Technology in Clinical Practice Made Ridiculously Simple - Twitter summary from 2012 #AAAAI meeting

This summary was compiled from the tweets posted by the following allergists/immunologists who attended the 2012 annual meeting of the American Academy of Allergy Asthma and Immunology (AAAAI): Sakina Bajowala, M.D ‏@allergistmommy, Tao Le @Taotle, Dr. Melinda Rathkopf ‏@mrathkopf, and Nathaniel Hare ‏@AllergyTalk. The tweets were labeled #AAAAI. The text was edited and modified by me.

EMRs

Russ Leftwich discussed meaningful use of EHR. Meaningful use is a journey, not a destination. Like any journey, it requires careful planning.

Engage patients and families in their health care. Patients look to us to promote engagement/communication. EHR can help.

Improve care coordination. EHR can simplify the exchange of information among various members of the health care team. Did you know: to qualify for meaningful use, requests for consultations should be accompanied by a summary document 65% of the time? As a specialist, you are at a disadvantage if your office can't easily accept these summaries from primary care doctors.

Maintain EHR privacy and security. How do we protect electronic forms of private patient information? If you use a free EHR, who bears responsibility if there is a data breach? Probably, you.

Apps

Tao Le discussed what technology can do for your practice. There are 300,000,000 tweets per day. Facebook has more than 800 million users (they will be 1 billion by August 2012).

We are seeing the "consumerification" of technology. No longer for the techies alone. This is where medicine is going.

Tao Le says that the traditional way of practicing medicine (e.g. clinic visit) will become obsolete within our lifetimes.

Examples of useful apps:

- Jiff pad. Use your iPad to teach your patients in clinic. They'll get a HIPAA secure link to the presentation to view again at home.

- Zoc doc allows patients to schedule their own appointments online. However, it costs $250 per month.

- Health Tap is like http://answers.com for medicine. There are some occasional problems with unreliable “experts”.

- Phillips vital signs app can calculate your heart and respiratory rate remotely, costs $0.99.

- Skin scan app will scan your moles and give you an opinion. Hmmm, that scares me.

- There is an iPhone app that serves as a digital otoscope (with an attachment). There's an EKG app/attachment too.

- Wheeze-meter, GPS-enabled inhaler dose counters, peak flow meters, etc. Related: "Smart" asthma inhaler teaches patients how to use it http://goo.gl/w4OzJ and Asthma patients will be equipped with “smart” albuterol inhalers that track time and location of rescue medication use http://goo.gl/49gMt

There are very exciting things on the horizon... Many are available now.

Related reading:

9 New Life-Saving Apps and Technologies for Doctors - Slideshow from PCMag http://goo.gl/ThACr
Apps for allergy patients http://goo.gl/AS5U4

Practice management software

Linda Green discussed practice management software and office automation. Full revenue cycle management provides additional services beyond insurance billing. Cost of billing services range from 5-10% of collections. In house billing increases your payroll expenses, but gives you more control.

Integrated practice management/EMR system minimizes need for software interfaces.

Document management is essential to the paperless office. The standalone fax machine is a dinosaur.

The patient portal will be essential for meaningful use - appointments, refill requests, history completion, bill pay, secure messaging. With a portal, it is important to manage patient expectations. For example, secure messaging does not obviate the need for in person appointments.

Auto-attendant is useful to manage call volume, but needs to be used properly. Remote call forwarding is also helpful. For example, I am answering patient calls to the office from my cellphone while I'm here at #AAAAI. Because my EMR is accessed using a remote desktop connection, I'll be able to schedule patient appointments from Orlando.

Speech recognition software has improved dramatically. It's helpful for more than visit note dictation.

Melinda Rathkopf discussed mobile devices: iPhones, iPads and Androids, oh my! Allergy-specific applications are growing in number and quality, for example, there is #AAAAI Annual Meeting App.

CARD is a contact allergen replacement database. It is available for both physicians and patients. Take it shopping with you.

There is MyEpiPen App. The name says it all.

Medscape app offers CME, drug information (similar to Epocrates), disease reference.

Epocrates is a drug reference app with free and paid/upgraded levels. It has a pill ID feature with photographs of various tablets.

American Academy of Pediatrics has a number of apps: redbook, AAP news, and a full digitized version of the journal of Pediatrics.

