#hellohealth

[goodbyeoven]

Vegan gourmet dinner #luckyme #datenight #openminded #soyummy #harvestrestaurant #rozelle #vegan #peppersauce #risotto #delicious #cleaneating #sharefood #sharethelove #vegetarian #lifeisgood #goodbyeoven #hellohealth

[goodbyeoven]

Getting my Korean on for lunch #leftovers #kimchi #hotpepperpaste #delicious #cleaneating #goodbyeoven #hellohealth #vegan #vegetarian

[goodbyeoven]

Making the most of #vegancheese #biocheese #delicious #tofusalad #sataytofu #mysalads #thissummer #sohot☀️ #sydneylife🇦🇺 #goodbyeoven #hellohealth #cleaneating #veganfood #veggies #sofull #soulfull

[jtlgilmore45-blog]

I got my Fat Fighters in the mail this weekend and started back on the Triple Threat today! I'm so ready to get back on track and kick butt on this weight loss adventure!!! #weightlossgoals #goodbyefat #hellohealth

[dingthis-blog]

This is my last treat before starting #whole30 ... Went food shopping and said goodbye to potato chips, baked goods and yummy cheese on my way out the store. Bring on Day 1 tomorrow! #goodbyesugar #hellohealth

[fit-and-fierce]

No, I'm not vegan anymore. No, that doesn't mean I eat red meat. No, that doesn't mean I don't care. Yes, I'm aware I will most likely get hate. Yes, I'm happier eating foods that I enjoy and make my body feel good and healthy. Yes, I'm on a weight loss "journey". I'll be changing this blog to fitness/weight loss, so if you follow it because it is vegan, I'm sorry but I am eating animal products and will be posting recipes and what not. Thanks for bein great everyone🤗

[nyhealthbiz]

Working for the patient

The HelloHealth homepage.

Photo| Maïa Booker

by Maïa Booker 

Sheri Stockman, a stay-at-home mom, sounds chipper on the phone despite having experienced an onslaught of health problems in the past several years. At 45, she suffers from lupus and rheumatoid arthritis, and underwent a hysterectomy five years ago. She has also been on anti-depressants, but found herself at odds with her doctors and wanted to find alternative treatment, a different way of doing things.

Many people are searching for new ways to access easy and affordable health care, as the economy falters and insurance premiums and prescription medication costs rise. A growing number of physicians are using social media and electronic communication to interact with and diagnose their patients, cutting office and transportation costs.

In April, Stockman set out on a search for a new doctor and new medical options, in an attempt to be less dependent on prescription medications. She began, as she usually does when looking for something, with online research.  For years Stockman has done most things online. She formerly worked as a corporate travel manager for Zimmer Corp, a manufacturer of orthopedic products and says she’s accustomed to receiving hundreds of emails a day.  Moreover, like many consumers, she wanted to take control over managing her health.  According to a the Pew Internet & American Life Project, a study conducted with the help of the Department of Health and Human Services, 83 percent of Internet users have accessed health information or done on-line research related to a medical problem. Patients search for everything from a specific disease to exercise tips to alternative treatments. Moreover, 57 percent of online health seekers claim they found answers they had sought.

Stockman found several doctors online and decided to make an appointment with Dr. Jeffrey Gladd.  He advocates a holistic approach to medicine, and replaced her piles of prescriptions with natural supplements to treat her lupus and arthritis. He also emphasized nutrition and detoxification, the process of purging the body of noxious substances. Stockman appreciated another aspect of his practice: the electronic communication.  Gladd is a member of New York based HelloHealth, a patient management system with several functions. Created in 2007, the platform heavily uses social media tools like video chats, instant messaging, and Facebook to disseminate information and facilitate communication between patients and doctors. The doctor can also diagnose a patient via video chat, for example. The HelloHealth platform can save time for the patient, who does not have to travel, and can schedule appointments online, as well as track prescriptions. All transactions are made through the site, and before that were made through Paypal.

Samantha Birk, a patient who started seeing Dr Gladd in 2009 after she was thrown from a horse, says she appreciates this system for routine appointments. “When you’re at the follow up stage of care giving, and it doesn’t require a physical exam, handling it through emails and video can be a better fit with the hecticness (sic) of everyday life.”

She receives signed orders from Gladd in a pdf format and takes them to the lab to get her blood work done. Birk lives 40 minutes away from the doctor’s office and travels six to twelve times a year for her job as an associate director for instructional technologies at Indiana University. She can log in to the system on any computer, and have an exchange directly with the doctor, whether it’s about symptoms she’s experiencing or questions about medication dosage. The doctor replies to emails from patients within 24 hours.  “It’s a much more direct line of communication. I get nervous when I leave a message with a phone nurse, in case they don’t get my tone or forget something, I don’t know if they got all the info, they may have missed something important.  It’s important to me that the doctor hear the question or request, in my own words.” Stockman outlines the benefits of this kind of system for her: “it’s just easier for me to reach him. I’m so electronic-based that having this option makes more sense to me… I get my test results back quicker, I can shoot him an email and get an answer back, I can reach him if he goes out of town.”

HelloHealth platform essentially moves a large part, and in some cases all of the administrative work in running a medical practice, online. Patients subscribe to the site, and a portion of the subscription fee (which depending on the services can range from $3 a month to $10 or $15) goes to HelloHealth, while the rest goes back to the practice. The fee can increase if a specialist consult, such as a dietician is included in the price, for example.

