Envisioning 2.0

Following is my contribution to an innovative project Jack Mason of HealthNex has started. It is called Blogposium, a “three-day collaboration of healthcare bloggers to expand the Clinical Informatics Wiki.”

Please help us make this effort a success by making comments and providing edits to each entry. You can find additional Blogposium submissions at the following blogs:

• Christina’s Considerations: Regional Health Information Organizations
• eHealth: Integration of Personal Health Records and Electronic Medical Records
• EMR and HIPAA: Electronic Medical Records and Biometric Integration
• HealthNex: Biobanking, Patient Experiential Data and Genetic Privacy Issues
• HITsmit: e-MAR Systems
• HIT Transition: RHIO Startup Funding and Finance
• Marketplace.MD: The Consumer-Driven Health Care Movement
• medmusings: Mobile Access to EMR/EHR/PHR for Providers and Patients
• Usemed: Ongoing and Completed EHR, CPOE and CDS Implementation Projects

My entry, focusing on the impact of SMS and blogs on the patient-provider relationship is below.

SMS, Blogs and the Patient-Provider Relationship: Enhancing Communication, Improving Treatment Outcomes

The healthcare provider-patient relationship is one of our most valued and important connections. This is true across a range of countries and cultures. For example, according to a 2003 study presented at the World Medical Association, people ranked their relationship with their physician as second only to their connection with family members.[1] Another study indicates that people want their physicians to have good communications skills, to be accessible and to partner with them to help them achieve good health.[2]

Unfortunately, patients and medical professionals face significant obstacles to building strong, positive relationships. One barrier is time. Many medical professionals complain that they have limited time to address all of their patients’ needs during a visit. Another challenge is behavior, specifically patient noncompliance with medication and missed appointments. It is difficult for providers to build rewarding connections with noncompliant patients or those who do not show up for sessions.

Fortunately, patients and medical professionals have access to a number of inexpensive and easy-to-use technologies that they can use to enhance communication, increase compliance, limit no-shows and improve treatment outcomes. This article focuses on how two of them, text messaging and blogs, can improve the patient-provider relationship and medical management.

Definitions: Text Messaging and Blogs

Text Messaging (SMS)

Short Message Service (SMS) or text messaging is a mobile phone technology that enables people to send and receive text messages (usually no longer than 160 characters) to cell phone or computer users.

Blogs

Blogs are Web sites containing an archive of content in reverse chronological order.[3] Over the past decade, blogs have increased in popularity because they enable people to publish content to the Web without having a great deal of technical expertise.

SMS and the Patient-Provider Relationship

As indicated above, two significant barriers to the development of a positive patient-provider relationship is noncompliance and patient no-shows. Evidence is building that SMS may be an inexpensive and efficient way to solve both of these problems.

Reducing Missed Appointments Using SMS

Missed appointments are a significant problem in many countries, especially in Britain. It is estimated that patient no-shows cost the National Health Service (NHS) about £575 million annually.[4] Some studies suggest that SMS may help reduce the rate of missed appointments. For example, a trial conducted at London’s Homerton Hospital indicates that SMS helped reduce missed appointments at the institution’s Department of Sexual Health by eight percent.[5]

Improving Compliance and Treatment Outcomes with SMS

As medical professionals are all too aware, it is very difficult to monitor patients to ensure they comply with therapy. Using SMS may be one way to increase patient compliance and improve treatment outcomes.

A study published in early 2006 in the journal Sexually Transmitted Infections indicates that patients who receive text messages may be more likely to seek treatment. Patients using SMS took less time to get treated (an average of nine days versus 15 for those not receiving text messages) and used fewer staff resources.[6]

In the United States, healthcare providers have been using SMS to help patients take an active role in their diabetes treatment. In one study, researchers used a text messaging service called “Sweet Talk” with teenage patients. Each day the patients received a reminder to take their medication. Patients that received text messages felt that their treatment was much improved and had better control of their blood glucose levels.[7]

These studies indicate that SMS may help patients have more productive and rewarding relationships with their healthcare providers because they will be more likely to show up for appointments, comply with therapy and have better treatment outcomes.

