronic Health Record• Online collaboration• Guides to everything

From:BMC Res Notes. 2012; 5: 548. Published online 2012 October 3. doi: 10.1186/1756-0500-5-548

Design and process evaluation of an informative website tailored to breast cancer survivors’ and intimate partners’ post-treatment care needsEvelyn Pauwels,1 Elke Van Hoof,2,3 Caroline Charlier,1,4 Lilian Lechner,4 and Ilse De Bourdeaudhuij

BMC Dermatol. 2011 May 18;11:10. doi: 10.1186BMC Dermatol. 2011 May 18;11:10. doi: 10.1186/1471-5945-11-10.Mapping randomized controlled trials of treatments for eczema--the GREAT database (the Global Resource of EczemA Trials: a collection of key data on randomized controlled trials of treatments for eczema from 2000 to 2010).Nankervis H, Maplethorpe A, Williams HC.

“An international, publically available and comprehensive resource which brings together all randomized controlled trials on eczema treatment using a highly sensitive search has the potential to release more filtered knowledge about patient care to those who need it most and to significantly shorten the duration and costs of many clinical eczema research and guideline projects……The database can be accessed free of charge at http://www.greatdatabase.org.uk .”

Considerations

Recognise limitations:• Demographics – potential user profiles• Information in context• Ability to interpret information• Ability to appraise information• “incomplete and impersonal”

Need for selection and direction

http://blog.tutorspree.com/post/54349646327/death-of-organic-search

Roughly 13% of your screen will display actual results; the rest will be taken over by ads and other unsolicited activity.

Untangling the Web — Patients, Doctors, and the InternetPamela Hartzband, M.D., and Jerome Groopman, M.D.

N Engl J Med 2010; 362:1063-1066March 25, 2010DOI: 10.1056/NEJMp0911938

“The benefits, though, must be weighed against the potential negative effects of receiving clinical data without context. Patients and families may be confused by results and worried that minor abnormalities might portend serious consequences.”

Conclusion: The study demonstrates that online counseling via e-mail reaches patients with unmet therapeutic needs, but also indicated its limitations, suggesting that the online setting may be most useful for prompting and supporting a transition to conventional counseling services.

Psycho-Social MedicineJanuary 1 2011 | Volume 8 | ppg Doc05doi: 10.3205/psm000074

Online counseling via e-mail for breast cancer patients on the German internet: preliminary results of a psychoeducational intervention.David N, Schlenker P, Prudlo U, Larbig W

http://blogs.biomedcentral.com/blog/2013/08/12/a-call-to-action-from-alltrials

/

The Western Journal of Emergency MedicineNovember 1 2011 | Volume 12 | Issue 4 | ppg 442-7doi: 10.5811/westjem.2010.9.1895

Can emergency medicine residents reliably use the internet to answer clinical questions?Krause R, Moscati R, Halpern S, Schwartz DG, Abbas J

SVHG Clinical Information Portal

A single entry point for communication and access to all clinical information required for patient care in SVHG.Current discussions with Pharmacy and ICT.

Mobile/tablet uses

CONCLUSIONS: While the smartphone's role in medicine and education appears promising and exciting, more high-quality studies are needed to better understand the role it will have in this field. We recommend popular smartphone applications for physicians that are lacking in evidence and discuss future studies to support their use.

Journal of Medical Internet Research

January 1 2012 | Volume 14 | Issue 5 | ppg e128

The smartphone in medicine: a review of current and potential use among physicians and students.Ozdalga E, Ozdalga A, Ahuja N

http://www.docphin.com/

The future?

Cloud computing

“… application would allow workers to log into a Web-based service which hosts all the programs the user would need for his or her job. Remote machines owned by another company would run everything from e-mail to word processing to complex data analysis programs.”

http://www.howstuffworks.com/cloud-computing/cloud-computing.htm

http://www.youtube.com/watch?v=A7G3gzdLDcQ

http://www.kevinmd.com/blog/2013/08/fix-google-maps-patients-start-dying.html

You may not have asked to be added to Google maps, but it’s up to you to try to correct it. And this isn’t easy.

Harnessing the cloud of patient experience: using social media to detect poor quality healthcareFelix Greaves, Daniel Ramirez-Cano, Christopher Millett, Ara Darzi, Liam DonaldsonBMJ Qual Saf 2013;22:3 251-255 Published Online First: 24 January 2013 doi:10.1136/bmjqs-2012-001527

BMJ Qual Saf doi:10.1136/bmjqs-2012-001744Editorial: Patient-centred healthcare, social media and the internet: the perfect storm?Ronen Rozenblum, David W Bates

“In the past, healthcare was managed mainly via interpersonal communication between the caregiver and the patient, while today, social media offers different modes of interaction. For example, Facebook has become a significant source of healthcare information, such as specific data about health conditions and healthcare facilities,15 and blogs have become a powerful communication tool to disseminate health information and engage patients with their care. Researchers have found that, based on the data posted on Twitter, they can detect an array of types of activity, most notably disease outbreaks such as cholera and influenza,16 ,17 but more recently, data about issues like headache appearance.18”http://qualitysafety.bmj.com/content/early/2013/01/31/bmjqs-2012-001744.full

Big Data:http://www.autonomy.com/content/Technology/what-is-big-data/index.en.html

Online privacy• Earlier this year a Harvard professor was able to re-identify individuals

in a genetics database by cross referencing with public records, with an accuracy rate of 42% if only three types of information - zip code, date of birth and gender - were present, rising to 97% when first name or nickname - information that could easily be extracted from many email addresses - was added.

