EP Lab Digest speaks with David Lee Scher, MD, FACC, FHRS (@dlschermd), a cardiologist, consultant, award-winning blogger, and Director of DLS Healthcare Consulting, a company specializing in digital health technology and social media.
So much has changed in digital health since our interview (http://bit.ly/29RpKIm) in 2012! What would you say are some of the new challenges faced today in digital health?
Digital health was in its infancy in 2012. Fortunately, it is now out of its embryonic stage and into its late infancy or toddler phase. The reason is because a lot of the technology has matured and companies that were not in healthcare before (including traditional IT companies) are now in healthcare. IBM, Microsoft, Apple, and Google are companies that are not going to necessarily become huge healthcare drivers in the absolute sense — in other words, you may not see Apple all over your hospital. However, the fact is that these companies are getting into healthcare and accelerating adoption of digital health. There has also been a consumer adoption of digital health tech due to the wearable technologies such as Fitbit and Apple Watch. These consumers are mostly young and relatively healthy people that want to stay that way versus the people who utilize the most resources in healthcare, older people with multiple chronic diseases. On the provider side, the challenge to digital health tech developers lies in proving that these technologies work. There are still not many traditional clinical studies of these technologies, and that is important on a couple of fronts. For example, companies can’t raise substantial money because investors want to see the proof that the technology works. Healthcare enterprises are hesitant to adopt then because of other IT priorities meant to meet new regulatory requirements. Physicians are hesitant to use these technologies because of lack of clinical proof and the bad taste left in their mouths from unfulfilled promises of mandated electronic health record adoption. Regulatory agencies were slow in providing guidance, but the FDA’s Mobile Medical Apps Guidance (http://bit.ly/1cTOlYq) was certainly a big step. The Federal Trade Commission and the FDA have also made strides in delineating guidance with regards to social media and information technology. Everything is in place for the right company to step in. There are a lot of companies getting involved, both on the consumer and enterprise sides — including companies you might not expect, such as Samsung and Comcast. So although we have made strides from where we were in 2012, we certainly have a long way to go.
Another significant challenge to adoption is the lack of ability for most of these technologies to fit into clinical workflow, specifically how these devices or technologies are used and incorporated into electronic records in ways that are useful for treating patients. Physicians don’t want a flood of useless data — they want data that is actionable. New technologies will hopefully advise on therapies or choices of therapies to clinicians in the form of clinical decision support or recommendations (via predictive analytics) to a patient or caregiver on the changes that they can make themselves, within bounds of patient safety of course. These recommendations will be customizable for the individual practice or patient. The idea is to seamlessly associate treatment plans with best practice outcome guidelines, and have this reference available to the clinician and patient at the time of prescription or significant test/data result transmission. There are now apps that prescribe insulin doses, and although I don’t think we’ll necessarily get there in the near future with the same kind of technology for heart failure treatment, we may eventually get there. Much groundwork has been laid from technology development to the creation of initial regulatory framework (e.g., expansion of telemedicine, reimbursement for chronic disease management via telemedicine by Medicare, and creation of cross-state licensing agreements).
How have you also seen the use of Twitter and other social media sites change over the last few years?
I use LinkedIn and Twitter in what I see as a complementary fashion. LinkedIn is a tool that has really matured. It’s something that people use every day to connect with people, organizations, and companies they know or would like to from a professional standpoint. It’s also become an important recruiting tool. A recent study revealed that 92% of recruiters use social media (87% LinkedIn, 55% Facebook, and 47% Twitter). Twitter as a social media tool has also certainly matured, but it has a different feel than LinkedIn. My view is that Twitter may not be necessary if all you want to do is take care of patients; however, it can be useful for such things as real-time global discussions with peers about procedure techniques, developments in technology, or medical politics. It is extremely important if you have any interest in non-clinical aspects of healthcare. It was on Twitter that the whole discussion about Maintenance of Certification began (fueled by people like @doctorwes)! We’re also seeing an increase in younger physicians who are interested in non-clinical aspects of healthcare, especially in digital health, and use Twitter as a real-time source of information. Twitter feeds can be customized to deliver a much greater breadth of clinical information than a few cardiology or EP journals. It also has the advantage of being global. I use Twitter as a real-time source of information. Most of us have enough real-time information coming in at the office, but the benefit of Twitter is that your feed can be customized to much more than a few cardiology or EP journals. Twitter can give you real-time feeds from FDA hearings about EP devices — you can’t get that anywhere!
I use LinkedIn for connecting with people in the digital health space in ways that I would never have access to them. I have created relationships with the CDC and the NIH — agencies that normally wouldn’t give you the time of day! In the old days, you had to call an agency, organization, or company, or visit their website. LinkedIn is a relationship builder — having people in my circle for when issues come up (and as a consultant, they always come up) helps me connect the dots much more easily — I certainly can’t remember over 5000 connections off the top of my head, but the search algorithms allow for easy filtering. A lot of people come to me to connect, but I really tend to remember the ones that I go out to connect with, because I have a purpose or specific project in mind. As a physician, I follow more individuals on Twitter, and more organizations (as a way to then network with individuals) on LinkedIn.
I have over 8500 followers on Twitter and 5000 on LinkedIn. There is more volume on Twitter and it’s less selective, but it’s also faster, customizable, and more personable than LinkedIn. Extremely important to me is that the Twitter app offers a much more user-friendly experience than LinkedIn, which in my opinion is very cumbersome and less intuitive. LinkedIn is slower and not necessarily a news source per se, but more for making personal connections. I use Twitter for getting really fast information, whether it’s about a company partnering with another in digital health, about a certain disease, etc. I also read Twitter feeds from conferences, although they don’t necessarily have to be EP related, because as a digital health consultant, I follow all fields of medicine. I am the source of information for my clients, so I need accurate information. I need to be on top of things more than my clients because that’s why they hired me. Social media helps build relationships to help my clients further their goals.
Why is it important to also maintain a blog?
Blogging is another aspect of social media and is a way for people to get to know you. My personal blog, The Digital Health Corner, is an industry overview for patients, caregivers, physicians, and industry. I also write blogs on digital health technology for a couple of my clients, one of which is Samsung. Blogs are a very important part of social media insomuch as reliable and respected blogs become the news or informational feeds for subscribers (most blogs are free to access).
Is there anything else you’d like to add?
Regarding the juxtaposition of using LinkedIn and Twitter, I go back and forth between the two social media sites depending on what I’m looking to accomplish. If I connect with someone on Twitter because they wrote a good article linked to a tweet, I would then go to LinkedIn and connect with that person for further interaction. I don’t like using Twitter messaging.
Social media and digital health are important. About 95% of physicians are on social media, but only 30-40% are on social media in a professional manner. It’s important for healthcare professionals to know that social media is not about interacting with individual patients (that is ill-advised by many standards), but interacting with other professionals, patient advocates, and others who appreciate benefitting from hearing a physician’s or nurse’s perspective on things happening in healthcare. I’m pretty active with TweetChats, which are regular discussions with patients, advocates, and professional leaders. It’s just brilliant how these conversations, which generally last for one hour, are so focused and appreciated by all. Questions are typically about navigating the healthcare system, healthcare policy, how social media can impact healthcare, and sometimes very timely topics. After a hospital sponsored by MSF (Doctors Without Borders) was bombed in Syria, we had a #HCLDR (healthcare leadership) TweetChat with a physician who was there. Social media is so important for patients and caregivers. Physicians need to be on social media as well — maybe not every physician, but those who have an inclination to interact on higher levels. It’s a very satisfying thing to do.