Looking For Inspiration From #MedX 2014

This will be my first in-person experience at the Stanford Medicine X conference (the twitter hashtag for the conference is #MedX). In the past couple of years, I have seen and experienced the meeting through the internet via their fabulous live video stream of the meeting.

As I was watching the meeting from thousands of miles away, I could not help but feel the energy and passion of the speakers as they were telling their stories and sharing how they believe the patient experience could be better in this broken health care system of ours. The meeting has shown a lot of growth and progression in the past couple of years.

Then comes 2014, this year. I made it a point on my calendar to block out those dates, and make sure that I was not working (the past couple of years, I found myself "on call" can could not attend the meeting).  I even felt inspired to even try to be a speaker at the meeting, but I do not feel that I have a compelling story to tell.

With the conference in just a few days, I find myself at another cross roads in my social media career. I was a year ago, when I quit the internet and social media, only to return about a month later.

My work life has become very busy, and possibly overwhelming. I just read an article from the New York Times entitled, "Why Doctors Are Sick Of Their Profession." A lot of that article applies to me. Now, I don't say that to try to garner sympathy. It is that article, coupled with my recent rant called, "The Medical Chart Is Coming To An End. Here's Why," gives you a snapshot into my mindset going into #MedX. 

I'm not going to lie. I have high personal expectations going into this Stanford Medicine X conference. I'm looking to recharge my social media passion, and my passion as a physician. The Health Care bureaucracy is frustrating, and as I said in my essay, "This is not what I signed up for when I went to medical school." 

So, even though Stanford Medicine X markets itself as being a conference for patients and for the patient perspective, there are many other people out there (namely me) that are looking to express an opinion, to tell a story, and to inspire others in the work that I do. I'm looking forward to catching up with long time friends and to make new ones as my #MedX story begins...

Ebola Vaccine: Why It Doesn't Matter

"Dr. Sevilla, what do you think about the Ebola virus," a patient recently asked me. My patient and I talked about the recent news reports stating that over 1,500 people have died because of the virus. "There's a vaccine that's being developed," I told my patient. "Well, that's great. I'm definitely going to get it, IF...."

"IF...," I asked my patient. "Well, Doc you know how these things go. IF it's covered on my insurance, IF there are no side effects, and IF there are no bad preservatives in the shot, then sign me up."

According to this article, human trials for a proposed Ebola vaccine will start this week. However,  I really don't think the future Ebola Vaccine will matter. Let's change the word "Ebola" to "Influenza" or "The Flu" for a second. Yes, Ebola has killed around 1,500 people, none within the United States. Influenza kills from 300 to 49,000 people EACH YEAR in the United States according to numbers from the Centers for Disease Control and Prevention. How successful are we (and I'm including me in this) at giving our patients influenza vaccine? We can do better. I can do better.

Here are the factors determining whether patients in the United States will consider taking a proposed Ebola vaccine:

Law of Vaccine Supply and Demand: Remember the Flu H1N1 epidemic from 2009? The country was obsessed with the Bird Flu, like they are now with Ebola. My patients were scared to get the Bird Flu, and they refused the regular Flu vaccine because H1N1 was initially not included. Then, a few months later, H1N1 was included. What happened? Suddenly, demand dropped. In the vaccine world, in my experience, when there is no supply (like the current Ebola non-vaccine) or few supply, the demand goes way up. However, when there is an abundance of flu vaccine (like this year), many patients gladly refuse the vaccine.

Insurance Coverage: A common question I get whether it's prescription drugs, testing, or vaccines is this one: Is it covered by my insurance company? Now, don't get me wrong. I'm very sensitive to this. My guess is that an initial wave of potential Ebola vaccine will not be covered, or will have spotty coverage, and this will drive down demand. In general, the annual influenza vaccine is covered by insurance. Do my patients take the flu vaccine? Some do, and some don't.

Side Effects: "Dr. Sevilla, I don't want the vaccine because I'm allergic to it." How many doctors have heard this before? With a potential Ebola vaccine, people are scared of Ebola, but some are more scared of potential side effects of a vaccine. Of course, there are some legitimate allergic reactions. But, I believe some patients use mild reactions as a cop out to receive any vaccine, especially the yearly Influenza vaccine.

Preservatives: As soon as a potential Ebola vaccine is announced, I predict the anti-vaccine extremists will be out there on social media and traditional media - trying to scare the public that the Ebola vaccine is worse than Ebola itself. They have previously used the excuse that preservatives and additives to vaccines in the past to try to scare people. Will this decrease demand? We'll see.