Epic (a major hospital-based EMR system) has a mobile app called “Haiku”.

More mobile digital resources: New England Journal of Medicine, Up to Date, and Pub Med on Tap.

ITap RDP allows you to connect to your computer desktop from your iPhone/iPad.

Productivity apps:

- Evernote. Stored in the cloud. It can be accessed from multiple devices.

- Dropbox: saves files remotely. It obviates the need to transfer everything to your thumb drive or email large files.

Tools for marketing and communication

Ves Dimov @drves discussed tools for marketing and communication. Ves discussed "app fatigue" - it is difficult to use more than 10 apps on your iPhone or iPad. He has 3-4 iPad applications that he uses on a regular basis.

IT and clinic visits

Ves posts to his blog frequently (constantly), and the addresses to his website and blog is printed on his business cards. Patients love it.

"If you can send an email, you can tweet and have a blog".

Ves describes 2 cycles: 1st is that of patient education. Clinic visit--> printouts --> website --> feedback.

Ves recommends loading illustrations of common physical findings onto a tablet/iPad as images, and sharing them with patients during visits. Pre-loaded Android tablets can be useful for patient education during visits, for example, MDI use videos. They are much less expensive ($100) than Apple products such as iPad ($399-$499).

Always reinforce the digital information with a hard copy printout. Provide something tangible to take home.

Social media tools

How to be a Twitter superstar in 2 easy steps. Step 1: read. Step 2: share. That's it.

Consider integrating Twitter into your blog. It's actually easy to link all of your social media accounts, expanding your reach.

Post to the 3 major social networks: Twitter, Facebook, Google +. If you come across interesting info, push it out to all 3 networks. Send blog posts to a Facebook page.

Sharing information from your colleagues allows you to leverage each other's research and reach a wider audience.

Who needs a blog? If you feel the need to share information that's longer than 140 characters, consider writing a blog. Starting a blog is easy. Maintaining a high quality blog is the part that takes commitment.

Social media keeps you relevant in a rapidly changing world. Your patients are there, and you need to be there as well.

The two cycles work together as two interlocking cogwheels (TIC).



Cycle of Patient Education (click here to enlarge the image). An editable copy for your presentation is available at Google Docs.



Cycle of Online Information and Physician Education (click here to enlarge the image). An editable copy for your presentation is available at Google Docs.

David Shulan discussed technology and the bottom line. Before you dive into a technology practice, make sure you've done your due diligence.

Have contingency plans for when your technology is "down". Because at some point, it WILL go down. Murphy's Law: if something can go wrong, it will. Be prepared for changes in goals and timelines based on unforeseen circumstances. You must be adaptable.

Don't bet a great new technology that hasn't been tested. You don't want to beta test in your practice. It may be very costly.

Keep work flows in mind. Map it out and see what can be done to structure your technology to cut down on "steps". Try to adjust technology to an ideal work flow, rather than compromising work flow to suit a technological glitch.

Implement technology in stages, rather than all at once. Invest in good training. Productivity will drop at first. That's normal.

Sometimes, the implementation of technology requires modification or elimination of employment positions (for example, “the person who brings the paper charts”). Be up front about this.

Security and privacy are of the utmost importance. Patient data is sacrosanct.

Allergists achieved highest use of social media by any specialty

During the 2012 AAAAI meeting, the allergists achieved the highest use of social media by any specialty. There are more than 100 allergists on Twitter and 30 of them posted simultaneously from the annual meeting, broadcasting thousands of tweets tagged with #AAAAI. The annual AAAAI meeting was attended by approximately 5,000 people. In comparison, the 30 allergists on Twitter reached 250,000 people (measured by TweetReach.com on 03/04/2012).

This summary was compiled from some of the tweets posted by Sakina Bajowala, M.D ‏@allergistmommy, Tao Le @Taotle, Dr. Melinda Rathkopf ‏@mrathkopf, and Nathaniel Hare ‏@AllergyTalk. I would strongly encourage you to post updates on Twitter from the CME conferences that you are planning to attend in the future. Here is how to do it: Twitter for Physicians: How to use Twitter to keep track of the latest news and scientific meetings, and share information with colleagues and patients.

Disclaimer: The text was edited, modified, and added to by me. This is one of a series of posts that will be published during the next few weeks.