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Smart phone “use” by physicians. What do the numbers really mean?

A recent article entitled “Why industry surveys on physician adoption of smart phones could be overestimating reality”at iMedicalApps [Mobile Medical App Reviews & Commentary – A publication by medical professionals] explored what recent market research really means…

It has been cited in market research that 72% to 94% of physicians are using smart phones in clinical practice (Questions: How are they using them? And, how often?).  Josh Herigon, MPH  a second year medical student and blogger at Number Needed to Treat comments:

“Although these studies show a high degree of smartphone adoption among physicians, these results should be interpreted cautiously. These firms provide few details on how they actually conducted these studies. A major hurdle to conducting such research is sampling bias. This can occur in survey research when researchers get a low response rate (i.e.—researchers approach a large number of individuals to fill out a survey but few actually fill it out).”

A little bird told me that a PTJ internal study revealed that no more than 50% of the physical therapists they sampled used smart phones. And, while the percentage of professionals who have and use smart phones is interesting data, I think there is a bigger question to consider. How many physicians, physical therapists, and other healthcare providers who own smart phones are using them routinely and effectively in clinical practice?

Owning a smart phone and leveraging its capabilities during clinical practice are two vastly different things. I am an avid smart phone owner and user, but to be honest, I rarely use my phone in clinical practice. I actually use it most while practicing within the in-patient hospital setting to look up medications, abbreviations, surgeries, and specific diagnoses. But, that is only when I am not near, or logged into, a computer. Admittedly, in the outpatient setting I grossly underuse the capabilities of my phone.

Why are we still giving out paper copies of exercises and patient education? I believe the opportunities for leveraging this technology for clinical support, aiding in clinical decision making, and pt. education are infinite. In my opinion, routine use could actually markedly increase efficiency and quality of care especially in physical therapy. Patient’s use and love their smart phone, so why aren’t we interfacing with them using technology? [Yes, I understand the potential HIPPA considerations and that is not the point of this post]

  • Patient education
  • Home exercise programs: Pictures, videos, directions
  • Pictures and videos of patient performance (motor control, motor learning, and feedback)
  • Documentation
  • Scheduling

Do you think it would be possible to run a private practice and physical therapy LLC strictly from a smart phone. If not, why not? Paper is messy and overated anyway…

Do you have a smart phone? If so, how are you using your smart phone in clinical practice? Do you use specific applications? Any ideas for how we can better utilize this technology as we move forward?

Considering making the switch to a smart phone? Check out this article targeted towards medical professionals: iPhone, Blackberry, or Android?

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Did you forget what I told you?

via Markle.orgI stumbled across this interesting little bit from the Markle Survey on Health in a Networked Life. It concerns perceptions of communication gaps between patients and physicians. Simply put, doctors think patients forget things they tell them and patients think doctors forget things about them.

While both situations are probably true, the gap in the perceptions is something to take note of. Underlying this gap is the question of responsibility of ownership of health data. The survey reported that nearly half of patients feel their “main doctor” should be responsible for owning their data, but 2 in 5 consumer and physician groups felt that patients should have the ultimate responsibility for owning their data . Check out their slideshow. (Note the 27% response rate from a small convenience sample of physicians.)

In the world of physical therapy, no one really knows much about how data is stored and what perceptions exist about ownership of data, or even if patients think physical therapists likewise forget things about them at the same rate that they perceive physicians do. We simply have not asked those questions. That point aside, rehabilitation professionals would do well to consider the concept of data ownership. Perhaps engaging in initiatives like “The Blue Button” would be a great place to start. Physical therapists: does your paper-based documentation system have a blue button? Does your EHR?

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Medicare Physician Compare Fail

This scathing blog post by Michael Millenson concerning the U.S. Government’s new site to help patients locate Medicare providers caught my eye. Medicare’s new Physician Compare was designed to allow consumers to learn more about their providers. Here’s a little background on the site.

