The Association of American Medical Colleges (AAMC) recently released a report on Industry Funding of Medical Education which was reported on by the New York Times this weekend. Unexpectedly, this was a very strong report seeking to ban all medical giveaways to medical school faculty, staff and students. Though this report is not a mandate, it is very likely that most if not all of the 129 U.S. medical schools will adopt the task force’s recommendations on how to proceed with medical school and private industry interactions. The report does a good job of realizing the role private industry plays in medical education and they are obviously not looking to prevent pharmaceutical or medical device companies from presenting to the medical school community (though its hard to believe these recommendations would not stifle these interactions). Rather the AAMC is concerned with the perceived conflict of interest when private industry presentations involve paying faculty to present information or presentations are attached to gifts such as free food and/or pens.
It is not a secret that the pharmaceutical and medical device companies spend billions of dollars marketing to doctors. However, unlike traditional marketing (TV and print adds for example) doctors receive free meals, pens (and other office products) as well as some more extravagant gifts. Considering there are slightly less than a million U.S. physicians but billions spent on marketing to them it’s not hard to imagine that some of these giveaways have been, lets just say, a little over-the-top. However, my initial reaction to the AAMC task force report is that it took the easy route by attempting to deal solely with the conflict of interest issues and missed an opportunity to create guidelines that would impact the real crux of the issue which is how private industry should market their products. We have all noted the influx of direct to consumer advertising by drug companies and my concern is that the position of the AAMC will only lead to more drug advertising through mainstream media. I point to the controversy surrounding this common Lipitor commercial featuring Dr. Robert Jarvik:
Pfizer was forced to pull these adds over controversy that they imply that Dr. Robert Jarvik treats patients, where he is actually an inventor and entrepreneur who has developed an artificial heart. This is an example of blurring reality to create effective direct to consumer advertising, and this is not the only example. Viagra adds were pulled in 2004 for implying that Viagra increased libido. When the AAMC limits the marketing of drug products or medical devices to physicians the alternative is to market these products to patients. The Viagra and Lipitor examples may be extreme and in all fairness both are Pfizer drugs. But the impact of 30 and 60 second drug adds that have potentially devastating side effects that are rattled off and barely audible in these commercials seems like something that should be factored into any discussion of how physicians involve themselves in the marketing process. Taking positions that will lead to big pharma diverting marketing budgets from educating physicians about new drugs to creating slick commercials created by Madison Avenue firms will not help the ultimate goal of doctors, helping patients. A more useful report would have laid out guidelines for how private industry and medical schools interact and placed reasonable limits on giveaways to medical faculty, staff and students. I am just concerned that the tone of the report and it’s strong stance makes any and all private industry-physician interactions seem tawdry when in fact they are necessary. Physicians need easy access to new information on drugs and medical devices and private industry need an opportunity to create name recognition for their products. The drug and medical device companies can develop revolutionary products but if no one knows about them they are useless. Private industry understands this and will market their products regardless of reports by the AAMC. As a document to prevent all perceived conflicts of interest the AAMC report hits the mark. But it’s necessary to view these issues with a global focus and the ultimate goal of creating a better health care system, which I’m not convinced this report will do.
With the SavvyDocblog, we not only want to highlight what we’re doing as a company, we also want to highlight other business, mainly start-ups that have disruptive business models aiming to make the health space better for ordinary people. Today, it was announced that Health Plan One raised $6.5 million Series A funding to build out their health insurance comparison site, led by Pequot Ventures.
Health Plan One is aiming to be the Orbitz or Travelocity of health insurance, that aims to bring transparency to the entire process, as well as ease of use. I think this idea has a great deal of merit because instead of pricing out the three companies that come to your mind when you think of health insurance, their service can streamline that search and compare sites side by side with one search. These comparison sites have really transformed the airline industry, and I expect a couple of sites similar to Health Plan One to pop up furthering innovation and disruption in this space.
How does this relate to SavvyDoc? What we aim to do is provide transparency within the health space, by enabling the consumer to have more choice and make more informed health care decisions. Although I cannot vouch for the accuracy of Health Plan One, from a mission statement and from a thirty thousand foot view, I like the idea.
Recovering from a little Spring flu but of course we have still been keeping up with some of the most interesting stories regarding the intersection of health care and technology. I want to briefly recap some previous posts with updated information.
