From The Orange County Register
By Lauren Williams, Staff Writer
In a bustling emergency room in Orange, Dr. Seth Brindis doesn’t have to take time from patients to send a secure message to a colleague or check a peer-reviewed study.
He’s armed at the hip with a dozen medical smartphone apps that include UpToDate, Figure 1 and pingmd. The apps enable Brindis to review the latest medical journals and share patient information with other doctors while complying with privacy laws.
“It is much easier to access in the palm of my hand,” said Brindis, the medical informatics director at the Children’s Hospital of Orange County. “I’m in the emergency room, and I’m constantly moving, so it’s better for me.”
Brindis recently used an app to follow the case of a young patient who was brought into the ER with severe facial wounds from a dog bite. He was able to track his patient’s progress after a visit to the plastic surgeon.
“As an emergency doctor, I don’t usually to see the follow up,” he said.
Medicine is one of the latest industries undergoing a renaissance thanks to the widespread adoption of tech-enabled services created by small startups.
A BIG SHIFT FOR DOCTORS
There are thousands of healthcare-related apps on the iTunes store, with many aimed at patients and an increasing number engineered for physicians.
Among them are Figure 1, a Toronto-based startup that is essentially Instagram for medical professionals, and Isabel, a database filled with symptoms and possible diagnoses run by six people in Michigan.
“It’s changing this culture of medicine from the physician side,” said Dr. Warren Wiechmann, who teaches emergency medicine at the UC Irvine School of Medicine. “It’s no longer you’re expected to know everything. Here are tools to expand, or brush up on your knowledge base. I think that’s a big shift for physicians.”
Apps like Santa Monica-based Heal have revived doctor house calls. The website CrowdMed enables patients with unusual ailments to crowdsource a possible diagnosis. In turn, the impossible burden of being familiar with every illness known to man isn’t placed on doctors, who can be more candid with patients about seeking another opinion.
“There’s so much going on out there in terms of research and drug development. To really stay on top of the literature is nearly impossible,” said Wiechmann who also serves as the medical school’s associate dean of clinical science education and educational technology. “If you really wanted to stay on top of literature in your field, you wouldn’t be able to see patients. These apps are taking a decent stab at doing it. You don’t wait for two years for a textbook to come out.”
It was that obstacle for doctors that inspired Jason Maude to create Isabel Healthcare, an online portal and app in which users – clinicians and patients alike – can enter symptoms and get suggested causes. In 1999, Maude’s then 3-year-old daughter Isabel nearly died when her toxic shock syndrome and flesh-eating bacteria almost went undiagnosed.
“Doctors have a huge burden of memory on them,” Maude said. “How on Earth can they spot these slightly odd illnesses?”
In 2000, he founded Isabel as a computer-based diagnostic tool for doctors. The company wasn’t an instant hit because many hospitals didn’t see misdiagnosis as a problem. In 2012, Isabel extended its product to patient use. Since then, some 150 hospitals in the U.S. and U.K. have integrated Isabel onto their websites for patient use.
“What we found, was what we suspected,” Maude said. “Patients are a lot smarter than doctors think.”
In turn, CrowdMed puts a bounty on a malady, aiming to help frustrated patients find an answer.
CrowdMed’s website allows patients to tap into the collective knowledge of medical professionals worldwide. Users post a reward for the doctor, nurse, medical student or other “medical detective” who successfully suggests the appropriate diagnosis. A patient then brings these suggestions to their doctor.
Medical detectives can “like” a diagnosis they agree with or flag suggestions that seem inaccurate. A couple of flags can get a suggested diagnosis removed.
CrowdMed is a departure from the conventional doctor-patient relationship in more ways than one, said Dr. Greg Denari, a retired primary care physician and adviser to the San Francisco-based startup that has six full-time employees.
Traditionally, “you go see your doctor as one person, and one person absorbs the stuff and decides what’s going on,” Denari said. “What’s different with CrowdMed is you have a crowd. … One person may not know the answer, but in a crowd of people, one does. A physician may overlook a detail.”
Part of what makes CrowdMed powerful, Denari said, is that those who weigh in aren’t afraid of being embarrassed or going against another physician as they might be in a hospital or doctor’s office.
“There is more candor, and I think it’s the anonymity,” Denari said. “My only interest is really only helping the patient.”
There’s a chat function where detectives can talk about potential root causes, but no conversations are behind closed doors. Other detectives and the patient can watch and weigh in.
“In traditional medicine, at some point the patient sometimes gets cut out of the discussion,” Denari said.
USE WITH CAUTION
These emerging healthcare platforms come with some pitfalls.
Experience in the field and app usage don’t necessarily go hand-in-hand, said Wiechmann, and patients might not be able to distinguish between the more seasoned doctors and those whose only experience is in online cases. That can be especially problematic with unusual conditions.
“Someone who just started has tons of time and is their highest user but it has no correlation to true expertise,” said Wiechmann, the UCI doctor and professor. “When you get one thousand of the same answer, it’s probably the same answer. But for the more esoteric, where you only have one response, can you really hang your hat on that response?”
When launching Figure 1, Dr. Joshua Landy ran into other moral and legal quandaries inherent in launching a medical app. The app is filled with images of weird bone fractures, strange bumps and discolored skin, among others. In less time than it took to build and launch the app, attorneys weighed in on how to navigate patient privacy laws while still having a usable product.
To comply with privacy laws in the U.S., Canada and the United Kingdom, a moderator approves each photo uploaded to the site to ensure no identifying information is on display – from the obvious, like tattoos, to the more esoteric, such as a patient’s IP address. Before uploading a photo, metadata from the image is wiped clean, so when and where the image was captured can’t be shared with other users. Patients also sign a consent form.
“We don’t want sensationalistic photos, nothing that makes fun of patients,” Landy said. “Our users are really good about their behavior. … These people are professionals. The language they use there is the same language they use at work.”
At its best, Figure 1 taps into the collective knowledge of physicians worldwide, Landy said.
Still a practicing doctor, Landy recently snapped a close-up of a woman’s eyeball when it developed an odd film. Within minutes, he received input from an ophthalmologist and optometrist on Figure 1 who agreed on a possible cause. The top layer of her eye had dried out and needed aggressive lubrication and coverage.
“Having a doctor who can say ‘I don’t know, let me ask half-a-million professionals in 190 countries and get back with you in five minutes’ is a pretty big shift in medicine,” Landy said.
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