Remote Patient Monitoring Research

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Remote Patient Monitoring via Smartphone

Telehealth is finally beginning to show real adoption with the move to outcome based care.

Any number of virtual care platforms have now thrown their hat in the ring to attempt to make patient communications as easy as regular calls. 

Smartphone monitoring seems like a good option for physicians and patients alike. The literature on smartphone monitoring is limited, but it shows potential for clinical use.

In a recent study by Dalla Pozza et al. (2017), the researchers explored patient monitoring after treatment, which asked their patients to take photos of post-op procedure as they were instructed by their surgeons. Patients were asked to send photos of the front and side views of their face to send to the surgeons.

Out of the original 57 in the sample, only fifty followed-up with post-operative photos.

The following procedures performed were:

  • (32) Facelifts, platysmaplasty, submental lipectomy;
  • (14) Upper and lower blerophaplasty;
  • (11) Fat injections

After treatment, three patients experienced complications early on. The patient in the study still preferred the usual face to face consultation, but the researchers mention that most of their sample were older patients, and were not able to adapt to some applications used for the study.

A similar study also examined the use of patient monitoring via smartphone. Chee et al. (2016) focused more on laser resurfacing on the dermatological aspect of it. Their study provided insight on the patient’s use of smartphone monitoring. There were 123 patients in the study, and having done the procedure around 12% had adverse events after it. Due to the complications, the dermatologist treated them the day after. Numbers dwindled as only a few answered the follow-up survey leaving only a few to report the smartphone review had good effects on them.

According to the authors, 95% out of the 24 who completed their survey felt at ease with the teledermatology process.

There is the risk of violating HIPAA and HITECH. In the first study, the researchers mention that limitation as patients may not have a HIPAA-compliant smartphone to send images or details of their condition. In this case, physicians have the responsibility to make sure their images are secure. In the second study, patients were wary with sharing their photos as well.

To learn more you might take a look at the scores from the KLAS 2017 Virtual Care Platform Report in which a dozen or so telehealth platforms (TruClinic, American Wellness, InTouch, etc.) were scored across a number of criteria.

Medical Spa Phishing?

Phishing attacks have become more sophisticated and healthcare providers (especially cosmetic clinics) look like a prime target.

A few weeks after WannaCry’s attack on the NHS in the UK, a new cybercriminal group “The Team” hacked a Lithuanian clinic comprising private photos of their patients. The group demanded a ransom of around €50 to €2000 (approx. US$57 to US$2295), which should be converted to bitcoin. Among the compromised photos are nude photos and national IDs.

What do the WannaCry and “The Team”s hacking entail for everyone else in the globe? In simple terms, better security and privacy. However, it’s not easy to double up on security. You may need to heighten security measures on your devices and may have to change up any protocol concerning saving patient photographs and details.

The table below shows examples of privacy regulation acts in several countries

Heighten Your Practice's Security Measures

Your staff is probably already well informed about HIPAA or your country’s own Privacy Act, the dangers of having data online,  Wi-Fi passwords and such (Er... make sure your Wi-Fi is password protected.), but most attacks are not on the big players, they're a simple email that is sent to a staff member with an attachment or link that contains malware that can give access to a system. Sophisticated attackers simply find out a few emails and sends an email that looks like it's authentic. 

Unfortunately, many people will just click the link.

Example: You get an email that looks like it's from a patient complaining about a reaction with an image/link. Your front desk staff clicks on that link and malware infects your front-desk computer. 

Not somethign you want...

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The Coming Shift to Telemedicine (Everywhere)

2015 Telemedicine Report from Freelance MD

There is a rise of telemedicine startups everywhere, especially in cosmetic medicine. What might this mean for you?

Silicon Valley, New York, London and Berlin all are investing big in telemedicine, A.I. and big data services. There are massive changes in the US that are opening doors for new services. what does it all mean for a little one-doc clinic in Des Moines, Charolette or San Antonio?

Why is there a need to utilize telemedicine?

Telemedicine makes it easier to keep patient records, track patient progress, saves time (and money) and offers the promise of integrated deep learning for clinical decision support.

There has been a report that patient preference leans towards employing telemedicine. It provides follow-up care for those who underwent surgery and many patients favor that. The convenience allowed for better communication with the physician through email.

Why are some physicians skeptical about telemedicine?

While there are many benefits to telemedicine, it is still faced with criticism. Many physicians are hesitant to adopt telemedicine because of costs. One of the many concerns about adopting telemedicine is the HIPAA. Patient privacy can be breached, especially with aesthetic medicine where photographs and video can be saved or used as before and after media output. Tools and software can be costly, because of this doctors would prefer to stick with traditional practice instead.

When will aesthetic medicine adopt telemedicine practices?

Several dermatology and plastic surgery practices have made progress in using telemedicine. The most common telemedicine method for aesthetic practices are Skype consults. Virtual consults cost less and patient retention is slightly higher.

Another example of telemedicine applicable for aesthetic practices are Virtual (VR) and Augmented Reality (AR). Primarily known for its use in gaming, it has branched out to other science and technology fields. Several plastic surgery practices have installed some devices such as VR or AR for patients to visualize the expected outcome of their procedure. Back in 2015, plastic surgery performed through Google Glass resulted successfully. In other uses, scribes send data to physicians via Glass. Expectations to use Google Glass in the practice is huge.

