Health-On-Call

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Health-On-Call
Using Mobile and Web Technology to
Create More Informed, Better-Prepared
Patients and Caregivers
Published by
Health-On-Call
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Patients
and Caregivers: Engaged, Online and Social
It goes without saying that patients are increasingly engaged in managing their own
health care, including using computers, mobile tablets and smart phones to find,
download, store and share digital health information. According to 2013 data from Pew
Internet,
85% of US adults now use the Internet -- and 72% of Internet users say they’ve
looked online for health information within the past year.1,2 For over a quarter of
Americans,
mobile phones are already an established way to access health tools and
information, a number that’s expected to double in the next four years.3,4 The most
commonly searched health topics include specific diseases and conditions, treatments,
physicians
and other health care providers.2
Are
Older Patients Online, Too?
While
people age 50 and over may be less likely to search for online health topics than
their
younger
peers, they still represent a significant online presence: 54% of 50-64
year olds and 30% of people age 65 and over are now logging on to find health
information.
Among younger people, the rates are 72% for 18-29 year olds, and 67% for
30-49 year olds.4
Patients turn to the Internet not to replace providers, but
because they’re motivated to become more engaged in
their own health care.
What
About Caregivers?
Underscoring
the inherent social nature of health, Pew says over half of online health
research
is done on behalf of someone else: 72% of caregivers search online for digital
health information, outpacing non-caregivers on all health topics covered in the survey
-- including specific disease and medical problems, treatments and procedures, drug
options
and drug safety.5,6,7
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2013
Data: Patients and Online Health Information
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How
Are Patients Using Digital Health Info?
Patients
turn to the Internet not to replace providers, but because they’re motivated to
become more engaged in their own health care. Among the reasons for increasing
patient
activation and engagement are increased availability, accessibility, awareness,
and social exchange of health information. In addition, some evidence suggests
patients are motivated to improve their clinical encounter and health care quality using
the
information they find. A 2012 study published in the Journal of Health
Communication found that almost 70% of online health seekers planned to ask their
physician
questions about the information they found online, and 40% printed online
health information to take to their appointment.8
On the downside—for patients, caregivers and the
providers who serve them—are problems around quality
and credibility of online information, and patient ability to
effectively search, sort and comprehend massive amounts
of online information.
According
to Pew Internet, the Internet has changed the way people interact with
health information.2,6 While patients still seek face-to-face health care encounters most
the time, access to wireless and mobile devices combined with the prevalence of
of
online resources (such as e-commerce, social media and mobile applications) is
making it more possible, more acceptable and more convenient to complete all types
1,2,6
of
transactions --including health-related ones -- in cyberspace.
Ups and Downs of Online and Mobile-Health
One of the advantages of increased patient engagement with digital health information
that patients who take an active part in their health care tend to have better
is
outcomes and lower health care costs.9,10 According to a brief published by the Robert
Wood Johnson Foundation, engaged patients are more likely to seek and obtain
preventive
services, adopt positive behaviors, follow treatment and actively ask
questions when they see their providers.11
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On the downside -- for patients, caregivers and the providers who serve them -- are
problems
around quality and credibility of online information, and patient ability to
effectively
search, sort and comprehend massive amounts of online information.
Using
Non-Evidence Based Search Engines
the percentage of patients seeking online health information continues to grow, the
As
Internet (along with mobile and wireless technology) is becoming increasingly
important as a facilitator of health information flow between patients and providers.
Given
that, and the fact that 77% of online health seekers are using non-evidence
based search engines, such as Google, Bing or Yahoo to find health information, it’s no
surprise
that the validity of health information obtained by patients is a major concern,
not only to patients and caregivers, but also to their providers.6
Patients
come to docs with a huge amount of misinformation,” says Michael Roizen,
MD, chief wellness officer for Cleveland Clinic, a practicing physician and a member of
Sharecare’s
editorial advisory board. “They do an Internet search and come up with
possibilities that aren’t viable. You can put a symptom in Google and get infinite info - you love empowered patients, but you also want to help them be more selective.”