The truth of the matter is that we probably won't see an Ebola vaccine any time soon in the United States. Trials are set to begin in the United States, but the first vaccines will likely be deployed to the epidemic areas of West Africa. Don't get me wrong, it is a tragic situation in that part of the world. But, the hype that is being generated by people and by the press in this country, is overblown, in my opinion, at this point in time.

My patients ask me about a potential Ebola vaccine and Ebola treatments every day. When these vaccine and treatments actually become a reality in this country, will patients take the vaccine? Will you take the vaccine? Think about it...

Image Credit: Shutterstock.com

Countdown to Stanford Medicine X 2014

I'm very excited to be attending my first Stanford Medicine X meeting in just a few days. For the past couple of years, I was unable to attend in person, but was able to watch the live video stream of this fabulous event.

Later this week, I'll post some of my personal goals and expectations of the meeting. Before that, I wanted to share with you four pre-conference conversations that I had leading up to this years meeting.

What you will see below are Google Hangout interviews with Bryan Vartabedian, Meredith Gould, Sarah Kucharski, and Christopher Snider. These interviews were done in the past three weeks. My intention was to write a separate blog post about each interview. Unfortunately, I have run out of time, so I present these interviews all in one post. Hope you enjoy our conversations!

Finally, if you cannot attend in person, you can still sign up for the FREE video stream from the meeting through the Stanford Medicine X Global Access Program. Yes, that's right, it's free. However, you have to sign up at their website here and then you will have Global Access to the meeting :)

My guest will be Dr Bryan Vartabedian (@Doctor_V) from 33Charts.com and Assistant Professor of Pediatrics at Baylor College of Medicine. We will be discussing our current opinions about Physicians & Digital Technology, the upcoming 2014 #MedX Conference, and much more.

Digital Strategist & Author Meredith Gould will be joining me to talk about the upcoming #MedX Conference, her current & future writing projects, and whatever else comes up!

Sarah Kucharski, aka The Afternoon Napper on social media, is a 2014 #MedX E-patient Advisor. In our conversation, we'll be discussing the upcoming +Stanford MedicineX conference, her E-Patient story, and whatever else comes up!

Christopher Snider, ePatient Advisor at Stanford Medicine X 2014, will be joining me to talk about the upcoming #MedX conference. He is also the host of The Just Talking Podcast which celebrates its 5 year anniversary this fall

Direct Primary Care by Dr. Ryan Neuhofel

Dr Ryan Neuhofel (@NeuCare), Family Physician, will be joining me to talk about Direct Primary Care, his experience at the AAFP 2014 National Conference of Family Medicine Residents & Medical Students, and more!

Thanks to Ryan Neuhofel, MD, MPH, for the opportunity to talk about Direct Primary Care in the Google Hangout video above. I have interviewed him about six months ago while at the NeuCare Family Medicine office in Lawrence, Kansas. That video follows at the end of this blog post.

He is known as Dr. Neu on twitter and the internet, and he has been telling his story since the opening of his practice in December 2011. Earlier this month, he was on a panel telling the Direct Primary Care story at the National Conference of Family Medicine Residents and Medical Students of the American Academy of Family Physicians.

In the video above, our conversation begins with how he describes Direct Primary Care to prospective new patients. Just like trying to define Family Medicine, it can be difficult to exactly define Direct Primary Care, because each practice is different. He also describes how he differentiates between Direct Primary Care and "concierge" medicine.

We also cover some of the common misconceptions about Direct Primary Care, like DPC patients are usually young people without any insurance. He states that there are many patients who come to NeuCare Family Medicine, do have insurance, usually high deductible private insurance, who pay out-of-pocket expenses anyway.

Dr. Neu states that there are many medical students and residents who visit his practice with the goal of opening their own Direct Primary Care practice when they complete their formal medical training. In fact, right at the end of this video, he introduces us to a medical student who is shadowing him today.

As I have said on this website in the past, I am glad that medical organizations, like the American Academy of Family Physicians, are recognizing Direct Primary Care as a legitimate alternative to our current broken health care system. It's always great talking with Dr. Neu, except for the fact that I continue to mispronounce his name when I interview him. Sheesh...