We discussed the primary care crisis and the interesting solution of creating a doctor of nursing practice degree to fill the void of primary care physicians. I still think this is a reasonable idea if managed in the correct way so that medical doctors are still readily available for consultation when more complicated patients require care. My biggest issue with the DNP was that as a M.D. doctor it would be ideal if there were a better title for the DNP so as not to cause patient confusion. To update there was an interesting blog on pharmacists increasing their role in primary care. Having worked with an excellent pharmD in the past, I think this is a great idea. A pharmacist can be a great resource for patients when it comes to questions about medications and I argue could manage small medication adjustments just as well as physicians. The additional advantage comes in that actively involved pharmacists would be better equipped to help prevent medication errors.
There was a recent breach at the NIH where patient records were stolen from a doctor’s laptop. I argued that though these crimes of health care related information are serious they tend to be used as an excuse for not implementing electronic medical records (EMR) or other web based health care tools. My argument against limiting implementation of EMR’s is based on my experiences of paper based records being the least secure method conceivable for maintaining patient privacy. Having worked in a hospital with EMR’s and one without, the loose paper trail and privacy breaches when EMR’s are not implemented are atrocious. A colleague of mine brought up a great point one time, when a patient is hospitalized no less than 50 people are aware. This includes the doctors, nurses, phlebotomists, radiology techs, transporters, cleaning staff etc. To think a hospitalization is a private experience is a expectation based purely in fantasy. Using EMR’s will at least create a way for hospitals to monitor who is viewing records and make sure those records are only being viewed when necessary. This is how UCLA has been able to track down the staff members involved in the recent breeches of celebrity patients. Another point I made in this post was that medical information has little to no street value, this is compared to social security numbers and bank account information. Well, here is the evidence for that position. A patient admissions rep at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York sold 2,000 patient records for a whopping $1350. That’s less than 68 cents per record. Again, these security issues are important but considering a large percentage of us just recently e-filed are taxes and are awaiting our refunds to be direct deposited, which required providing our government a social security number and bank account number, these security issues should not continue to be used to prevent the progress in web based health care technology that will lead to more efficient and improved patient outcomes.
This was simply an introduction to what we are looking to accomplish with SavvyDoc. Through my experiences I have seen how difficult it can be for patients to obtain access to a quality physician or dentist. We are also aware that it is expensive and difficult for doctors to create a strong presence on the Internet. SavvyDoc is looking to be a simple and inexpensive alternative for both doctors and patients. This recent NY Times article on plastic surgeons and examining the expense of marketing cosmetic practices illustrates a lot of the pain we are alleviating with SavvyDoc. This article touches on the expense of obtaining and maintaining a website that is search engine optimized as well as the expense of being listed in a doctor search engine. Many doctors cannot justify these expenses but understand that they should have virtual access to their patients. SavvyDoc will provide an easy to use tool that puts doctor’s in control of how they are marketed and how patients find their doctor’s information on the web.
Here at SavvyDoc, and on our blog, we not only want to highlight and further the discussion of pertinent research in the health space, but we also will highlight other Web 2.0 or Health 2.0 companies, aiming to solve significant problems to make patients and physicians better off. We are not necessarily endorsing every company we review, but we want to showcase the innovation. The services we cover may not be the perfect solution, but by furthering the discussion, we hope to become a destination to get all of your latest news of innovation within this space.
One service that I learned about on one of my favorite tech blogs, ReadWriteWeb, is CureHunter. CureHunter is essentially a search engine for disease information mining tons of data to automate the process of trying to determine cures for various diseases. Very ambitious. Essentially, they aim to become the Google of disease information, and using their algorithm, they determine which cure is most effective and list it, in the same way Google uses their patented PageRank to determine the best search results.
Although I am somewhat skeptical at first blush about the ability for a web application to determine disease information and treatment, going to your physician seems to be the best choice rather than self-diagnosing or treating yourself through the site. At least for now. I did quite a bit of searches on the site, and it’s overwhelming for the non-physician, but maybe, it can be helpful for the doctor. The important take away for me is that there are tons of information on the web going from Google searches to your favorite health destination site such as WebMD. With over 117 million US adults searching for health information online, there has to be quite a bit of self-diagnosis that can be misleading to the medically untrained individual. The problem is that we need a way to sift through all of this information and that’s the power of Web 2.0 and why SavvyDoc is an advocate of utilizing web based technology and progressive web strategies to make patients and doctors better long-term. If we’re able to utilize weighted crowdsourcing, perhaps those 117 million people that search for health information online, can get a trusted resource to make more informed health decisions using the Internet, and hopefully because of the ease of use and transparency that SavvyDoc provides, they’ll seek out that physician at the first signs of needing treatment.
