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  • Disruptive innovations that will potentially change delivery of healthcare in the Philippines

    What is disruptive technology?

    A disruptive technology is an innovation providing a product or service that is so compelling that everyone rapidly abandons their current way of doing things and flocks to what is new- Hank C. Lucas Jr (University of Maryland)

    In an archipelagic country like the Philippines and with a healthcare delivery system lagging behind its neighbours, disruptive technologies offers us a new way of looking at problems. Disruptive technologies may also offer a cost effective solutions to lingering health care problems that has been besetting us for decades.  Healthcare problems that we often blame on lack of resources.

    Here are some innovations in healthcare that might have just been knocking at our healthcare doors (infographic from Bertalan Mesko, Medical Futurist)

    MEDICAL_infographic_final

    Here are my top three disruptive innovations that might just change the way we handle healthcare in the Philippines:

    1. Internet and social media– information explosion via the internet has tremendous leveraging effect on healthcare system. Access to medical information and collaborative work has never been easier and faster with internet. Social media on the other hand, has a provided us a new tool for engaging patients on a participatory type of medicine.
    2. Massive Open Online Courses (MOOC) revolutionized access to learning and education.  Healthcare education is already jumping on this innovation, albeit slowly in the Philippines. Although we definitely need formal, face to face, institution based medical education, other aspects of healthcare education (like learning healthcare systems or healthcare models that are not taught in medical school) can be learned tru MOOCs. MOOCs also brings down the prohibitive cost of medical education as well as “lack of resources” for learning that we so blamed in the academe.
    3. Telemedicine – Don’t have a healthcare professional in your location? Just video chat on an online physician elsewhere!  Don’t have a colleague to refer to or work with managing a patient? Just teleconference with another doctor elsewhere! The impact of this innovation to health care is enormous. In a country where healthcare delivery is very much affected by geography, human resources (the lack thereof) and prohibitive cost, telemedicine offers a unique way of addressing healthcare problems that remains under utilized until now.

    Of course there are other disruptive innovations I can add to the list. These have not yet ” landed” on our shores or are probably experimental in their uses for healthcare in the Philippines. The 3d printing technology or 3d bioprinters for example, has helped in replication tissues that are very much needed by our body. In orthopedics, 3D printers have helped scientists and doctors create stem cells that could eventually develop into both bone and cartilage in the long-term.

    So what among these disruptive technologies you think might help us solve some of our health care related problems in the Philippines?

  • Should the medical community recognize the social media work of healthcare professionals?

    A surgeon blogger  raised an interesting question about social media and academe in his blog Skeptical Scalpel.

    [quote style=”boxed”]Should academia recognize social media achievements?[/quote]

    The author compared his blog post‘s page views to the number of people who read his published scientific articles – peer-reviewed papers, case reports, review articles, book chapters, editorials, and letters to journal editors on a peer reviewed journal.  The 13, 400 pageviews his blog post generated “far exceeded the views his peer reviewed scientific articles” garnered!  The metrics he used maybe a bit crude but you can’t just disregard those numbers.

    This multi authored site Healthxph.net began eight months ago, published some 50 posts, had a total of 6K plus views as of today. HealthXPh health care related topics are broadcast and discussed over twitter via a healthcare tweetchat #healthxph. At one point, a healthxph tweetchat generated  some 9 million plus impressions spread  globally. Crude as it may seem, but that tweet chat impressions most probably far exceeded too the “page views” of all the published scientific articles of this site authors combined!

    We want the fastest way to share new medical information into the scientific community and jump start discussion. Or maybe refute it. The broader, general audience will most likely benefit if new healthcare information is readily available and accessible to them. That was exactly what we wanted for paper based journals a century ago. Peer reviewed online publications had the same goal with its launch twenty something years ago.Today, social media is poised to that too. We just need more healthcare professionals to run healthcare social media.

    Most of us acknowledge the value of social media to learning. It’s role beginning to take shape in the academe. Healthcare systems use social media to deliver vital medical information to the scientific community. The rapid spread of information on social media makes new medical information available to the general public, fast and easily accessible.