Mike Sevilla, MD talks with Ryan Neuhofel, MD, MPH two years following the start of his Direct Medicine practice called NeuCare Family Medicine in Lawrence, Kansas. Also check out the following links - http://NeuCare.net - http://DrMikeSevilla.com

The Bryan Vartabedian Interview

Dr. Bryan Vartabedian, one of today's most well-known Physician Social Media leaders, unofficially announced his new book on last night's Google Hangout interview (video above). The details will be outlined next week on his website 33Charts.com, but I received an exclusive preview of its contents.

"This is a practical guide to life as a doctor in the connected age," Dr. Vartabedian discusses at around eight minutes into the video above. He goes on to state that this book will be an extension of the current content that is on his 33 Charts website. @Doctor_V would not give up the title of the manuscript, only stating that more details will be revealed next week.

Not using the traditional publishing route, we discussed why he chose the E-publishing route. At around 45 minutes into the video, he states that he chose the platform called TinyPass to initially publish and to initially receive feedback from readers. "Publishing is traditionally an endpoint. I see this hopefully as a start. This type of book must evolve as technology evolves." 

We began the video interview above talking about next week's Stanford Medicine X conference in which he will be co-presenting a Master Class on Physician Online Identity with Dr. Wendy Sue Swanson. We agree that there is no other type of conference like this out there in which patients and the patient's point of view are placed front and center. There is certainly value to this, and I am looking forward to my first #MedX conference next week. 

On a personal note, I've been very happy using the Google Hangout format for video interviews. In the past, I have used audio podcasts, particularly the Mike Sevilla Radio Show, of which I have over 300 episodes, to create conversations and have interviews.

In addition to the #MedX interview with @Doctor_V above, I also invite you to check out recent Google Hangout video interviews I've done with #MedX E-patient delegate Meredith Gould and #MedX E-patient advisor Christopher Snider. Hopefully, I will be able to squeeze another interview or two before next week's #MedX conference...

The End of the Medical Chart

"Dr Sevilla, I have a question for you," a patient asked me this week. "I'm going to tell you something, but I DO NOT want it put in the chart." Hmmm, I asked myself, can I really do that? It's the patient's wish, right?

The patient went on to tell me that she heard about this week's story about a hospital network being hacked and 4.5 million records being stolen. "What if that was my information?," the patient asked. "Does that mean that information in an electronic medical record could be out there for anyone to see?"

"How do I know your server won't be hacked?" the patient went on to say. "Doctor, what if I asked you to not put this in the electronic record, and to put this in my old manila folder paper chart?" Can you imagine the disruption of trying to maintain a digital chart, and also going back to maintaining a paper chart as well?

Much has been written about the inadequacies of the digital medical record, but as more and more digital medical records breaches occur (and I'm not even going to touch on the security flaws of Healthcare.Gov), how comfortable will patients be in giving medical and non-medical (ie-financial) information?

Just a few observations on why I think we're coming to the end of the utility of the medical chart:

• Loss on the Story and Narrative: Back when I was a first year medical student 20 years ago, the most important thing was recording the patient's story in the medical record. For example, to be as specific as possible in who, what, were, when and why the patient was having their symptoms. In today's digital world, when I read a medical student or resident note, it's like reading twitter. Very brief, vague, and not really that useful. I think we, as medical professionals, have lost the art of telling the story of our patients because of the digital record.
• The Medical Record as a source of billing and false accountability: Now, I'm not the first person to say this, but the medical record has become a place, literally, to check the box and less a place to really come up with the solution for patients. Many believe that the electronic medical record is a way for "big brother" (whomever that is) to keep an eye on clinicians, and eventually find a way to compensate less. My cynical mind is slowly (and reluctantly) agreeing with this point of view
• Security Breaches will become MORE and not less frequent: I predict that there will be a coming wave of concern to the point where patients will insist that certain medical data NOT be recorded in the electronic health record. What will the clinician do at that point? Do we follow the "patient centered" model because that is what is being emphasized now? Or, do we follow the medico legal fears and record it anyway for fear of being sued for an incomplete medical record?

Of course, I'll have comments and tweets telling me I'm overreacting. And, still other tweets telling me that they have been saying things like this all along. Is this the future of medicine? Is this the future of medical care in America? This is not what I signed up for, and I'm mad, and sad, at the same time. All I wanted to do is take care of patients, and hopefully have an impact in their lives. It seems more and more that is becoming more difficult...