In my previous post on health care costs, I argued for further adoption of technology to help alleviate the long term cost issues that are plaguing Medicare. I briefly mentioned the impact the transparent appointment system we are creating at SavvyDoc will help to alleviate the over-crowding in emergency rooms. I was prompted to spend today relating the trickle down effect of web based doctors appointments on the ER because of this Wall Street Journal Health blog post describing recent research showing that the uninsured are NOT to blame for ER overcrowding. This is a common misconception that I am glad the WSJ picked up on. The uninsured unfortunately avoid health care all together. The cost of an ER visit is significantly more expensive than an office visit, so to think that uninsured patients are going to the ER for a bad cold is a false premise. The question then becomes why are insured patients visiting ER’s with such frequency? Thanks to the work being done at the Institute for Health Care Improvement a lot of the reasons for this phenomenon have been illucidated.
Before I go further, the primary source for the statistics in this post come from this JAMA article by Dr. Mark Murray (the link is to the abstract, you will need to visit your local library or have a JAMA account for access to the full paper).
In his paper Dr. Murray argues that issues with health care access are actually due to delays in obtaining care. For instance, in 2001 it was found that 40% of ER visits are not urgent and could in fact be seen in a primary care office setting. I have not seen recent research on this, but as the population ages I would imagine this percentage is increasing. Imagine for a moment the improved wait times in an ER if half of these patients were able to easily obtain a last minute office appointment rather than going to the ER. Realizing that the median ER visit is four to five times more costly than an office visit, think of the economic implications of patients easily finding an open office appointment rather than going to the ER. There are billions of dollars to be saved just by fixing this one problem in our health care system!
The follow-up question: why do patients see it as easier to sit in an ER for hours rather than going to a doctor’s office? Well, at least patients know they can be seen in a somewhat timely fashion in the ER. In 2001 1 in 3 patients reported an inability to find a timely appointment this increased from approximately 1 in 4 patients in 1997. Again, this number is likely rising as our population ages. It does not take a stretch of the imagination to realize patients who cannot find a timely office appointment are deciding to go to the ER for care.
Solution. A transparent wed based appointment system would allow patients to look for any last-minute appointment openings. Patients who desire last-minute care would prefer to see the doctor they are familiar with. Searching for that doctor on SavvyDoc, will allow patients to see if there is availability within the next 24 hours. If that doctor does not happen to be available then further searching will allow patients to find a doctor within their area that is available. The alternative is to walk into a crowded ER waiting room where the patient has no information on who their doctor will be. Our market research to this point has shown that patients overwhelmingly see the value of making on-line appointments with their doctor. Patients are becoming more savvy about how to use the internet for researching information on doctors as well as information on their health. Providing the opportunity for patients to have more control over the appointment making process has wide ranging benefits, this impact on reducing unnecessary ER spending is one of the most significant.
For those of you in downtown Chicago or have spent time there, there are many Potbelly Sandwich Works located every couple of blocks. For those of you not familiar with this restaurant, it’s a combination of Subway meets Starbucks. For many people, it’s a daily routine for their lunch hour. You can get a toasted sandwich and a pretty good vibe, all for about $5. Amateur musicians play in the background, and the cafe/restaurant is always filled with upbeat, high energy people.
While offering such a unique environment for a reasonable price, they have to have quite a bit of volume to stay in business. Sales per square foot are the name of the game, and Potbelly wins just about every day. Lines can be seen being formed outside of the restaurant, seemingly a huge bottleneck. Potbelly’s has done quite a bit to ensure that the throughput of the restaurant is reasonable, so that everyone keeps coming back during that vital lunch hour, which can make or break a downtown fast-food restaurant in Chicago.
Lately, I have noticed that they have really been promoting their website, where you can place orders, and pick up your food without the wait. Your sandwich will be prepared, so you can eat and run, or take your food back to your office. In promoting this website, they have inserted postcards with orders and have made it highly visible through every step of the order process when you’re in the store, that there is a viable alternative, not aimed at replacing the current way most people grab lunch. They are aiming to target those individuals that value convenience and speed, over long lines. From a business perspective, they improve their throughput and can better anticipate demand through a transparent system.
