By Brian Schilling
If you don’t recall the peanut-butter-based salmonella outbreak of 2009, thank social media. Without it, you might remember the outbreak as a sad and disturbing failure of the public health system that cost hundreds or even thousands of lives. But instead, a broad social media campaign waged mainly over Facebook and Twitter directed by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) largely blunted the outbreak, sparing countless lives by spreading a crucial message almost instantly to smart phones and other devices all across the country: Put down the PB&J!
This triumph of technology over a very real and potentially daunting health challenge bodes well for our health care future. This happened back in 2009 when Twitter had 29 employees and Facebook had a mere 200 million users, compared with 400 employees and 900 million users this year.1,2 Social media was still in its toddlerhood and the real potential of using it to improve population health had not yet been explored. Much potential remained untapped. It still does. But that’s changing fast.
Today millions of Americans with thousands of different conditions regularly turn to social media sites to help them research conditions, learn about medical options, trade treatment experiences, keep family and friends updated, or simply seek support. Among the more popular of these sites are: PatientsLikeMe, CarePages, CureTogether, iMedix, DailyStrength, and OrganizedWisdom, all of which make the same fundamental promise—to link people with the collective support and input of a caring community.
If this sounds like it’s perhaps nice, but not medically relevant, think again. Studies like “Perceived Benefits of Sharing Health Data Between People With Epilepsy on an Online Platform,” published in the peer-reviewed journal Epilepsy & Behavior, are cropping up in the established medical literature more and more frequently. Most find that patients can substantially benefit from the support and input social media so readily provide. The study referenced above found that among new members of a PatientsLikeMe epilepsy community, perceived benefits included finding another patient with the same disease to talk to (59%), better understanding of seizures (58%), and learning more about symptoms and treatments (55%). Study authors concluded that “sharing of health data via social media may have the potential to improve disease self-management.”
Leading hospitals and health systems are very much on board. The Mayo Clinic, Boston Children’s Hospital, and the Cleveland Clinic have all moved to integrate social media tools into their patient engagement efforts. Reviews have been almost universally positive and organizers say that the effort has also spawned online communities that independently arrange tweet-ups and in-person meet-ups.
Smart Phones and Apps Galore
Apart from allowing on-the-fly access to social media resources, today’s smart phones—more than 100 million Americans have them3—enable patients to play a much more active role in their own health care. In addition to serving as a mobile phone, a smart phone is a small, Web-enabled computer that, with the right app (i.e., application for mobile devices) and hardware, can be made to mimic a range of diagnostic equipment. Some 18,859 such apps are now available for purchase or download4 and they give users an impressively broad menu of options for measuring, monitoring, tracking, and controlling various conditions. For example, there are currently apps or devices that help users to:
- monitor and measure glucose levels;
- perform a basic electrocardiogram (EKG);
- find conveniently located providers or urgent care centers;
- refill prescriptions;
- scan bar codes and retrieve related nutrition information;
- view and store x-rays;
- triage medical conditions based on symptoms;
- check drug information;
- quit smoking; and
- track body mass.
The more sophisticated of these apps can automatically upload data to a patient’s electronic health record (EHR), as well.
Regulatory issues abound. To date, very few of the apps on the market have earned FDA approval. Little wonder: app makers tend to be small, fast-moving, regulation-averse entities that prize being first to market even to the exclusion of having a viable business model. The FDA is only now working to define which apps might eventually require FDA approval. For its part, the Senate seems unsure that regulation is called for at all, having recently voted to delay an oversight effort over concerns that it might stifle innovation and cost jobs.
Hello Health
The rapid embrace of smart phone technology to communicate, research, buy, play, and otherwise live begs an interesting question for the standard physician practice. How much longer will the “let’s-do-everything-in-person” business model stay viable? While there are no signs of an impending collapse, a number of vendors are eager to help practices offer patients a wide range of communications options and interactive tools.
There may be a very large market. According to a 2012 Accenture survey5 (which, notably, was conducted online), 90 percent of patients want to self-manage their health care by using technology. That means that they would like to have the option of viewing records, seeing physician notes, making appointments, and receiving test results, among other functions, via their computers or phones.
Most physician practices can’t yet accommodate that desire. Barriers to establishing secure systems for communicating sensitive medical information include cost and Health Insurance Portability and Accountability Act (HIPAA)–related privacy concerns. Even so, many physicians are at least considering their options. And some systems have already taken the plunge. Kaiser Permanente members enjoy all of the interactivity in the paragraph above and as a result, the insurer estimates that it avoids more than a million office visits a year.