Maine Quality Counts Conference

I'm honored to be speaking at the Maine Quality Counts Conference on a topic titled, "Using Social Media In the Patient Centered Medical Home." This conference is very exciting for the organization because, according to the website, this is the "First Learning Session that will bring together all practices from both the Patient Centered Medical Home (PCMH) Pilot and the Maine Health Homes (HH) Initiative as well as Community Care teams. The theme of the conference is "Primary Care Leadership In A Changing World: The Next Big Thing." The latest registration that I heard was over 500. So, this will be an exciting first event for the organization.

Using Social Media In The Patient Centered Medical Home from Mike Sevilla

Above, you'll see the slide set used for my presentation entitled, "Using Social Media In The Patient Centered Medical Home." In addition, I hope to video record the presentation as well and share it here with all of you.

As far as the conference itself, I'm hoping to bring you social media coverage of it as well. You can follow my twitter account here. In addition, I encourage you to follow the twitter account for Maine Quality Counts, if for anything else, they have been doing these creative Health Care Related Haikus with the hashtag #DailyHealthCareHaiku. I don't know if there is a twitter hashtag to the conference, but I will also be using the hashtag #AF4Q which is associated with our friends at Aligning Forces For Quality. Follow the conference on twitter!

Mike Sevilla, MD presents at Maine Quality Counts PCMH Conference on June 20, 2014 in Augusta, Maine. Slides at http://drmikesevilla.com/blog/2014/6/19/maine-quality-counts-conference - Also check out http://DrMikeSevilla.com

Apple HealthKit for iOS8: A Doctor's Take

Today, Apple previewed a new app called "HealthKit" that will be included in their next mobile operating system called iOS 8. There has been extensive coverage on this from the following sites: Apple (photo above and below from Apple website), The Verge (video from The Verge website), 9 to 5 Mac, MacWorld, Mashable, The Unofficial Apple Weblog, and Forbes.

Features mentioned in the video above (3 minute segment):

• One central app to integrate data from wearable technology like NikeFuel, Withings Blood Pressure Monitor, and Fitbit
• Working with the Mayo Clinic (for an app to launch in September) to integrate incoming and outgoing health information into HealthKit so that if there is a really high blood pressure, the Mayo Clinic will be notified, through the app, so that a medical professional can proactively contact the patient
  • Quote from Mayo Clinic CEO, Dr. John Noseworthy: "We believe Apple's HealthKit will revolutionize how the health industry interacts with people. We are proud to be at the forefront of this innovative technology with the Mayo Clinic app."
• Working with Epic, a huge player in the EMR market. The Epic EMR mainly administers to major hospital systems. From the video above, sounds like "the promise" is the integration of incoming and outgoing iPhone health information between Epic hospitals and the HealthKit app
• Emergency Card: The best part of this app, in my opinion, was brushed over very quickly. Within HealthKit is something called "Emergency Card," and according to the Apple website, "You can create an emergency card with important information - for example, your blood type or allergies - that's available right from your lock screen." I like that!

My Take: I know that this is only a preview, and they were only able to scratch the surface at this point. But, to be honest, even though the tech press is very excited about this, I am not impressed. Why?

• Has Apple solved the Patient Privacy problem: I've talked with many tech people about the challenges of making an app reach the standards of the strict HIPAA compliance. Not only does Apple want to hold health information on the phone, but also potentially have two way health information exchange with institutions like Mayo Clinic and Epic hospitals.
• Patient comfort level with digital health information: When I talk to patients (especially the less tech adventurous patients), they are most sensitive to their health information. They are really going to be anxious about potentially transferring health information to Mayo Clinic or Epic hospitals. How is Apple going to assure patients and providers that health information is safe and secure?
• Mayo Clinic false positives: In the presentation, it was stated that if something like a blood pressure was really high, that this information would be transmitted to Mayo Clinic and then a patient would be contacted by Mayo. I'd love to see the initial testing of this function. Blood pressure monitors have machine errors and user errors. How will they sort that out?
• Epic integration: I won't even rant about my hospital not having access to Epic because we're too small of a hospital, which means my patients won't have this HealthKit integration. I've seen the Epic system, and it is a lot of information even for a 13-15 inch laptop screen. Will typical patient portal information be available on HealthKit? Will patients be able to transmit health information from HealthKit to the Epic hospital system? Will patient's even use HealthKit for this purpose?
• Integration of the mythical iWatch: For months now, everyone from the tech press to the tech savvy medical providers have been saying that a wearable device like an iWatch is inevitable. Would an iWatch be helpful for health? An iWatch cannot take a blood sugar, a pulse, or a blood pressure. Yes, it can count your steps, but there are already a variety of devices that already do that.