After reviewing the site and doing some searching for physical therapists, I have to concur with Millenson. The site is a bust. It should be re-named, “Pointless Partial List of Participating Providers.” I know they are planning to add more content over the next few years, but why start out with such nothing to begin with? It lacks patient-centric factors or any potential interactivity like maps or web-sites. It certainly doesn’t compare anything.

Sites like Healthgrades.com do a much better job of providing some form of information that’s useful, but where are physical therapists on these sites? Consumers are presently lacking a good site to compare providers of physical therapy. As a profession, we can’t leave it up to big Physician sites or the federal government. We need to actively reach out to consumers and show them who we are. Thoughts?

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Hi-Tech at CSM

As healthcare continues to integrate new web technologies, fittingly, there is an increase in the technology-based offerings at the APTA Combined Sections Meeting this year. This conference, the pinacle of the PT meetings each year in terms of attendence and scope of programming and exhibitors, will be in New Orleans.

I found this handy way to read down some of the HPA Technology SIG programming via a Google Group. You might notice one tech session is Connecting the Classroom and Clinic: Use of an International Collaborative Classroom Wiki. I’m particularly excited about this session, as Rachael Lowe, Elaine Lonnemann and myself will be presenting Physiopedia! Hope to see you there!

Of course you can always check out all the programming on the APTA’s event page.

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iPad: PT’s New Best Friend?

By Bronwyn Spira, PT, and Tejal Ramaiya, DPT, CSCS

The iPad is quickly transforming the way business is conducted in the media, entertainment and education sectors. But what about health care? What are the specific benefits of the iPad for physical therapists and what should you be cautious about? As a clinic that has actively been using the iPad for about 6 months now, we have found a number of tangible benefits. Documentation is much faster and happens in real time with each visit. We can track and log the time of each modality, which is especially useful for insurance billing. The small, flat screen is less obtrusive than a laptop – We always felt the screen created a physical and potentially emotional barrier between my patients and myself. We also like that the ipad can be easily handed to the patient for demonstration of a video exercise or other visual aids.

A couple of notes of caution – the iPad doesn’t have a USB port or printer connection so document management is challenging. Current battery life is shorter than the 12-hour workday and common flash-based applications don’t work.

The other issues we face when evaluating the iPad as a medical tool are fragility (it will break if dropped) and hygiene since it cannot be sterilized. The latter is probably less of an issue for physical therapists than other medical professionals, but certainly bears mentioning.

The true future of iPad use within physical therapy clinics will depend on the availability of medical apps for clinicians. It seems inevitable that as our world becomes more and more technology focused we will have to start thinking about how to maneuver our own clinical landscape.

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Bronwyn Spira, PT, and Tejal Ramaiya, DPT, CSCS authored this guest post. They can be found at Force Therapeutics or Twitter.com/ForceTherEx.

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Sickening Report from WSJ

Spine Surgery Greed

Already controversial, yet continually growing more common, instrumented spinal fusion surgery took a public relations hit in an article in today’s Wall Street Journal. “Top Spine Surgeons Reap Royalites, Medicare Bounty” is an excellent, if not disheartening piece of investigative health journalism.

This piece is a must read for anyone involved in the care of patients with back pain, anyone with back pain, and hopefully, anyone involved in health policy that can help. Senator Grassley, You read this, right?

“One surgeon at a hospital in the Midwest disclosed receiving between $400,000 and $1.3 million in royalty, consulting and other payments from three spine-device makers. Using the Medicare-claims database, the Journal found this surgeon performed 276 spinal fusions on Medicare patients in 2008, by far the most of any surgeon in the country.”

