Self Service Medicine: It’s Clinical Now!

Self-service medicine – it’s now more than using an appointment-scheduling kiosk, conversing with a phone robot or ordering electronic prescriptions.  Already mastered by many, these essentially administrative tasks – the equivalent of supermarket self-checkout – are looking a lot like false summits to patients climbing the healthcare learning curve.

In truth, the climb continues.  Patients are learning that self-service medicine now includes self-diagnosis, self-medication, self-entered histories, self-care, self-management and self-monitoring, with the latter sometimes relying on clever gadgets attached to app-equipped smartphones.  The clinical realm clearly is no longer off limits to patient self-service.

Not too long ago, clinicians frowned on patients arriving for appointments with print-outs in hand, having researched and self-diagnosed their symptoms on the Internet.   Now, some physicians are encouraging patients to prepare for appointments by consulting reliable symptom checkers, as reported recently by the Wall Street Journal.  These include the widely used WebMD, as well as symptom checkers available from the Mayo Clinic, the American Academy of Pediatrics, and companies such as A.D.A.M, iTriage and Isabel.

Why the turnabout?  As Dr. George Reynolds, chief information officer of Omaha’s Children’s Hospital and Medical Center told the Journal, “We are giving them a much better tool than just googling a bunch of stuff.”  Dr. Mark Graber, president of the Society to Improve Diagnosis in Medicine, observed that “suggesting a range of possibilities to your M.D. might help prevent the premature closure errors that underlie so many diagnostic errors.”  Isabel founder and chief executive officer, Jason Maude, explained that “patients are experts on their symptoms and doctors are experts on working out their probably causes.”

Driving self-diagnosis and self-service medicine into the mainstream will be additional factors closely aligned with self-service expansion throughout the economy.  These include saving time during office visits, more productive consultations and potentially better clinical outcomes, for example in helping doctors think of something they hadn’t considered and preventing diagnostic errors.   In other words, self-service medicine such as self-diagnosis helps drive down provider cost and increases quality.

Inspired by Mary Meeker’s annual Internet trends presentation, HealthPopuli author Jane Sarasohn-Kahn recently observed, “the more consumers can do for themselves in remote monitoring, on-time efficacious care, and safe aging at home, the more providers can manage their risk for that patient’s conditions” within the context of value based healthcare and risk management.  So the more Medicare and commercial insurers (e.g. UnitedHealth Group) move away from fee for service to value or population based reimbursement, the more self-service medicine will grow.

Here are some additional examples:

    • According to Physicians Practice, patient entered histories can effectively address problems with traditional physician-patient interviews identified in a Mayo Clinical Proceedings article.  The Mayo review noted that 50% of psychiatric problems are missed, about 50% of patient problems go unaddressed and patient and physician do no% t agree on the primary complaint 50% of the time.  And, there’s less work for providers.  As Physicians Practice observed:  “Whether you are writing a note, using dictation, or typing into an EMR, documenting the subjective part of the note can be time consuming.  Why not have patients tell (i.e. document) their own stories?
      • The 2013 TEDMED conference in Washington, DC, featured “The Smartphone Physical” exhibit, where attendees saw how a special cell phone case doubled as a one-lead EKG, an attachment snapped pictures of the inside of a subject’s eye and another attachment produced a “picture perfect” magnification of the inner ear.  Harvard medical student Ravi Parikh wrote in the Washington Post that smartphone medical applications cost less, produce better quality results and more fully engage patients – once again, the factors driving expansion of self service medicine. As the curator of the exhibit, Johns Hopkins medical student Shiv Gaglani told Parikh:  “Some of the smartphone devices are already being used by patients to collect and store their data, so when they see their clinicians they can have productive and informed conversations.”

Underlying each of these examples of self-service medicine, from self-diagnosis to self-service physicals, is a technology platform for use on the Web but typically also available via a smartphone.   So, with the growth of self-service medicine, how many people, unable to own smartphone or access such a device or the Web, will find themselves on the wrong side of a healthcare “digital divide?”

Not as many as might be feared.  According to the Pew Internet Project, 85% of U.S. adults use the Internet, 91% own a cell phone and 56% own a smartphone.  Of these, 31% of cell phone owners and 52% of smartphone owners have used their phone to look up health or medical information.  Notably, Pew, observes that young people, Latinos and African Americans are significantly more likely than other groups to have mobile Internet access.

However, some are concerned that smartphone prices may go up, hampering widespread access, due to a pending decision by the International Trade Commission in a battle between Apple and Samsung over Samsung smartphone imports.  The controversy is arcane, involving Apple’s claimed exclusive rights to the rounded rectangular touchscreen design.  If the ITC rules in Apple’s favor, the concern is that prices could go up.  That could impact the next 100 million new smartphone users, who BI Intelligence predicts will be older and/or lower income.

Meanwhile, Boston’s safety net hospital, Boston Medical Center (BMC) will offer low-income patients access to the OneHealth online and mobile platform to promote self-management of chronic diseases, offer peer support and engage them in between office visits.  As BMC’s Dr. Robert L. Sokolove told MobiHealthNews, “Many of our patients can’t use a desktop because they don’t have a desk, but they do have smartphones.”

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