Navigating
Online Information Chaos
The
Internet provides endless potential and value if used well. However, if not
harnessed and combined with quality care from physicians and other trained providers,
it also has the potential to increase anxiety and confusion for patients and caregivers -not
to mention, frustration for the medical community. This is especially true if patients
are overcome with information overload and cyberchondria (the unfounded escalation
concerns about common symptoms) due to inaccurate, irrelevant or disorganized
of
Internet or symptom checker search results.12, 13
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What's more, many patients and caregivers who seek online health information now
use
search results instead of visiting a qualified physician or provider, while lacking the
ability -- often, despite being highly educated -- to discern the validity of the
information or its online source.
The Power of Online Information
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Importantly, information obtained from online search and symptom checker results can
influence patient decisions about when to engage a physician or provider, as well as
behaviors
related to diet, exercise and preventive health activities.12
However, to date, the average symptom checker often
falls short, providing patients and caregivers with
overly-generalized, unreferenced information and health
risk assessments—then failing to tie the digital health
encounter back to the “real life” patient-provider encounter.
Assuming the right content and features, this is good news for developers, sponsors
and users of web and mobile health applications and media. However, to date, the
average symptom checker often falls short, providing patients and caregivers with
overly-generalized, unreferenced information and health risk assessments -- then
failing to tie the digital health encounter back to the “real life” patient-provider
encounter.
Less Time, More Pressure
While patients are sifting through large amounts of online health information and
becoming more proactive medical consumers, physicians and other providers are
facing information overload on their end as well, due to increasing patient loads,
increasing amounts of patient and medical data and the effects of new information and
communication technologies.14
In addition to too much information, too little time is also a problem for busy providers.
Time with patients and on all job-related responsibilities is short -- and likely to get
even shorter given population growth, aging and the 30 million newly-insured patients
expected to walk through the door next year under the Affordable Care Act.15,16
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For patients and providers, this means targeted, productive office visits are more
critical than ever. If patients come in misinformed or unprepared, valuable office time
that could be spent addressing patient concerns and on personalized patient
education may be wasted.17
Says Darria Long Gillespie, MD, MBA, executive vice president of clinical strategy at
Sharecare and a practicing emergency room physician, “It can be extremely time
consuming to get the core of what’s going on with a patient, and you’re also likely to
get different answers if you ask the same question more than once. In the role of
patient, most people aren’t great historians and don’t always give doctors the answers
or info they need to make the best decisions, especially within the timeframe of a
typical office visit.”
Add to this the fact that all stakeholders -- providers, patients and payers -- are looking
for innovative ways to improve health outcomes, reduce errors and reduce medical
costs -- and the need for information technologies that create more informed, prepared
patients and facilitate better patient-provider communication is readily apparent.
Connecting Patient and Provider Needs
Despite the clear challenges, problems with information chaos and too little time have
spurred growth in R&D and innovation around patient-provider technology solutions. In
2012, Sharecare, the nation’s fastest growing health and wellness social technology
media platform, acquired PKC Corporation, a leading developer of health care decision
support software, to create AskMD, an application for mobile devices and the web.
AskMD offers a personalized, evidence-based platform that uses pattern recognition
software to delve into patient complaints, prompting them with questions about their
medical history and symptoms. The result is accurate, relevant, fully-referenced health
information delivered to the patient in an organized format, and a thorough history of
the patient’s symptoms prepared before the office visit. Patients can print this
information or share it electronically with family, friends or their physician.
Using GPS technology, the app instantly generates a mapped list of qualified, nearby
physicians, so that connecting with health care providers becomes a seamless part of
the patient's digital health experience -- not an afterthought.