    We recognize social media’s value to healthcare  yet , we seem reluctant to accept the fact we need healthcare professionals to “run” healthcare social media.

    Join us his Saturday October 11, 2014 at 9PM Manila time as we discuss the following issues

    • T1. Should the medical community recognize social media works of healthcare professionals? Why or why not?
    • T2. How should the healthcare system quantify social media work by healthcare professionals?
    • T3. How should the medical community peer review social media work of healthcare professionals? Why or why not?

  • Who owns Healthcare data on Social Media?

    What constitute healthcare data? Who owns it? Who has complete control over healthcare data?

    Let me describe first the two general types of health data:(Wikipedia)

    A personal health record, or PHR, is a health record where health data and information related to the care of a patient is maintained by the patient.

    An electronic health record (EHR), or electronic medical record (EMR), is a systematic collection of electronic health information about an individual patient or population

    Patients have total control over their PHRs.  Although an EHR maybe co-created by both the HCP and patient, it generally resides and is maintained within an institution such as a clinic or hospital.

    In countries with paper based systems of recording healthcare data, the same type of healthcare data “ownership” may be inferred. The patients have total control of their personal health record while the healthcare institution, over hospital/clinic records.

    Some patients wanted access over his or her clinic/ hospital records (EHR or paper based). Others, want total control over it. The rising trend of sharing healthcare data in social media fueled fears of healthcare data privacy breaches.  In this age of smartphones and social media, who owns healthcare data?

    These are the burning issues on #HealthXPh tweetchat this Saturday September 13, 2014 at 9:00 PM Manila time. I highly encourage both HCPs and patients to share their thoughts and opinions!

    • T1. What healthcare data can patients share on social media?
    • T2. If HCP names are redacted, does that remove need to secure consent before posting?
    • T3 .What can the HCP/patient do if he/she’s identifiable in any social media platform posted?

    Follow #HealthXPh on twitter and join us on our regular Saturday tweetchat!

  • Crowdsourcing disease surveillance using social media: a tool to fight off disease outbreaks?

    Early this year, an unknown disease  affecting horses broke out in one local community and downed people  who consumed the presumably infected horse meat. For the most part of the disease outbreak, healthcare institutions had the difficulty  of identifying the pathogen. Results of the diagnostics done on ill patients took some time to arrive. The mode of transmission of the pathogen, hasn’t been established yet early on in the disease spread. Manpower and logistics for validated methods of disease surveillance is also depleting resources of government healthcare unit handling the case. These made outbreak surveillance became increasingly difficult if not impossible in some areas.

    In develop countries, disease or outbreak distribution maps gives our healthcare leaders an overview of the size and magnitude of outbreak. It is usually based on validated diagnostic results from centers equipped with such capabilities.  But even in such highly develop healthcare systems, results from equipped labs may still take at least 2 weeks to be confirmed.

    What about a symptoms map – a map of disease outbreak base on symptoms alone? What about mobile phones or sms maps? Reporting using mobile phone and sms is already problematic. We don’t have the huge manpower on the ground and centrally to collect and collate data from sms.

    I was toying on an idea. Can we crowdsource disease surveillance using social media?  Since I was a bit familiar with google mapping, thats what came immediately to my mind. Then twitter. Then Facebook. and my list of possibilities went on.

    Social Media Network Connections Among Twitter Users by Marc Smith January 2012 via Flickr
    Social Media Network Connections Among Twitter Users by Marc Smith January 2012 via Flickr

    In the recent days, social media became a common platform where people reveal their locations and travels. You might also notice the frequent status updates containing contextual concerns such as “sick” , “sneezing”, “hospitalized” and many other health related issues . Those data can be aggregated, funneled, analyzed (so called data mining) and be made available for health research or even mitigate disease spread.

    It is without some caveats though.

    Crowdsourcing disease surveillance raises several questions about health data privacy and accuracy. Many healthcare personnel are reluctant to actually use it even as an adjunct to validated, diagnostics based disease surveillance. Given that the Philippines don’t have that many diagnostics centers for disease outbreaks, can social media crowdsourcing help in disease surveillance?

    Join #HealthXPh this saturday August 16 2014, 9PM Manila time , as we discuss crowdsourcing disease surveillance using social media.