Blogs and the Patient-Provider Relationship

In 2005, Harris Interactive reported that 117 million Americans regularly turn to the Internet for healthcare-related information.[8] This statistic indicates that the Web has become an important tool for people seeking to become educated about medical conditions.

The Internet is also having an impact on the patient-provider relationship. Traditionally, patients have viewed providers as their primary source of healthcare information. With the advent of the Internet, patients no longer relied primarily on healthcare providers for medical information. They began to gather medical content from the Web and share it with healthcare providers.[9] Today, a significant proportion of medical information available on the Internet is published on blogs and other sources of consumer-generated content (i.e., bulletin boards, podcasts).

With increased education, patients began to feel more comfortable partnering with healthcare providers rather than relying on them to make the majority of medical decisions.[1]

Blogs enhance the provider-patient relationship because they enable both parties to apply and share highly relevant medical information. Blogs can also improve relations between medical professionals and patients by:

- Facilitating Patient-Provider Communication: Blogs can provide an opportunity for patients to ask anonymous questions of providers about how to identify and manage medical conditions. Providers can use blogs to educate patients and direct them to credible sources of healthcare information. However, patients should always be warned that a blog is no substitute for professional, customized medical advice.

- Enhancing Patient Therapy: Some healthcare providers are prescribing blogs to patients as a part of their therapy.[9] They ask patients to use blogs to relate their experiences and share information and insights with others.

- Informing Providers About Best Practices: Patients and healthcare providers can both benefit from the careful application of evidence-based medicine and best practices. Blogs can be a good source of detailed information about how to manage common and rare medical conditions. One example of a good “treatment” blog is Clinical Cases and Images, which physicians at Case Western Reserve University maintain.

Drawbacks

While blogs and SMS have the potential to improve the patient-provider relationship, there are a few drawbacks to these technologies:

- Patient Privacy: Before the use of SMS becomes widespread in patient care, healthcare providers will have to determine ways to preserve patient privacy. With blogs this is less of a problem, as people can post content anonymously.

- Lack Of Data: While investigators have conducted a number of studies examining the benefits of SMS on patient care, additional information is required. Moreover, there has been no systematic review of healthcare blogs to determine if they have a positive impact on the patient-provider relationship or treatment outcomes.

- Access Issues: While SMS technology is available in most parts of the world, many do not have regular access to the Internet. The digital divide between and within countries may hamper the widespread adoption of blogs by medical professionals and patients globally.

References

1. Magee, M. Relationship-Based Health Care in the United States, United Kingdom, Canada, Germany, South Africa and Japan. in World Medical Association Assembly September 11 2003. Helsinki, Finland
2. Anonymous, Future Of Family Medicine: Selected Quantitative and Qualitative Research Findings. 2002, Future of Family Medicine Leawood, Kansas.
3. Anonymous. Blog. 2006 February 16, 2006 [cited 2006 February 19]; Available from: http://en.wikipedia.org/wiki/Blogs.
4. Atun, R. and S. Sittampalam, A Review of the Characteristics and Benefits of SMS in Delivering Healthcare, in The Role of Mobile Phones in Increasing Accessibility and Efficiency in Healthcare. 2006, Vodaphone Group. p. 18-28.
5. Dyer, O., Patients Will Be Reminded of Appointments by Text Messages. British Medical Journal, 2003. 326(7402): p. 1281.
6. Menon-Johansson, A.S., et al., Texting Decreases the Time to Treatment for Genital Chlamydia Trachomatis Infection. Sexually Transmitted Infections, 2006(82): p. 49-51.
7. Anonymous, A Text a Day . . . , in The Economist. March 25, 2006. p. 95.
8. Anonymous. Number of “Cyberchondriacs” – U.S. Adults Who Go Online for Health Information – Increases to Estimated 117 Million. 2005 July 15 [cited 2006 March 19]; Available from: http://www.harrisinteractive.com/harris_poll/index.asp?PID=584.
9. Johnmar, F., The Emerging Healthcare Blogosphere: What Is It & Why Does It Matter? . 2006, Envision Solutions, LLC. New York, NY.

This entry was posted on April 18, 2006 at 12:58 pm and is filed under Blogposium, Healthcare and Technology, Most Popular Posts. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.