[UPDATED] Driving in Traffic: Blogs in the Health-O-Sphere

The Driving in Traffic blog had a great post last week about the role of Blogs in the Health-O-Sphere.  It asks whether (and how) evidence-based medicine and Web 2.0 technologies can improve the quality of healthcare provided by health organizations. That strikes close to home, being a major part of the research work to which my work contributes, so I have some tentative answers to the questions she raises.

UPDATE: I forgot to mention Fard Johnmar's excellent report on healthcare blogging called The Emerging Healthcare Blogosphere: What Is It & Why Does It Matter?.  It costs a few bucks, and by 'few' I mean both very affordable and way too little to compensate for the effort manifested this labor of love. Check it out. Be enlightened on a very important subject.

Carol's thoughts make a lot of sense to me. I work with a physician, Lee Green, who is a strong proponent of evidence-based medicine. He has put this into practice in the form of a program he called ClinfoTracker, developed in a multi-year collaboration with a software engineer named Tim Morris.

ClinfoTracker is a prompt and reminder system, which looks at who's coming into your clinic today and what ongoing problems and risks they have, and prepares cover sheets for their charts. It goes beyond telling you what the patient has, using evidence-based medicine to suggest what you should be doing about it - what to look for, what to ask, what to suggest, and so on. It goes beyond what the primary practice doc knows about the patient from past experience, using an elegant rule-based system component to augment simple reminders with heuristics that represent best practices and up-to-the-minute research findings. In this way the family doc can apply not just his or her own experience and wisdom, but that of the faculty of a tertiary/quaternary care center, and of the fund of knowledge under continuous development by the larger community of clinical translational researchers worldwide.

You, the primary practice doc, can look at the cover sheet for fifteen seconds before you enter the examining room, and you will be significantly better prepared for the visit than you ever would by usual practices, of which there are two main varieties: either walking into the examining room without ever looking at the chart, trusting your memory and the patient's to bring relevant issues to the fore, or walking into the room with eyes on the chart and keeping them there through much of the patient visit. Either of the current approaches tend to focus on the presenting problem, which is then dealt with symptomatically at worst, or at best with its etiology and prognosis as the limit of the visit context.

It's 10:53 AM, and you are standing outside the examining room of Mr. Baxter, a 59-year old patient recently assigned to your practice by his HMO. Mr. Baxter is here because of a bad case of sinusitis, so it's easy to forget (as if you ever knew) that he is a Type 2 diabetic who needs to have his eyes and extremities looked at and to be asked if he is checking his blood sugar regularly. If he also comes from genetic stock with a propensity for thyroid cancer, the visit also represents an opportunity to take 15-30 seconds to check for its early signs as well, an opportunity likely to be missed in the typical rushed clinic visit.

Dr. Green and his colleagues in our health system's community-based family practice centers have proven empirically that ClinfoTracker significantly reduces the chance of such missed opportunities for preventive medicine. He is now in the process of setting up a larger trial in the context of a statewide practice-based research network, a trial supported in part by the NIH Roadmap contract on which I work. A technology transfer deal is also in the works that will ultimately take this concept into the mainstream world of family practice. (More details on that when I have them in hand...)

So back to Carol's ideas about the potential role of the blog in the provisioning of patient care. She says:

However for some reason, a personal face and good scientific, evidence-based health care are perceived as mutually exclusive. I think pundits that hold to this stringent view are not taking into consideration how blogs, Web 2.0 or whatever you want to call it are changing the way we communicate. Most would agree that blogs, in and of themselves, are evolving. New technologies and plug-ins are expanding functionality everyday. Additionally, every major news outlet has implemented RSS in some form or fashion.

Here's a couple thoughts along these lines that takes both Carol's ideas and Dr. Green's to the next level. If CinfoTracker's evidence-based prompts and reminders are useful during the patient visit, what about using Web 2.0 technologies to extend evidence-based medicine to patients in the context of their own day-to-day lives?

• A personal patient portal that delivers individually tailored prompts and reminders based on the patient's health record and personal preferences. It can provide links to whatever kinds of detail the patient wants and can handle - from mostly visual presentation of suggestions, to consumer-oriented detailed health literature, to the underlying references in the corpus of medical research publications available freely online through PubMed and other similar portals.
• An RSS-based push system that delivers appropriately timed reminders to the patient's cell phone or PDA. Or, since many of the patients most in need are low-tech, they can be delivered by outbound IVR to the patient's home phone, or through automatically generated snail-mail pieces. For homebound low-tech patients dependent on community- or HMO-provided home health resources, the prompts could be delivered to the patient's direct caregivers by any of the same means already described.

These are just some of the possibilities. I'm sure there are more. But I gotta go - it's near the end of the term and my Social Networking term project beckons.

Comments

[Fard Johnmar]

Hi:

I enjoyed this post (and Carol's) on the important subject of how blogs can further the practice of evidence-based medicine. I wanted to let you know (at the risk of sounding self-promotional) that I talk about this issue quite a bit in my recently-published report on healthcare blogs: "The Emerging Healthcare Blogosphere: What Is It & Why Does It Matter?" Given your focus on these issues I thought that you might find it interesting and helpful.

Thanks for furthering the dialogue about this important topic.

Best,

Fard Johnmar

[Hunscher]

Comments with a self-promotional aspect are welcome as long as they contribute to the fund of knowledge. I actually saw your post when it first came out and would have referenced it in my post had I remembered it. I'll edit and put in a reference right now. Best of luck with your publishing endeavor; I'm hoping in the near future to publish a nuts-and-bolts how-to guide for getting started in business blogging with a focus on healthcare professionals and practices, and will want to be "self-promotional" myself someday soon.

[Carol Kirshner]

Hi Dale,
This tag-team approach is what blogging is all about. I'm quite flattered that you think about my posts and do a great job expanding on the notions in practical ways. I love the collaboration in all of this and it is so exciting to dream for the future.

[Fard Johnmar]

Dale:

Thanks for mentioning the report and for welcoming my quote. Are you particpating in the "Blogposium" by any chance? If you don't know what that is, please check out HealthNex. It might be a great opportunity for you to further discussion and knowledge about this issue.