Small practices without Kaiser’s infrastructure can turn to one of dozens of vendors vying for space in this market. One such vendor is Hello Health, a four-year-old New York–based firm that markets interactive EHR technology to practices in 26 states. The firm is small. Its clients number in the hundreds rather than the thousands, but its software offers a robust, fully HIPA-compliant platform for online scheduling, prescription renewals, medical record access, instant messaging, lab result review, and even video visits.
Patients and physicians seem happy with the decision to move some care and administrative activities online. One patient, John Dias, a retired IT professional from Universal City, Texas, noted that his doctor’s switch to Hello Health had saved him at least one very awkward trip to the doctor’s office. “I had a nasty bruise on one leg that was related to a chronic condition and was supposed to go back for a follow-up visit. At the time I couldn’t easily get to his office, so we arranged a video chat instead. My doctor looked at the bruise, saw that it was healing nicely, and that was that.”
Overall, about 90 percent of patients opt to continue using Hello Health year after year despite the fact that it may cost them a small monthly fee. Few, if any, physicians have dropped the platform. For many practices, the switch to Hello Health’s software has meant a bump in revenue.
“It has meant a little extra income that has added up over time,” said Gary Leeds, M.D., a New York City–area family practice physician and an early adopter of the technology. But, he says, that’s not the real benefit. “A lot of our patients have mentioned that they like the online aspects of Hello Health,” he noted. “It’s a huge time saver for our tech-savvy patients and they appreciate knowing that we’re only a click away.”
The target market for Hello Health’s software and the price are both somewhat surprising. “We target solo practitioners or practices with just two or three doctors,” said company vice president Stephen Armstrong. “And the price is zero.” Hello Health’s revenue comes from a percentage of the annual fee practices charge patients for access to the platform. Those fees are typically $60 a year.
Potential Cost Savings?
Whether more practices will elect to offer online interactive tools in the future remains to be seen, but the high level of interest and the broad penetration of technology seem to suggest a Web-enabled future for health care. Many believe this will bring savings. In 2011, there were nearly 1 billion doctor’s office visits in the United States.6 Each one presumably generated some sort of bill. Employers pick up the bulk of the tab for those bills. But what if 3 or 4 or 5 percent of those visits became unnecessary? How many lost hours of work might be recaptured if, instead of going to the doctor’s office, an employee could snap a picture, e-mail it, and dash off a note to his doctor?
“I think the potential for savings is underestimated by a wide margin,” said Armstrong of Hello Health. “How much does the average practice spend on administrative costs? We have Hello Health practices that have been able to redirect administrative staff to other activities because they’re almost entirely paperless.”
A Tech Firm Emphasizes the Human Touch
Tesla Motors, the billionaire-backed maker of sleek, all-electric sports cars, is perhaps ideally suited to highlight social media and technology in its health benefits. The company’s demographic skews heavily in favor of young, well-educated employees. It’s hard to imagine that even a single Tesla employee doesn’t already have a smart phone and can navigate comfortably around the online world. The company is working with its health vendors to ensure that employees will soon have at-work access to a full range of options that allow them to chat with their doctors, renew their prescriptions, and download lab results.
Nevertheless, Tesla is purposefully not leveraging technology as a substitute for the kind of one-to-one interactions that might seem quaint in a tech-enabled era. Benefits manager Nate Randall eschews blast e-mail as a communications medium, having sent, he estimates, only three in the past 18 months. “Ninety percent of those e-mails get deleted,” explains Randall. “We prefer to communicate about benefits face-to-face; there’s just no good substitute.”
Randall still meets with every new Tesla employee either individually or in a small group during orientation or in days-long open enrollment sessions to go over benefits and make sure they fully understand their options and resources. He says it’s well worth it.
“We were recently named one of the top employers in the Bay Area,” says Randall. “Part of that is because we’re a cool technology company, but part of that is also because we know when not to be.” Randall explains that the Tesla human resource department’s quasi-official motto is “do the right thing,” which sometimes means leaving the smart phone out of the loop.
References
1. http://blog.twitter.com/2011/03/numbers.html
2. http://en.wikipedia.org/wiki/Facebook
3. http://www.geekwire.com/2012/100-million-americans-smartphone-47-percent-choose-windows-phone/
4. http://www.washingtonpost.com/business/economy/health-care-apps-for-smartphones-pit-fda-against-tech-industry/2012/06/22/gJQAHCcBvV_story.html
5. http://www.accenture.com/SiteCollectionDocuments/PDF/Accenture-Is-Healthcare-Self-Service-Online-Enough-to-Satisfy-Patients.pdf
6. http://www.ahrq.gov/research/pcwork1.htm