Now, before everyone starts to come after me, let me say that, yes, I am impressed by the technology above. But unless I see more features and the patient privacy and integrations are answered, HealthKit may be as functional as the previously overhyped, but underutilized Passbook app. Remember that app?

Wrap-Up: AAFP Summer Cmte Mtgs 2014

Yes, it's that time again. It seems like the only times I get to write a blog post is sitting in an airport somewhere on my way home. Alas, that is what is happening this time. Woke up at 3:30am in Kansas City to start my trek, and to contemplate. The AAFP completed its most recent advocacy meetings discussing topics in areas like governmental advocacy, education, and membership.

Here are a few of my highlights from the meeting:

Family Medicine for America's Health: This is a bold initiative that will be unveiled later this year by the American Academy of Family Physicians. According to their website, "Family Medicine for America's Health is to examine the challenges and opportunities facing Family Medicine today, and define a path forward in the context of a rapidly changing healthcare landscape."

About a year ago, the "Family of Family Medicine" organizations came together came together to start these discussions. Since then, there has been extensive national research, multiple feedback sessions with stakeholders, regular updates on the initial stages of the initiative, and more.

I wish I could share more, if I knew more. I think it's very exciting that the specialty is taking this step of outlining the problems of our broken healthcare system (which we already know), but also seeking out feedback for solutions from AAFP members, Family Physicians, and key stakeholders. I'm curious what the final report will reveal.

Family Physician Networking and association update: It's very difficult for an association to try to address all needs of its members, because of limitations of financial and staff resources. But, recently, the AAFP created an new opportunity for Family Physicians with similar interests to network and "find a home" in the Academy. These groups are called "Member Interest Groups," and the AAFP committee I serve on has its task to review applications of these potential groups. I think this is a great opportunity for the Academy to reach an entirely new group of Family Physicians for networking and communication.

Family Physician Friends and Fellowship: As I have said in previous blog posts, meetings like this energize me and recharge me. Catching up with old friends is always fun, as well as meeting new people. Last night, there was even fireworks to conclude the evening!

I have always said this in the past, but I really hope to write more about my experiences this weekend. From a social media front, more and more people are approaching me at these Family Medicine meetings about their excitement for utilizing social media. It's been a slow growth process, but I'm happy with the results up to this point! Time to go home!

2014 #AAFPNCSC: Initial Thoughts

Welcome to those of you who I met at the meeting this week and are checking out the website for the first time. My long time readers will know that I like to write an "initial reactions" blog post when I'm sitting at the airport (sometimes with an adult beverage), and ponder about what just happened in the past few days...

AAFP Leadership Conference of Current and Aspiring Leaders: This past week, the American Academy of Family Physicians announced a "reimagination" of their annual leadership meeting currently named the "Annual Leadership Forum" and the "National Conference of Special Constituencies." You can see the video announcement above. But next year, in 2015, will be the 25th anniversary of this meeting, and the Academy stated that a natural evolution of this leadership meeting needed to take place. The new name is above and the two leadership tracks will be "National Conference of Constituency Leaders" and "Annual Chapter Leader Forum." I'll write more about this soon....

Family Medicine Social Media Impact: It's no secret that I've been encouraging the #FMRevolution community to share our story on social media. This was a tremendous week in getting more people signed up for platforms like twitter, and encouraging more people to use twitter. The final stats are above including 2186 tweets, 196 participants, and 4.2 Million impressions. The next big event will be in the fall at the AAFP Congress of Delegates and Annual Scientific Assembly....

New Friends & Catching Up With Long Time Friends: One of the things I love about these meetings is the opportunity to meet new people can catch up with long time pals. As you all know, social media only goes so far as keeping up with people's lives. There is nothing like those in person interactions, telling stories, and laughing a lot. As always happens at gatherings like this, there have been some life long friendships started here, and it will be exciting to see their professional leadership careers develop.

Finally, thanks to all those who make this week's leadership meeting possible. Shout out to the AAFP staff, the physician leadership teams, the conference presenters, and the enthusiastic participants who continually make this meeting fun for me. What will happen for the 25th Anniversary of this conference? We'll see...