With SavvyDoc, we aim to do the exact same thing. We don’t aim to replace using the telephone to make doctors appointments, we want to make it easier for those individuals that highly value efficiency and transparency. For us to be successful as a company, we do not need to have 98% of the doctor’s patients utilizing the online tool, it’s a system that can alleviate the bottlenecks so the physician can better anticipate demand. As an industry, by most studies, far less than 10% of the carryout orders are done online, yet it translates into a multi-billion dollar space. For tech savvy individuals, ordering online is a huge plus, which GrubHub capitalizes on.
Their are inherent bottlenecks in making appointments, which is why in our market research, 20-30% of the office staff’s time is spent on patient scheduling. Imagine the impact if 40% of the the appointments were done online. Imagine this power, coupled with decreasing the no-show rate, filling last minute cancellations, and the ability to recruit additional patients to the practice. That’s the goal of SavvyDoc. Some patients will enjoy utilizing SavvyDoc because of the real-time scheduling, but there are still others that may not see the value, but as with online banking, over time, I believe that it will be just as common, at least we at SavvyDoc think so.
The robust business of cosmetic surgery is apparently feeling the economic downturn just like everyone else. According to an article in yesterday’s Chicago Tribune the multi-billion dollar business of plastic surgery will have a difficult 2008. This revelation is not surprising considering plastic surgery falls under discretionary spending, but it is interesting in that for many the practice of medicine is appealing because it’s a recession proof career. Despite the desire for a steady career many doctors have resorted to providing cosmetic services to patients due to decreasing Medicare reimbursement. It will be fascinating to follow how the economy affects not only cosmetic surgery but other discretionary procedures such as LASIK surgery, or cosmetic dentistry. For any practicing doctors out there, are you noticing any affects on your practices with regards to discretionary care? Let us know in the comment section.
An April 2ndarticle in the Wall Street Journal, Making Room for Dr. Nurse, details the new Doctor of Nursing Practice (DNP) degree being standardized by the Council for the Advancement of Comprehensive Care (CACC).The program will require two post-graduate years and one year of residency.A DNP will have earned prescription, Medicare reimbursement and hospital admitting privileges.A major stated goal of the program is to fill the dearth of primary care physicians (PCPs).Though to be fair a primary care physician has completed at a minimum four years of post-graduate training and three years of residency.It seems misleading for those that complete the DNP program to call themselves a doctor.
I understand the need to fulfill the need for PCPs.With lowering Medicare payouts many of my colleagues are committed to practicing specialized medicine because of the higher reimbursement of medical procedures versus seeing patients in an office setting.However, I think it’s misleading for DNP’s to use the prefix Dr., which they will be allowed to do.There is no doubt that DNP’s will have the necessary training to take care of patients in their prescribed role (they will be expected to take exams similar but less comprehensive than doctor licensing exams.The issue is that a doctor with a M.D. has significantly more training and a larger knowledge base for therapeutic decision making than a DNP.However, if a DNP and a M.D. go by the same title their distinction will be blurred.Doctor’s (with a M.D.) are not the only ones worried though, with the nursing shortage as critical as the shortage of PCPs there is concern that nurses will turn to the DNP degree and increase the nursing shortage.
One solution I have been kicking around recently is for internists and family medicine physicians to fully adopt the model that is currently being used by Anesthesiologists.With the advent of the Certified Registered Nurse Anesthetist (CRNA) there was initial concern over the role a M.D. trained Anesthesiologist would continue to play. However, the two groups have created a model that exemplifies the skills of both the CRNA and M.D.The Anesthesiologist has become an operating room manager, where they are available for consultation when a CRNA is having difficulty with a case or if the type of anesthesia necessary is very complicated.This allows the Anesthesiologist to be in control of multiple operating rooms at once.A PCP could create a similar model, and I suspect many have, where they manage multiple patient rooms at once by having DNP’s, nurse practitioners or physician assistants see patients on a preliminary basis.When a patient’s case becomes complicated or requires unconventional treatment options the PCP will become increasingly involved.I like the CACC’s unique approach to eliminating the shortage of doctors but they are doing so in a way that alienates PCPs and only straining the already contentious doctor-nurse relationship.Fitting the CACC’s plan into my rudimentary thoughts, I think, will be a more encompassing solution.