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Combining Patient Data with Medical Knowledge
AskMD has its roots in the work of Lawrence Weed, MD, who developed the concept of
the Problem Oriented Medical Record (POMR) and the SOAP note in the 1960s. In a
seminal article published in the New England Journal of Medicine in 1968, Weed
outlined his vision of the POMR as a way to help clinicians deal with and document, in a
structured and rigorous manner, the multitude of patient problems they routinely face.18
During the 1970s Dr. Weed led an effort to develop an electronic version of the POMR
designed to make patient data more organized and retrievable in clinical practice. In
1991, he founded Problem Knowledge Couplers Corporation (PKC), to continue his work
and help solve the dilemma of physicians relying only on their memory and processing
capacity to solve complex problems.
Optimizing Information for Patients
Weed developed his decision-support technology to help overcome the inherent
limitations of the human mind when faced with complex health problems. Problem
knowledge couplers (known as “consultations” in the context of AskMD) are
computerized systems designed to gather relevant patient data and offer clinical
guidance on a specific health problem or complaint. After collecting a patient’s data via
a detailed questionnaire, the system organizes the data (based on current medical
research) to expose meaningful medical patterns and deliver a clinically valid analysis.19
Originally developed to optimize clinical decision-making by anticipating and enhancing
a physician’s way of thinking, Weed’s technology is now being leveraged by Sharecare
to empower patients and caregivers with physician-quality health information.
20 Years of Research and Development
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In 1998, PKC began work on a series of contracts with the Department of Defense,
totaling over $55 million dollars and contributing to over a decade of expansion and
development of PKC’s clinical knowledge platform and medical content repository. Both
the platform and content repository were developed with direct input from physicians
and used exclusively by physicians prior to Sharecare’s development of AskMD. AskMD
is therefore built upon over 20 years of knowledge, expertise, research and
development.
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Not Just Another Symptom Checker
AskMD’s clinical knowledge platform is extracted from the core literature
upon which providers consistently base their practice decisions. The
AskMD clinical content development team follows a rigorous policy for
methodically reviewing the literature and selecting best-quality
information sources appropriate to each specific complaint or health
condition.
Sources for literature review include:
•
•
•
•
Best-of-breed medical textbooks
Peer-reviewed journals
Evidence-based clinical practice guidelines
Systematic reviews
Sample Sources Used to
Support AskMD
Top-Cited Peer-Reviewed Journals
• Annals of Internal Medicine
• BMJ
• Chest
• Circulation
• Cleveland Clinic Journal of Medicine
• JAMA
• New England Journal of Medicine
• The Lancet
• Mayo Clinic Proceedings
• Neurology
Gold Standard Clinical Guidelines
Asthma Management
The AskMD content development team -- including physician reviewers,
other medical professionals, librarians and editors -- continually works to
update AskMD consultations. Updated text book editions are regularly
incorporated and automated, intelligent queries of the scientific journal
literature are run on a daily basis. The content team relies on the
scientific literature to determine what is included in the platform.
Treatments and recommendations are included only when they reach
the level of guidelines or endorsement by leading health organizations.
They are then analyzed and synthesized using a proprietary system to
extract the relevant facts and provide the most important information for
patients and caregivers.
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Personalized, Valid Health Information for Patients
AskMD provides patients and caregivers with an easy-to-use interface that
allows them to search for and obtain health information that is real-time,
valid, well-organized and personalized to their unique health history. Users
can select a “symptoms consultation” to get a list of common causes of a
health problem, such as knee pain or shortness of breath. Or they can
select a “management consultation” to get information about managing a
health condition, such as asthma or high blood pressure. The ability to
generate maps of qualified, nearby providers ties the patient’s digital
encounter back to the provider’s office -- encouraging “real world” patientprovider encounters when they are needed.
National Institutes of Health,
National Heart, Lung, and Blood
Institute. Expert Panel Report 3 (EPR 3):
Guidelines for the Diagnosis and
Management of Asthma, 2007.
Global Initiative for Asthma
Executive Committee. Global Initiative
For Asthma (GINA) [Internet]. 2012.
Global Strategy For Asthma
Management and Prevention: 2012
Update.
Heart Failure Management
Hunt SA, Abraham WT, Chin MH, et al.
