How to Use Technology to Improve the Practice of Medicine

Robert Miller, MDDecember 2016AboutCancer.com

Are Doctors Happy with the way Medicine is Being Practiced Today?

Medscape survey in 2015 found that 46% of physicians felt burnout (up from 39% in 2012 with other studies ranging from 30 – 65%

Issues cited by doctors included:

Too many bureaucratic tasksToo may hours at workIncome too low for the hoursIncreasing computerizationInability to keep up with current science

The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic ReviewJournal of the American Medical Informatics Association Volume 12, Issue 5September–October 2005, Pages 505–516

the use of central station desktops for computerized provider order entry (CPOE) was found to be inefficient, increasing the work time 238.4%

According to the Mayo Clinic, more than half of all physicians are burned out, and On average, doctors spend 158 million hours per year on administrative tasks and 49.2% of their day on EHRs

Increasing demands for documentation

“I’m from the government and am here to help you.”

PQRSICD10

MACRAMIPSQPP

What will the government do to “get the hearts of minds of doctors back?”

QPP (Quality Payment Program)The Quality Payment Program improves Medicare by helping you focus on care quality and the one thing that matters most — making patients healthier. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula. https://qpp.cms.gov

Merit-based Incentive Payment System (MIPS)

You earn a payment adjustment based on evidence-based and practice-specific quality data. You show you provided high quality, efficient care supported by technology by sending in information in the following categories.

Are Doctors Happy with the way Medicine is Being Practiced Today?

Too many bureaucratic tasksToo may hours at workIncome too low for the hoursIncreasing computerizationInability to keep up with current science

John Henry (African American folk hero)

‘We’ need to help doctors use computers in a way that:• Faster (time efficient)• Cheaper (cost efficient,

free is best) • Better and Safer Care of

the patient

Used a hammer and was a ‘steel-driving man’ who died trying to prove he could outperform a modern steam drill

1. How to use technology and the internet to better self educate and remain current.

2. How to use apps, more sophisticated EMR (electronic medical records) or EHR (electronic health records) systems to try to run a more efficient practice (better and safer patient care.)

3. How to use web sites and other social media outlets to better communicate with your patients or colleagues

Computer tips from Dr. Miller

Best ways to get reliable information from the cloud

• Specialty medical sites (NCCN, Up-to-Date, Pubmed, etc)

• Specialty Journals• Medical sites or apps (Medscape, Epocrates,

etc)• Search (Google or Bing or Wikipedia)• Medical Calculators

Most Important Web Sites if Your are on Oncologist

• PubMed (Medline) ? • NCCN (National Comprehensive Cancer Network)• UpToDate• Google (need to take advantage of all the free

apps that make doctors more efficient and keep them up to date)

ncbi.nlm.nih.gov/pubmed

Medline is now called PubMed

MEDLINE (Medical Literature Analysis and Retrieval System Online, or MEDLARS Online) is a bibliographic database of life sciences and biomedical information Compiled by the United States National Library of Medicine (NLM), MEDLINE searchable via PubMed 

How to Use PubMed?

NCCN.org

Epidemiology, risk factors and the clinical approach to ER/PR negative, HER2-negative (Triple-negative) breast cancer

All topics are updated as new evidence becomes available and our peer review process is complete.Literature review current through: Oct 2016. | This topic last updated: Aug 10, 2016.

Is search the quickest way to get useful medical information?

Triple negative breast cancer

14,300,300 results from basic google search

But hit the scholar button

scholar.google.com

scholar.google.com

Create an Alert in Google Scholar

Click to learn more

Triple negative breast cancer

google.com/alerts

google.com/alerts

translate.google.com

Are you having trouble breathing?Problémái vannak lélegzik? Hungarian

Ertu í vandræðum með öndun?Icelandic

לנשום מתקשה אתה ?האםHebrew

When you ‘google’ a name

Often dozens of high quality video lectures

If the quality is good you can subscribe to their site

Subscribe to University You Tube Sites

The way to survive is with Medical Apps

Running an Oncology practice with just 4 apps

1. ePSS ( Electronic Preventive Service Selector from the US Preventative Task Force) : update guidance for screening and prevention

2. NCCN (National Comprehensive Cancer Network) constantly updated treatment and testing and follow up

3. Epocrates: to make sure medication orders and safe and appropriate

4. Up to Date: if I need more detailed review of a subject

What is a chatbot? A messaging application, sometimes referred to as a conversational interface, designed to simplify complex predefined task(s). Chatbots came on the scene in 2011 as business intelligence, artificial intelligence and messaging platforms combined into new forms of responsive technology

https://www.google.com/intl/en/about/products/assistant/

Pixel with built in google assistant

Google Home

1. Pick One 2. Train the staff properly 3. Use it

Remember the software works for you and not the other way around.

Is it possible to teach (train) a doctor how to use EMR/HER Software?

1. They may not have the time (or interest) to commit and participate in training courses or attend up date courses

2. Unless they use the software frequently or exclusively they may not be able to remember or keep straight how to use it properly and efficiently.