One of the biggest myths when speaking to people about our product is the lack of attention to the marketing value proposition that, in my opinion, is one of the strongest aspects of our service offering. In our market research, we’ve found that 37% of the dentists claimed to have a website, yet 18% of their patients actually knew about it. With the SavvyDoc platform, we give the physicians an easy to set-up website, that enables them to provide much more information than most physician websites, in an easy to read and edit format. Most of the physician websites that we’ve come across look like an off-the-shelf solution, that is extremely arduous for the physician or their staff to update or easily manage. If they need to make a change, they have to hire a webmaster or IT specialist that can be costly.
With the SavvyDoc profile page, the physician can easily edit their educational information, awards and certifications, languages spoken, insurances accepted, payment methods accepted, and a host of other fields that take a couple of quick clicks of the mouse. The physician won’t need expensive software, or have to worry about maintaining their server and website, because that’s SavvyDoc’s job. We provide the back-end support and systems upgrade, which allow the physician to do what they went to school for, practicing medicine and helping people.
With our market research, we found that there are actually two main demographics for doctors in this space; those 28-39 and the over 40 physician. In that market research, we have also found that the 28-39 demographic cares about acquiring more patients to the practice, and the over 40 physician would like to maintain a solid pipeline of new patients, but their primary concern is to streamline and enhance their practice.
For the 28-39 individual, the marketing aspects of SavvyDoc is a tremendous value add. With our embeddable schedule “widget” which enables anyone to add the physician’s schedule to their blog, personal website, MySpace account, and soon to be completed LinkedIN and Facebook accounts, we aim to provide endless access points to the schedule of the physician, which is both viral and useful, the key to all widgets. Additionally, we spent a considerable amount of time enhancing the search engine optimization of each physician website, to ensure that they are located at the top of Google searches, not some spam site which provides inaccurate data about physicians. With over 117 million U.S. adults searching for health information online, you, the physician, want to be where the people are searching, and SavvyDoc will be the most cost effective solution. We provide analytics that detail just how many people are going to your SavvyDoc profile so you can test different marketing campaigns and promotions to determine what works best from a marketing perspective.
Additionally, we are going to provide additional services and marketing tools for the doctors to market themselves, and we’ll touch on them later on, so stay tuned.
Previously I have blogged about the impact of doctor-patient communication on reducing health care costs . When it comes to contacting a doctor outside of the office, communication tends to fall apart; traditionally patients will call their doctor’s office and are directed through an answering service that will subsequently get in touch with the doctor.In rare cases I know of physicians or dentists providing their patients with direct access via pager or phone number.During my training I was always intrigued by the doctors that provided patients with direct access, especially the docs that gave out their home number, because I assumed patients were constantly calling or paging them 24 hrs a day.However, most patients are not comfortable directly contacting their doctor unless it’s a true emergency (in which case their doctor wanted to be the first to know anyway).In fact many of my mentors stated that they gave patients direct access as a comforting tool and were rarely if ever contacted directly.
It is from this experience that I found this paper from the Archives of Surgeryso interesting.Dr. Stalberg et al from the University of Sydney in Australia found that providing patients e-mail access to their surgeon improved communication between patient and surgeon.100 patients undergoing elective surgery were randomized to either receive a pre-operative information sheet promoting e-mail communication with their doctor versus a standard information sheet.Many doctors are concerned with providing patients e-mail access due to worries of abuse.This study actually indirectly gives insight into the potential for patient abuse of e-mail access.There was more communication between surgeon and patient in the e-mail group but only 38% of those patients contacted their doctor, this was compared to 14% of patients contacting their doctor from the standard group.This is a significant increase in doctor-patient communication, but this is not an abuse of e-mail access when one considers these patients were mostly looking to address one issue regarding their surgery rather than using e-mail as a way to ask an overwhelming number of questions.Few doctors would argue against the small investment in time communicating with patients over e-mail if it meant that patients better understood their post-operative care or the medications they are taking.Good communication between doctor and patient limits the misunderstandings that can lead to improper post-operative care or the misuse of medications that force patients to seek emergency care.A couple of extra hours a week leisurely responding to e-mails are better than spending those hours rushing to the emergency room in the middle of the night.
The major issue against e-mails however is the lack of security.It is hardly appropriate to answer patient inquiries between responding to friends or family.Electronic doctor-patient interactions have to be secure, which is why with SavvyDoc we have created an internal messaging system for doctors and patients to interact with each other.In this way patients can feel comfortable communicating with their doctor without fear of that correspondence being in an insecure format.Doctors have the added benefit of separating the business of taking care of patients from the rest of their lives.
In my previous post on 