ACC/AHA 2005 Guideline Update for
the Diagnosis and Management of
Chronic Heart Failure in the Adult: a
report of the American College of
Cardiology/American Heart Association
Task Force on Practice Guidelines.
Circulation. 2005;112(12):e154-235.
Jessup M, Abraham WT. 2009
Focused Update: ACCF/AHA
Guidelines for the Diagnosis and
Management of Heart Failure in Adults.
J Am Coll Cardiol. 2009;53(15):e1-e90.
Heart Failure Society of America,
Lindenfeld J, Albert NM, et al. HFSA
2010 Comprehensive Heart Failure
Practice Guideline. J Card Fail.
2010;16(6):e1-194.
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How AskMD Helps Patients
•
•
•
•
•
•
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Completing health history questions before office visits may save valuable office time,
potentially resulting in more time to discuss concerns and get information directly from
the provider. AskMD also benefits patients by allowing them to answer and save history
questions while symptoms are happening, before key factors and symptoms are
forgotten. Patients can create and save consultations and other medical history -including medications, preferred physicians and health insurance information -- for
themselves and other family members. Their personalized results can be printed and
shared electronically with family members, friends or with their provider.
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Provides patients with a real-time source for valid, personalized health
information (not generic symptom checker results).
Allows patients to create and save AskMD consultations and other medical
history for themselves and family members.
Allows patients to create and save lists of medications, medical conditions,
insurance information and preferred physicians for themselves and family
members.
Offers opportunities to answer and save health history questions while
symptoms are happening, before relevant factors are forgotten.
Gives patients more time to discuss concerns and education in the office with
their provider, with less time spent on history-gathering in the office.
Offers patients the opportunity to print out and share consultations
electronically with family members, friends or their provider.
Conclusion
Today’s patients are actively involved in managing their own health care, including
searching for health information online and using mobile and wireless devices at
growing rates. There is no denying that the Internet and mobile applications will
become increasingly important as sources of health information. At the same time,
physicians and other health care providers are faced with information overload,
increased responsibilities and less time per patient, making productive office visits
more critical than ever.
Developed and fine-tuned by clinicians over more than 20 years, AskMD is at the
forefront of digital patient health management tools. As a mobile and web application
that provides evidence-based, peer-reviewed information and personalized results for
patients, AskMD uses pattern recognition software to delve into patient complaints,
creating an organized, thorough history that can be printed or shared electronically with
others, including the patient’s provider.
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While traditional symptom checkers deliver generic, unreferenced information based on
a few standard questions, AskMD goes deeper, empowering patients to actively
engage in their own health care and become more informed, better-prepared patients,
potentially improving communication with their provider and enhancing their own
patient experience.
About Sharecare
Sharecare is a health and wellness social media platform that connects people with topranking experts ranging from doctors and specialists to hospitals, health care
companies and health conscious consumers. The power behind the site’s unique Q&A
format is its collective wisdom, providing health-seeking consumers with answers
reflecting multiple expert perspectives -- greatly simplifying the search for quality
information. Created by Jeff Arnold and Dr. Mehmet Oz in partnership with Harpo
Studios, Sony Pictures Television, and Discovery Communications, Sharecare allows
people to ask, learn, and act upon questions of health and wellness, creating an active
community where knowledge is shared and put into practice -- simply said, sharing
care. Launched in 2010, Sharecare is based in Atlanta, Georgia.
AskMD is an information tool that allows users to be better informed. The application is not intended to collect or provide
information in connection with services provided by a health care provider to patients. Health care providers must
continue to comply with their obligations of patient confidentiality, including without limitation, their obligations under the
Health Insurance Portability and Accountability Act ("HIPAA"). Sharecare's services to users are governed by the
Sharecare Terms and Sharecare Privacy Policy at Sharecare.com. Additional terms and conditions may apply.
References
1
Pew Research Center. Who's online trend data (adults), 2013. Pew Internet & American Life
Project.http://pewinternet.org/Trend-Data-(Adults)/Whos-Online.aspx. Accessed July 10, 2013.