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Medical Illustration: Entertainment and Education

One of my favorite activities in Augusta was/is to attend trivia at a local hang called, Helgas. Apart from the irony and inconvenience of the ultra smoke filled bar that’s frequented by graduate students at a medical college, it’s a solid game of trivia. It was always a treat for me to run into some of the medical illustration folks there. I admire the work and skill of medical illustrators, and one of my long-time favorite blogs is Street Anatomy. If you happen to be in Chicago next Friday, you can plan to attend Street Anatomy’s very first Gallery Show! Yes, I’m jealous if you do.

Medical illustrators are hard to come by, and there are only 4 accredited programs in the United States! Their work with animation and interactive learning images is priceless and plays an integral role in the education of all health professionals as well as the general public. I love to stumble across collections of medical illustrations, and so here’s one you can check out too: The 2009 Salon Award Winners from the Association of Medical Illustrators. Everyone should have a friend who’s a medical illustrator!

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APTA 2010: Boston Wrap

Image courtesy werkunz via Flickr The Annual Conference and Exposition of the APTA was recently held in Boston. It was a fun time and had the highest attendance in the past 4 years! Boston is a great city.

My personal conference highlights included a an amazingly constructed and delivered McMillan Lecture by Dr. Andrew Guccione, and getting to catch up with some of my former classmates and professors from Quinnipiac University. I also had the opportunity to present two educational sessions. One session was with Dr. Tim Noteboom from Regis University on Collaborative Web Tools, and another was with Rachael Lowe on the future of text books and Physiopedia.

Head on over to Physiopedia to check out our slides from that presentation! I’ll be posting the slides from the web tools talk in a day or so.

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Medieval Therapy Techniques?

Graston Tools

Do PTs today practice medieval therapy techniques? An ABC affiliate in San Francisco seems to think we use medieval tools, anyway. The technique reported on is the Graston Technique,® an aggressive form of soft tissue mobilization aimed at breaking up adhesions between fascia and muscle fibers using specialized tools. In theory, this treatment is essentially the same as aggressive STM; the difference lies in the use of the specialized tools.

So do the tools really make the technique more effective than traditional STM? The literature results are extremely limited. Only one study directly compared STM and the Graston Technique ®:

Burke et al. compared Graston Techniques ® to regular STM provided by the therapist’s hands for the treatment of Carpal Tunnel Syndrome. They resulted no clinical differences between the two groups, but did substantiate the clinical efficacy of conservative treatment for mild to moderate CTS. For those seeking convenient and relaxing care options, services like 인천출장안마 can be a beneficial addition to a conservative treatment approach.

Perhaps the effectiveness of the Graston Technique ® occurs from the ability to detect adhesions better than manual palpation alone. Users report feeling vibrations or hearing clicks as they move the tools over adhesions that were not detected by palpation. There are a few case studies that report solely on the effectiveness of the Graston technique.

Hammer reports on the ability of the Graston Technique ® user to both feel and target treatment on areas of degenerated tissues in three cases involving plantar fasciitis, Achilles tendonosis, and supraspinatus tendonosis.

Aspergren et al. effectively used thoracic (HVLAT) manipulation and the Graston Technique ® to treat a collegiate volleyball player with acute costochondritis. Although the authors did not compare to thoracic manipulation plus manual STM, pain and functional levels improved.

Other foreseeable benefits include the ability to really dig-in during STM and saving your own joints as a PT, benefits that may also be found in simple massage tools. The side effects include being too painful for many patients and causing bruising in some patients. In all, more research needs to be performed comparing the technique to regular STM by independent examiners.

Bottom line: for now, trust in your hands – they have been around since before medieval times, and are the most powerful tool a PT possesses.

1. Burke J, Buchberger DJ, Carey-Loghmani MT, et al. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manipulative Physiol Ther. 2007;30(1):50-61.

2. Hammer WI. The effect of mechanical load on degenerated soft tissue. J Bodyw Mov Ther. 2008;12(3):246-256.

3. Aspegren D, Hyde T, Miller M. Conservative treatment of a female collegiate volleyball player with costochondritis. J Manipulative Physiol Ther. 2007;30(4):321-325.