We face ongoing changes in Medicine today which will alter our future practice patterns. We all recognize the need for better communication with patients. If the full impact of ObamaCare is realized, this may be more of a challenge as 47 million Americans will enter the pool of insured with access to medical care. Also, statistics show 10,000 Americans are retiring each day. When coupled with a potential shortage of 100,000 doctors by 2020, we realize there will be significant challenges to meeting the future healthcare needs of our citizens.
One hopeful prospect for dealing with the changes in demand and demographics of the future is the cellphone. It is estimated that 55% of World citizenry have cellphones now, and by 2018 there will be a cellphone for every person on the planet. In the United States over 80% of the population has cellphones. We are entering an era when patients will become more involved in their own medical care and participate with their physician in this care. Aside from having access to the medical records, cellphone applications are becoming more available for disease management. Patients are already participating in chat rooms with people with similar diseases to discuss their treatment options. Patients with multiple sclerosis, for example, interact in chat rooms to discuss response to therapy and new therapy.
Cellphones can be programmed to remind patients to take their medications. In Mexico, where 80% of the people already have cellphones, patients with HIV now can join interactive services to remind them when to take medicine and see their physicians. They can enter into their phones when they take the medicines and get reminders when it is time to take their next dose antiretroviral therapy. They also get updates urging them to adhere to treatment schedules with actual statistics showing how their adherence can affect success of treatment or limit response.
Patients can also get updates for dietary counseling. With the epidemic of obesity and diabetes, diet counseling and peer discussion is also available through internet connections and cellphones. There is now a dermal patch that can be worn to continuously monitor blood sugar on the cell phone. The phone can be programmed to sound alarms when sugars are too high or too low throughout the day. Eric Topol, M.D., the author of “The Creative Distruction of Medicine,” has demonstrated a backing that fits cellphones and can give an EKG reading to his smartphone. He even used this device to get a cardiogram on a patient with chest pain on a nonstop flight. When his phone showed the patient was having a myocardial infarction, the flight was diverted and the patient taken off to get lifesaving care.
Smartphones and mobile devices can also be used by physicians to access medical information from EMR or from the ICU setting when a patient is calling in for information to their doctor on call. Another application is storing blood pressure readings and lab data on the patient’s smartphone. This can be transmitted to physicians for ongoing review. Smartphones can be used by patients in areas where physicians are not readily available to receive advice about management by offsite specialists. Smartphone photos can be taken of lesions and sent to a specialist for review and for treatment suggestions. These devices can also be used by physicians to gain second opinion from specialists in tertiary care centers. Applications are already available to alert physicians and patients to drug interactions and potential harmful side effects.
In the past, information was available only to the high priests and highly educated few. The Guttenberg Printing Press ushered in an era where the Bible and scholarly works were eventually available to the masses. We have now entered an era where the multitudes of patients throughout the world will find access to medical information and opinions and participate in their own medical care through the revolution of the smartphone technology.
Harvey B. Lefton, MD, is President of the Philadelphia County Medical Society.