Data security and privacy: can we have both? Companies store copies of information in multiple locations to minimise the risk of data loss, but does our right to privacy suffer as a result?Email : John Burn-Murdoch; theguardian.com, Wednesday 31 July 2013 07.30 BST

References & bibliography1: Ryhänen AM, Rankinen S, Tulus K, Korvenranta H, Leino-Kilpi H. Internet based patient pathway as an educational tool for breast cancer patients. Int J MedInform. 2012 Apr;81(4):270-8. doi: 10.1016/j.ijmedinf.2012.01.010. Epub 2012 Feb 22. PubMed PMID: 22361159.

2: Kaufman N. Internet and information technology use in treatment of diabetes.Int J Clin Pract Suppl. 2010 Feb;(166):41-6. doi:10.1111/j.1742-1241.2009.02277.x. Review. PubMed PMID: 20377663.

3: Hill-Kayser CE, Vachani C, Hampshire MK, Metz JM. High level use andsatisfaction with internet-based breast cancer survivorship care plans. Breast J.2012 Jan-Feb;18(1):97-9. doi: 10.1111/j.1524-4741.2011.01195.x. Epub 2011 Nov 20.PubMed PMID: 22098063.

4: Pauwels E, Van Hoof E, Charlier C, Lechner L, De Bourdeaudhuij I. Design andprocess evaluation of an informative website tailored to breast cancer survivors'and intimate partners' post-treatment care needs. BMC Res Notes. 2012 Oct3;5:548. doi: 10.1186/1756-0500-5-548. PubMed PMID: 23034161; PubMed CentralPMCID: PMC3583797.

5: Wakefield DS, Kruse RL, Wakefield BJ, Koopman RJ, Keplinger LE, Canfield SM,Mehr DR. Consistency of patient preferences about a secure internet-based patientcommunications portal: contemplating, enrolling, and using. Am J Med Qual. 2012Nov-Dec;27(6):494-502. doi: 10.1177/1062860611436246. Epub 2012 Apr 18. PubMedPMID: 22517909.

6: Krause R, Moscati R, Halpern S, Schwartz DG, Abbas J. Can emergency medicineresidents reliably use the internet to answer clinical questions? West J EmergMed. 2011 Nov;12(4):442-7. doi: 10.5811/westjem.2010.9.1895. PubMed PMID:22224135; PubMed Central PMCID: PMC3236170.

7: Miller DM, Moore SM, Fox RJ, Atreja A, Fu AZ, Lee JC, Saupe W, Stadtler M,Chakraborty S, Harris CM, Rudick RA. Web-based self-management for patients with multiple sclerosis: a practical, randomized trial. Telemed J E Health. 2011Jan-Feb;17(1):5-13. doi: 10.1089/tmj.2010.0133. Epub 2011 Jan 9. PubMed PMID:21214498; PubMed Central PMCID: PMC3064874.

8: Miller DM, Fox R, Atreja A, Moore S, Lee JC, Fu AZ, Jain A, Saupe W,Chakraborty S, Stadtler M, Rudick RA. Using an automated recruitment process togenerate an unbiased study sample of multiple sclerosis patients. Telemed J EHealth. 2010 Jan-Feb;16(1):63-8. doi: 10.1089/tmj.2009.0078. PubMed PMID:20064056; PubMed Central PMCID: PMC2998972.

9: Ozdalga E, Ozdalga A, Ahuja N. The smartphone in medicine: a review of currentand potential use among physicians and students. J Med Internet Res. 2012 Sep27;14(5):e128. Review. PubMed PMID: 23017375; PubMed Central PMCID: PMC3510747.

10: Mosa AS, Yoo I, Sheets L. A systematic review of healthcare applications for smartphones. BMC Med Inform Decis Mak. 2012 Jul 10;12:67. doi:10.1186/1472-6947-12-67. Review. PubMed PMID: 22781312; PubMed Central PMCID:PMC3534499.

11: Timm J, Renly S, Farkash A. Large scale healthcare data integration andanalysis using the semantic web. Stud Health Technol Inform. 2011;169:729-33.PubMed PMID: 21893843.

12: Park JB, Choi HJ, Lee JH, Kang BS. An Assessment of the iPad 2 as a CTTeleradiology Tool Using Brain CT with Subtle Intracranial Hemorrhage UnderConventional Illumination. J Digit Imaging. 2013 Aug;26(4):683-90. doi:10.1007/s10278-013-9580-0. PubMed PMID: 23404630; PubMed Central PMCID:PMC3705008.

13: Bradley WG Jr. Teleradiology. Neuroimaging Clin N Am. 2012 Aug;22(3):511-7.doi: 10.1016/j.nic.2012.05.001. Epub 2012 Jun 24. Review. PubMed PMID: 22902118.

14: Maclean DL, Heer J. Identifying medical terms in patient-authored text: acrowdsourcing-based approach. J Am Med Inform Assoc. 2013 May 5. [Epub ahead ofprint] PubMed PMID: 23645553.

15: Cueva M, Kuhnley R, Slatton J, Dignan M, Underwood E, Landis K. Telenovela:an innovative colorectal cancer screening health messaging tool. Int JCircumpolar Health. 2013 Aug 5;72. doi: 10.3402/ijch.v72i0.21301. Print 2013.PubMed PMID: 23930245; PubMed Central PMCID: PMC3736451.

16: Hartzband P, Groopman J. Untangling the Web--patients, doctors, and theInternet. N Engl J Med. 2010 Mar 25;362(12):1063-6. doi: 10.1056/NEJMp0911938.PubMed PMID: 20335581.