2
Fox S., Duggan M. Health online 2013. Pew Research Center's Internet & American Life
Project. January 15, 2013.
3
Manhattan Research. Mobile health trends for 2012. http://manhattanresearch.com/Images--Files/Data-Snapshots/Mobile-Health-Trends-for-2012. Accessed July 3, 2013.
4
Fox S., Duggan M. Mobile health 2012. Pew Research Center's Internet & American Life
Project. November 8, 2012. http://www.pewinternet.org/Reports/2012/Mobile-Health.aspx.
Accessed July 10, 2013.
5
Fox S., Duggan M., Purcell, K. Family caregivers are wired for health. Pew Research Center's
Internet & American Life Project. June 20, 2013. http://www.pewinternet.org/~/media//Files/
Reports/2013/PewResearch_FamilyCaregivers.pdf. Accessed July 10, 2013.
Sharecare
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6
Fox S. Highlights of the Pew Internet Project’s research related to health and health care. Pew
Research Center’s Internet & American Life Project. June, 6, 2013. http://www.pewinternet.
org/Commentary/2011/November/Pew-Internet-Health.aspx. Accessed June 9, 2013.
7
Cohen RA, Adams, PF. Use of the internet for health information: United States, 2009. Centers for
Disease Control and Prevention. Number 66, July 2011.
www.cdc.gov/nchs/data/databriefs/db66.htm. Accessed June 9, 2013.
8
Hu X, Bell RA, Kravitz RL, Orange S. The prepared patient: information seeking of online support
group members before their medical appointments.J Health Commun. 2012;17(8):960-78. Epub
2012 May 10.
9
Hibbard J, Greene J. What the evidence shows about patient activation: Better health outcomes
and care experiences; fewer data on costs. Health Affairs. February, 2013; 32(2):207-214.
10
Hibbard J, Greene J, Overton V. Patients with lower activation associated with higher costs;
delivery systems should know their patients’ scores. Health Affairs. February, 2013; 32(2):216-222
11
Which approaches encourage patients to become more engaged in their own health care?
Robert Wood Johnson Issue Brief, January 2012. http://www.rwjf.org/content/dam/
farm/reports/issue_briefs/2012/rwjf72086. Accessed July 3, 2013.
12
White RW, Horvitz, E. Cyberchondria: Studies of the escalation of medical concerns in web
search. ACM Transactions on Information Systems, November 2008; 27:4(23). http://research.
microsoft.com/apps/pubs/default.aspx?id=76529. Accessed June 11. 2013.
13
Greenberg, R. Health care advice: The problem of health information overload. Huff
Post Healthy Living: The Blog. June 10, 2010. http://www.huffingtonpost.com/rivagreenberg/health-care-advice-the-pr_b_605606.html. Accessed December 8, 2013.
14
Hall A, Walton G. Information overload within the health care system: a literature review. Health
Information and Libraries Journal. 2004; 21:102-108.
15
Colwill JM, Cultice JM, Kruse RL. Will generalist physician supply meet demands of an increasing
and aging population? Health Aff. 2008; 27:w232-41. http://content.healthaffairs.
org/content/27/3/w232.abstract. Accessed July 9, 2013.
16
PricewaterhouseCoopers. 30 million newly-insured under the American Affordable Care Act: who
are they? http://www.pwc.com/us/en/health-industries/publications/health-insurance-exchangesand-medicaid-expansion.jhtml. Accessed July 25, 2013.
17
Haupt, A. How to maximize a doctor visit. U.S. World & News Report. July 26, 2011.
http://health.usnews.com/top-doctors/articles/2011/07/26/how-to-maximize-a-doctor-visit.
Accessed December 8, 2013.
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Weed, LI. Medical records that guide and teach. NEJM. March 14, 1968; 278(21):593-600, 652657.
19
Burger C. The use of problem-knowledge couplers in a primary care practice. The Permanente
Journal. Spring 2010; 14:1(47-50).
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