Keep Up On What's New
The world of medicine is continually in motion. Here, we will provide you with a selection of interesting news items from our practice and the medical world.
Coffee Consumption and Risk of Stroke in Women
Stroke, 03/15/2011
Larsson SC et al. – After adjustment for other risk factors, coffee consumption was associated with a statistically significant lower risk of total stroke, cerebral infarction, and subarachnoid hemorrhage but not intracerebral hemorrhage. The association between coffee consumption and cerebral infarction was not modified by smoking status, body mass index, history of diabetes or hypertension, or alcohol consumption. These findings suggest that low or no coffee consumption is associated with an increased risk of stroke in women.
Source: www.mdlinx.com
Deficient brain insulin signaling pathway in Alzheimers disease and diabetes
The Journal of Pathology, 04/13/2011
Liu Y et al. – Brain glucose metabolism is impaired in Alzheimer's disease (AD), the most common form of dementia. The findings provide novel insight into the molecular mechanism by which type 2 diabetes mellitus increases the risk for developing cognitive impairment and dementia in Alzheimer's disease.
Doctors, patients use smartphones, but can't make mobile connection
A study cites a lack of payment from insurers to physicians for electronic monitoring and an unwillingness among patients to pay for that service.
By PAMELA LEWIS DOLAN, amednews staff. Posted Oct. 4, 2010.
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Joel De Ocampo, MD, a neurologist and sleep specialist from Scottsdale, Ariz., is disappointed that he can't read his patients' headache journals on his smartphone. His patients have expressed similar regrets.
And yet, Dr. De Ocampo's patients are still writing their journals on paper, and he is still reading them in that format.
The mobile disconnect between Dr. De Ocampo and his patients -- and other physicians and their patients -- is happening for two major reasons, according to a study released by the PwC (formerly known as PricewaterhouseCoopers) Health Research Institute.
One is a lack of connectivity between mobile phones and practice and hospital systems. The other is money.
PwC says the inability of many practice and hospitals electronic medical records systems to integrate data from smartphones isn't stopping doctors from using them, but it is limiting their use.
Two-thirds of doctors using smartphones can't connect them to a practice or hospital EMR.
Meanwhile, money is an issue, according to PwC, because of a lack of payment from insurers to doctors for electronic monitoring of patients, and an unwillingness among many patients to pay for that service themselves. "Unfortunately, the payment wires are crossed," PwC said.
The survey, which included about 2,000 patients and 1,000 physicians, didn't determine an overall smartphone ownership rate for both parties. But it painted a picture of doctors and patients who each were enthusiastic mobile users -- just not with each other.
About two-thirds of doctors using their smartphones in the course of a practice day said they could not connect the devices to a practice or hospital electronic medical records system. The report notes that such a barrier is keeping physicians from using their smartphones as much as they would like, particularly in tasks such as patient monitoring.
Dr. De Ocampo said he is frustrated that his device won't connect to his EMR. "I just want to have the ability to tweak the EMR system to work in a way I am comfortable with," he said.
Cliff Bleustein, MD, a director at PwC on the advisory team overseeing the research institute's survey, said it will take a joint effort "not only from hospital environments but from information technology vendors as well as telecommunications companies."
The report noted that most medical practice EMRs aren't able to integrate with their doctors' smartphones. Hospital EMR systems, even if they could be integrated with doctors' smartphones, are struggling to have enough bandwidth to process the information they have.
Medicaid patients are the most active text messagers of any class of insured or uninsured.
Reimbursement becomes a stumbling block because in most cases, physicians are not paid for communicating electronically with patients, whether through a mobile device or some other form. The report quoted some insurers who said they still are waiting for proof that mobile health monitoring saves money before they start reimbursing for it. Meanwhile, 40% of doctors said 11% to 30% of their office visits could be eliminated with mobile monitoring of patients. PwC said this could affect the severity of any future physician shortages. Left unanswered in the report was how physicians would make up revenue lost from fewer office visits.
Only about half of patients surveyed said they would pay for some sort of mobile health technology or device, according to PwC. Of those who would pay, most would prefer to spend less than $10 a month for the service, and less than $75 for any device. Patients also said they would like those costs to be picked up by a third party.
One observer quoted in the report, Mike Weckesser, director of emerging business-health solutions at Best Buy, said consumers' expectations that insurers would pay for mobile health monitoring was "slanting the data" on their supposed willingness to cover the cost.
Based on the amount consumers are willing to pay for some of these services, the potential market for remote/mobile monitoring devices is estimated to be between $7.7 billion and $43 billion annually, according to PwC research.
Which patients use mobile
The report noted that mobile devices might have physicians finding themselves connected to patients with whom they previously had relatively little interaction.
For example, while most surveys show women to be the health decision-makers in most households, the PwC study showed that men were more likely to express an interest in connecting with a doctor through a mobile device. Those who are individually insured and patients who had delayed visits were more likely to be willing to pay for smartphone contact.
Medicaid patients were found to be the most active text-message senders of any class of insured or uninsured, with 79% of Medicaid recipients with phones considered active texters.
The report was less positive about contact with chronic patients, saying those in good health, rather than bad, were likely to participate in and pay for mobile health monitoring.
Despite the barriers, some physicians are forging ahead. Claudio Palma, MD, a San Francisco-based anesthesiologist and pain management specialist, said he implemented mobile technology into his practice to make his life easier. Dr. Palma mostly uses resource applications, such as drug references. He said it's convenient to have that resource with him wherever he goes.
"I'm a pretty busy guy. I'm running around, I have a couple of practices, I see tons of patients, and this really allows me to deal with all the information that's coming from all different sources."
Daniel Slaughter, MD, an otolaryngologist and facial plastic surgeon from Austin, Texas, said he foresees app development becoming customized so that apps can be designed with each specific practice and physician in mind. His practice is working on one that will allow him to access his EMR in a read-only mode from his iPhone. He is able to open attachments from his EMR sent to him by his nurse.
The momentum for mobile technology in health care mostly has been pushed by technology and telecommunication companies, the study points out. But it found that doctors and hospitals could create their own revenue streams by developing mobile products for their patients. According to the survey, consumers said hospitals are the preferred place to purchase mobile health products, and physicians are overwhelmingly the most trusted source of health information.
The print version of this content appeared in the Oct. 11 issue of American Medical News.
ADDITIONAL INFORMATION:
| Physicians interested in monitoring | |
|---|---|
| Weight | 65% |
| Blood sugar | 61% |
| Vital signs | 57% |
| Exercise/physical activity | 54% |
| Calories/fat intake | 36% |
| Pain level | 36% |
| Sleep patterns | 35% |
| Cardiac rhythm | 28% |
| Bladder control | 17% |
| Acid reflux/indigestion | 16% |
| Digestive health | 13% |
| Percentage who would pay for task | |
|---|---|
| Patient monitors fitness/well-being | 20% |
| Doctor monitors condition remotely | 18% |
| Patient monitors previous condition | 11% |
| Patient not willing to pay anything | 51% |
| Mobile users who text | |
|---|---|
| Medicaid | 79% |
| Tricare | 74% |
| Employer-sponsored | 68% |
| Individual policy | 65% |
| No insurance | 63% |
| Veterans' health | 45% |
| Medicare | 43% |
Copyright 2010 American Medical Association. All rights reserved.
Source: "Healthcare Unwired: New business models delivering care anywhere," PwC Health Research Institute, September
Source: "Healthcare Unwired: New business models delivering care anywhere," PwC Health Research Institute, September
Source: "Healthcare Unwired: New business models delivering care anywhere," PwC Health Research Institute, September