Solution: build short help screens, FAQ or videos into the interface so they can refresh their knowledge in real time

Using the Internet to Educate Patients

What are patients getting from the internet?

• High percent of patients access the web (60% in 2001 and 80% 2013)

• Medical sites but also blogs and Facebook• Survivorship and patient participation

According to one study, only 43.5% of websites provided accurate information. Most accurate sites were from government organizations (80.1%) The least accurate websites are blogs (30.9%)

FAKE NEWS

Doctors need to identify the best patient information sites for their specialty and share these

sites or links with their patients

Direct patients to society’s web site, for cancer ASCO

http://www.cancer.net/

http://www.cancer.net/

nccn.org/patients/

https://www.cancer.gov

Are Social Networking Sites a good way to convey medical information to the public?

There likely will be numerous competing on line physician resource sites in the future

Are patients satisfied that all of their questions were answered?

Do doctors think the patient and family actually understand and remember what they were told?

1. The patient may be too emotional or upset to even listen to what is said2. They may just not comprehend3. They may not remember what was discussed4. Often the family member who should have been there wasn’t available

If only you could clone your mini-lectures and teaching sessions with the patients so that they can (at home and on their own schedule)

Re-read the slides and descriptions or

Re-listen to your explanations and have them available to share with other members of their family.

www.slideshare.net

Slideshare is now part of Linkedin which is now part of Microsoft

First 5 years

Last 12 months

www.slideshare.net

At the top of your Gmail page look at the upper right corner and click on the box which will show you the attached apps

https://support.google.com/docs/topic/21008

google.com/docs/about

Turn PowerPoints into YouTubes or other Videos

Windows Movie Maker Microsoft PowerPoint

At the top of your Gmail page look at the upper right corner and click on the box which will show you the attached apps

At the top of your Gmail page look at the upper right corner and click on the box which will show you the attached apps

Then click on the You Tube

youtube.com/user/robertmillermd 

Views = 261,216

12,647 hours

At the top of your Gmail page look at the upper right corner and click on the box which will show you the attached apps

Create a web site

At the top of your Gmail page look at the upper right corner and click on the box which will show you the attached apps

Then click on the More

Under Sites you can easily create a simple free web site

sites.google.com/site/robertmillermd/

Facebook

Web Site Software

www.aboutcancer.comCancer Information

• Basic Cancer Information• General Cancer Statistics• Most Common Cancers

* brain* breast* colon/rectum* gynecologic * lung* prostate

• Other Specific Cancers Radiation or Chemotherapy

• All Other Cancer Topics• Other Topics• Best Web Sites

Advice for Patients

www.aboutcancer.com/premed.htm

Favorite Non-Medical Web Sites

aboutcancer.com/best_webs.htm

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aboutcancer.com/you_tube_videos.htm

How will the internet and AI change medicine?

Patients and researchers will continue to produce massive quantities of health data that only super computers will be able to make sense of in a timely manner.

Who ever controls and knows how to mine big data will have the power to control health care in the future.

Patients will be more and more comfortable accessing this data from virtual assistants without the cost and delay involved with seeing a physician.

Doctors of the future will need to reinvent themselves to remain a relevant part of the future health care delivery system.

Will doctors become obsolete?

1. They should use technology and the internet to better self educate and remain current.2. They should use apps, more sophisticated EMR/EHR (electronic medical or health records)

systems to try to run a more efficient practice with safer and better care.3. They can use web sites and other social media outlets to better communicate with their

patients (you need to score well on patient satisfaction surveys.)4. They can use ‘telemedicine or telehealth’ software to try to reach patients more effectively

and efficiently. (May be better than becoming an Uber driver!)

But…. many physicians may be replaced by increasingly sophisticated soft ware and AI programs and patients may turn to digital assistants and robotics for the majority of their care in the not too distant future!

See video here: aboutcancer.com/future_of_medicine

How to Avoid ObsolescenceIn the past college graduates had to “find a job” now they have to “create or invent a job”, Thomas Friedman

Doctors need to move up the “intellectual food chain.” Need to move forward with the understanding that health care is now information technology and they to need to become experts in medical informatics. You should be better than your patient in accessing medical information from the internet!

At the same time they need to be retro in the sense of returning to the traditional role of physician as teacher or guide. They need to emphasize their role as a patient ombudsman and someone who can translate or interpret the increasingly complex medical options and present it to the patient and

family in a way that is both compassionate and understandable.

Virgil guiding Dante

If you have a terrible bedside manner, then fix it!

You should at least be as capable as your patients in accessing medical information

New job description: “I’m an expert in medical information technology.”

What do patients want from their doctor when can google the information themselves?

1. Validate the information (“Is this accurate and current?”)2. Translate the information (“Am I understanding this

correctly?”)3. Buffer them from some information (“There are some

things I won’t want to see, so don’t tell me everything!”)

www.aboutcancer.com