 For Dr. Gladd, who left his job as a medical director at Parkview Hospital in Fort Wayne, Indiana, in August 2010 to launch his own practice, HelloHealth has given him increased freedom and provided a better connection to his patients. This might seem counter-intuitive at first, since electronic communication means you interact less frequently face-to-face, but he and other doctors assert it doesn’t dilute the essential patient-doctor bond. In fact, he argues, it’s safer for the patient. “Patients calling outside 9 to 5 office hours no longer have to deal with a phone nurse to dispense medical advice.” He goes on to explain that in his former position he would essentially be paying staff to take care of ‘quick visits,’ of about 15-20 minutes.  “I basically used to pay people to keep patients out of my office. Now I directly accept all their messages.” They all go to his email address or phone number.

 He charges $25 for an “email visit,” a basic email exchange, and $250 an hour for an appointment in-person. As of now, insurance companies don’t cover the electronic delivery of medical services. Dr. Jay Parkinson, HelloHealth’s co-founder said, “The insurance companies won’t pay you for email visits. It’s obnoxious, but I think it’s going to change.”

 Even consumers with insurance will pay out of their pocket to go see these doctors.  Stockman is one of these people.  Moreover, at a time when many people are uninsured and the cost of insurance keeps rising, a 15-minute email visit at $25 dollars may be just what someone is looking for.

 On the other hand, this online model of care is not for everyone. Stockman admits that some people might have trouble using this system. The user interface takes awhile to get used to, and she imagines that elderly patients might find the whole system daunting. Moreover, when she joined and opened up a HelloHealth account, she had to fill out her entire medical history on the website, which was time consuming.

 “At first the website is disarming, we’re conditioned to the doctor patient relationship,” says Birk. Some of the text and icons on the site could be simpler, she adds, as could the process of getting a prescription authorization. The authorizations are sent to the patient electronically, but the lab she had to go to for blood work needed a printed copy. She had to leave, find somewhere to print it and return. 

 There are also risks involved in shifting the patient-doctor paradigm from a traditional office to a virtual platform. For instance, doctors must be very careful not to violate patient privacy laws, especially if they’re using third party platforms (like Twitter or Facebook) to discuss medical conditions between doctors and patients, and among medical staff. It can become a liability, and they might open themselves to lawsuits. For example, friending patients on Facebook can violate privacy laws if they disclose the patient’s public health information through messages with the patient on this platform. Even if the patient is engaging in the conversation about their own health problems, symptoms, and diagnosis, the provider is violating the the HIPAA Privacy Rule.

Dr. Karen Scott, the VP for Quality and Patient Safety at New York Presbyterian Hospital.

Photo| Maïa Booker

This is also a concern for hospitals. Dr. Karen Scott, the VP for Quality and Patient Safety at New York Presbyterian Hospital, admits social media present challenges. “There’s both a recognition that this is very much not only the future but current day in how that’s how a good share of the population communicates, we’re not ignoring it, but we have to figure out how to do it in a way where we’re protecting any privacy issues related to patient care. Committees are working on this to make sure it’s very clear to everyone who works here that you don’t put anything out in a venue like that that might be tied back to a particular patient or episode.” To address as many patient and public health questions as possible in one go, hospitals are also integrating social media into their marketing practices.  In December 2009, the New York Health and Hospitals Corporation, the largest municipal healthcare organization in the country, comprising eleven public hospitals, created its Twitter, Facebook and Youtube pages. These pages address questions on diseases, symptoms and treatments. Other hospitals have followed suit.

Dr. Kevin Pho, a physician based in Nashua, New Hampshire, is a prominent figure in the intersection of social media and medicine. His medical blog KevinMD.com boasts over 100,000 subscribers across the country. He explains, “Social media takes a tremendous role in educating patients, but…there are privacy risks, too. Patients don’t really know who’s on the other end of a Twitter page, and it’s fully public, anyone can read it.”  He created his blog in 2004, and addresses a variety of topics ranging from ‘Why doctors need to be better negotiators,’ to ‘How much guidance do patients want with their medical decisions?’ . Social media can be an important public health tool. “It has potential, but it’s not there yet. It’s why some physicians are hesitant to go online.” He adds, “But you can’t form the patient-doctor relationship just on social networks.”

 Information management in medicine is also changing. One of Birk’s main problems was how to juggle relationships with three doctors (a physical therapist, Dr Gladd, and a doctor specializing in pain management) and all of her medical records. She sometimes had to pay up to $100 to get her records copied from one doctor to another and wants medical information automatically replicated in a database so she wouldn’t have to handle all the paperwork. This is beginning to happen at the hospital level. For instance, New York State funds are being disbursed to hospitals to facilitate the sharing of electronic data with other hospitals, such as patients’ Electronic Medical Records (EMR).  “There are grants from the state level helping to support this work. If you were at a NYU hospital last week in the emergency department and came to our emergency department, I could go into a website and see the basic info of what happened at the hospital…I’d have that added piece of history,” says Scott. The program is called HEAL17, and falls under the umbrella of the New York Clinical Information Exchange (NYCLIX). Every year, New York State comes out with grants to improve health services, and this year $120 million is going into developing data information exchange.

For hospitals, joining social media platforms may have more to do with keeping their brand name, so to speak, in the public eye, and broadcasting public health information. Private practitioners may use these platforms for patient management and diagnosis. Whatever the case, it is clear there is a growing push to develop a patient-driven approach to healthcare management using new technologies. In terms of advertising, although many practices have begun using SEO programs to attract new clients searching for physicians on-line, Dr. Gladd estimates 90 percent of his client base come to him through word-of-mouth.

For many patients including Birk, the biggest problem in seeing a doctor was time management. “It was frustrating scheduling an appointment and then sometimes having to wait hours in a waiting room.” Patients have to take time off from work to go see a doctor, or cancel other obligations. “What makes their time more valuable than your time?”