Telemedicine is also not limited to patient care, as it focuses also on the devices you use for your practice. While Luan et al., (2015) study focuses on access to plastic surgery literature, a physician can utilize their devices to use to communicate with patients. In addition, since the rise of smartphones, it is easier to enforce telemedicine. Video messaging apps like FaceTime and Skype can be used for telemedicine.

How to prepare yourself in integrating telemedicine in your practice?

Telemedicine, while mostly beneficial, may be difficult to integrate to a practice especially if it is not telemedicine-ready. You may need to consider these factors.

According to Krupinski (2014), set-up a room dedicated for all telemedicine needs. You will need to examine factors such as lighting and audio and video so you can examine them better. Let your patients feel comfortable inside the room as well.

Choose the telemedicine tools, methods, and technologies you will adopt. As we have mentioned there are various tools and devices for the physician’s use, but you do not need to employ everything. Some examples of the telemedicine methods you can use are Real Time (RT), which you can do on your own devices or through store-forward (SF). A physician can find a telemedicine tool or software online, which one can subscribe to.

Training is important, as studies have shown that those who are mishandling telemedicine tools or software can make patients feel uncomfortable. Train along with your staff so everyone in the practice has an idea how your telemedicine devices and software work.

Most physicians overlook the hindrances and barriers to using telemedicine for easier accessibility. Telemedicine is not just implementation just to keep up with trends, but its convenience and eventual cost-cutting advantages can help save practices.

Download the Medical Spa MD Telemedicine Report here.

Getting Naked on the Internet: What does the law say?

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Telemedicine and Cyber Security

The Health Information Portability and Accountability Act (HIPAA) is a federal law that protects the privacy of your personal health information (PHI). HIPAA includes several rules and provisions that set guidelines and requirements for the administration and enforcement of HIPAA. The relevant ones for the exchange of PHI in the digital cyberspace are the Privacy Rule1, the Security Rule2, and the aptly named Health Information Technology for Economic and Clinical Health (HITECH) Act3.

Telemedicine is a burgeoning field of medicine that incorporates digital technology such as electronic health records (EHR), information sharing, and videoconferencing to enhance the interaction between physicians and their patients, and ultimately, improve the delivery of healthcare. Having been a plastic surgeon for several years now, I’m all too familiar with meeting people at social events, and immediately getting bombarded with intrusive and unusual questions and requests as soon as my chosen profession is ousted. Sure, it’s unlikely that a woman will disrobe and expose herself in front of me and my wife at a friend’s dinner party, but get us into an online “private” videoconference call, and who knows what body parts will make an abrupt entrance into the conversation. Physicians must approach with caution, says American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) President Stephen S. Park, M.D. in a recent article4. But, for me and most physicians I know, I feel like the cat is already out of the bag. Considering the amount of texts, emails, online chats, phone conversations over internet and satellite lines, and selfies of both pre- and post-op patients I’ve been privy to, I’m sure I’ve already broken too many laws, and completely disregarded the good doctor’s advice. The truth is, though, that we’ve only begun to scratch the surface.

Telemedicine may involve the electronic exchange of PHI which is protected under HIPAA law. Security considerations with telemedicine involve making sure unauthorized third parties cannot eavesdrop on or record a videoconferencing session where sensitive PHI is transmitted seamlessly, and unfortunately, innocently. Recently, a monumental data breach at one of the nation’s largest insurance providers has spurred a bipartisan political effort to reexamine HIPAA as it relates to telemedicine, possibly adding costly and cumbersome requirements to encrypt EHR data5. Additionally, a recent report done by BitSight Technologies, a cyber security risk analysis and management firm, found that healthcare and pharmaceutical companies ranked the lowest among the four industry categories studied6. Suffice it to say, people are taking heed of this emerging new threat.

The aforementioned laws, rules, and regulations guide the generation, maintenance, and implementation of telemedicine HIPAA compliance. We must be cautioned, though, that HIPAA compliance does not necessarily equate to actual cyber security, and that simply meeting standards set forth in these regulations may not be enough. As more public attention and scrutiny rise to the forefront of media exposure, look for the healthcare industry to take the cyber security threat much more seriously.

Daniel Kaufman, MD
Discreet Plastic Surgery

Bibliography
1. http://www.hhs.gov/ocr/privacy/hipaa/administrative/privacyrule/
2. http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/
3. http://www.healthit.gov/policy-researchers-implementers/health-it-legislation-and-regulations
4. http://cosmeticsurgerytimes.modernmedicine.com/cosmetic-surgery-times/news/cosmetic-virtual-consult
5. http://medicaleconomics.modernmedicine.com/medical-economics/news/senate-review-hipaa-security-medical-records-light-anthem-breach
6. http://info.bitsighttech.com/bitsight-insights-industry-security-ratings-vol-4-rc

Telemedicine Startups: TruClinic

TruClinic is delivering on the promise that telemedicine can finally get to work in health care.

I've mentioned TruClinic before and my guess is that you'll be hearing more about them since they look like they're starting to gain traction with larger providers who need to become more efficient in delivering care without lowering their standards or running afoul of compliance issues. TruClinic lets them do that by taking many patient interactions onine.

TruClinic has just been awarded a $50,000 prize as a "health venture with business solutions to challenges faced by patients and healthcare systems".

Here's the press release.

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