    • T1. Is there a role for social media crowdsourced health data for outbreak or disease surveillance? Why or why not?
    • T2. As a patient/ HCP will you approve the use of volunteered social media data for outbreak or disease surveillance?Why or why not?
    • T3. Who do you think is accountable for all the crowdsource data generated and its analysis? Will it be the social media platform? the data miner?

    As closing thought, please give one major reason why you would use/allow (not use/ not allow) crowdsourced social media data for disease surveillance.

    See you on saturday for an interesting tweetchat on one timely topic!

    References:
    Using Twitter to Put Disease Outbreaks on the Map
    http://www.sciencefriday.com/blogs/07/20/2012/using-twitter-to-put-disease-outbreaks-on-the-map.html?audience=4

    2014 Ebola Outbreak in West Africa – Outbreak Distribution Map
    http://www.cdc.gov/vhf/ebola/resources/distribution-map-guinea-outbreak.html

    http://www.crowdbreaks.com/

    http://www.sickweather.com/live-map.php

    Trending Now: Using Social Media to Predict and Track Disease Outbreaks
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3261963/

    Twitter Can Track Disease — Can It Predict Outbreaks?
    http://mashable.com/2012/06/08/social-media-disease-tracking/

    How Twitter Tracks the Spread of Disease in Real Time
    http://mashable.com/2011/10/19/twitter-track-h1n1/

    Social Media and Environmental Health Crises: An Examination of Public Response to Imported Drywall and Perchlorate Health Risks
    https://apha.confex.com/apha/139am/webprogram/Paper247309.html

  • Flying with an angel

    “Rest in peace Samantha. I will always remember you.”

    3A. Window side. That was supposed to be my seat on the plane. Seeing a dad comforting a special kid on his lap on seat 3b and 3C (near aisle), I volunteered to sit on the 3c so that the kid will not be bothered by aisle passers by. Her dad started a pleasant conversation with me – our common medical background (he is a retired med tech), his wife ( originally from my place and was a classmate of my elder sister ) to Samantha’s condition.

    Samantha has demyelinating disease and cardiomyopathy diagnosed 11 years ago. With muscular dystrophy and muscle wasting, Samantha couldn’t control her head and is dependent on her parents and siblings for her basic needs. She’s been on and off medical complications that her parents had a “mini ICU” in her room. The day prior this flight, Samantha had difficulty breathing, prompting her dad to cut short their visit and boarded the earliest flight back home to Davao. Samantha’s family and her “life support” including her doctor is in Davao. Samantha’s dad knew the risk of flying Samantha in that state given they were in the same predicament several times before. The family also knew and has accepted Samantha’s fate even before, despite the numerous exhaustive struggle to fight the poor prognosis of children affected by this rare disease. It’s only a matter of time.

    That time was a little about over 30 minutes after I sat beside her. She was initially responsive to her dad’s assurances, nodding and giving out quaint sounds while her dad hand comb her hair. Later I noted Samantha’s quick but labored breathing. I checked her extremities, it is cold and cyanosis was setting in. This went on for some 20 minutes then she gasped for one big breath, never closing her eyes, staring on us both, quietly and without noise, then she stopped breathing.

    After quickly introducing myself as a physician, I asked the stewardess for the plane’s on board medical oxygen. I immediately hooked Samantha to oxygen via facemask.Samantha wasn’t breathing. I auscultated her chest and checked her pupils. No heart rate. Fixed, dilated pupils. Her eyes was still open as if staring on me. “No heroics doc” her dad told me. “Let’s not prolong Samantha’s agony.” I continued giving medical oxygen and asked for an ambulance on the ground ready anyway. Just in case. Or maybe.

    9:56 AM on board flight 5J348.

    I will not forget this day. I have seen dying people and have tried reviving most. Some lived, others died. I held Samantha hands tightly until we transferred her to a stretcher then to an ambulance. Just in case… Rest in peace, angel. Thank you for choosing me to watch over you on your last moments. Be our angel. Rest now.

    (My condolences to the bereaved family. To Samantha’s mom, thank you also for allowing me to post this publicly )