Warning: digital challenges ahead

There were a few interesting tech news facts this week. I thought this one was interesting: a Dutch campaign group used a drone to deliver abortion pills to Polish women, in an attempt to highlight Poland’s restrictive laws against pregnancy terminations.

There was scary news too: a private health insurer encouraged its members to use a Facebook-owned exercise app to qualify for free cinema tickets. Not surprisingly, Facebook was entitled to disclose all information shared via the app, including personal identity information, to its affiliates.

But there was also this: Telstra has launched its ReadyCare telehealth service. For those willing to pay $76, a doctor on the other end of the phone or video link is ready to care for you. No need to visit a GP or emergency department.

The telecom provider will offer the service to other parties like aged-care facilities and health insurance funds. Telstra is aiming for a $1 billion annual revenue.

Digital revolution

Digital developments increasingly create new opportunities, challenges and risks, but we have yet to find ways to incorporate the new technologies in our existing healthcare system.

In an interview in the Weekend Australian Magazine Google Australia boss Maile Carnegie warned that the digital revolution has only just started and that Australia is not ready for the digital challenges ahead.

Carnegie said that 99% of the internet’s uses have yet to be discovered and although Australia is the 12th largest economy in the world, it ranks only 17th on the Global Innovation Index.

She said that Australia has become a world expert at risk-minimisation and rule-making. Unfortunately this seems to slow down innovation.

“We are either going to put in place the incentives and the enablers to create the next version of Australia as a best-in-class innovation country or we’re not,” she said. “And I think it’s going to be a very stark choice that we have to make as a community.”

Who’s taking the lead?

In the last ten years we have seen major progress in for example mobile technology, but my day-to-day work hasn’t changed much. Healthcare has difficulty harnessing the benefits of the digital revolution.

Is the industry leading the way and letting governments, software developers and other parties know what is required? Do we have industry-wide think tanks to prepare for the near future? Have we listened to what our patients need and expect from us in the 21st century?

Your GP and Dr Google: a good team

Many of us use Google to look up health information. Even doctors google. I often use the search engine to show my patients for example images of anatomy or skin problems. As more people become tech-savvy and websites get better, I expect that Dr Google will be even more popular in the near future.

A study published in the Australian Family Physician in 2014 found that 63 percent of patients accessed the internet in the previous month; 28 percent had sought health information online; and 17 percent had obtained information related to problems addressed during a GP visit.

The challenge is of course to find reliable information. To help differentiate the good from the bad, have a look at this post: 6 warning signs that online health information may be unreliable.

It is recommended to check with a health practitioner that the information is applicable to you. Your doctor may be able to recommend some good resources too.

6 warning signs that online health information may be unreliable

If you are using Dr Google to find information about a health problem – like most people do – you will come across unreliable information. Here are 6 warning signs that will help you stay clear from quackery sites.

Information may simply be outdated or incomplete. But sometimes it is deliberately incorrect or manipulated, for example to make you buy something. How to differentiate between the good and the bad? (I admit, this is not always easy).

#1: The site wants to sell something

If a website is trying to sell a product, the information provided may not be objective. Be careful if the site is:

  • Showing lots of advertisements or testimonials, difficult to distinguish from the website content
  • Offering a free trial, money back guarantee or special offer
  • Using phrases or words like: Recommended by doctors, used by professionals, scientifically proven, patented technology, or guaranteed results.

A site may not explain that its main purpose is to sell something. Stay clear if it sounds too good to be true, for example if the website is promising you a miracle or magic cure, amazing results, or a new, quick or easy way to fix your health problem.

#2: It is not clear who makes the claims

Always check if a trustworthy health professional or professional organisation is providing the online information, like the Royal Australian College of General Practitioners or Physicians, the Australian Medical Association, the Consumer Health Forum of Australia or the National Prescribing Service.

Are links to original sources or scientific research provided? Missing or insufficient information may be a clue that a website is not reliable. Websites carrying the HON Code or HealthInsite logos are usually reliable.

#3: The website is out-of-date

Always check how old the information is. Has the website recently been updated? If the information is more than 2-3 years old it’s best to look for a different source of information – or talk to a health professional.

#4: The site has a less reliable domain

Trustworthy health websites contain the domains .gov, .org or .edu, indicating that the information comes from the government, a not for profit organisation or a university.

This doesn’t mean that other websites are always unreliable, but it’s good to find out who is sponsoring or paying for a commercial website (.com or .com.au) before relying on the information. You particularly want to know if the information favors the sponsor.

Websites written by a single person are less reliable than websites run by professional organisations. Yes, that includes this blog (I just shot myself in the foot, didn’t I?)

#5: You have landed on Wikipedia

Wikipedia scores high in search engines so it’s easy to arrive at a Wikipedia page. As much as I like Wikipedia, one study showed that it may contain errors.

#6: The site is requesting your information

Reliable health information is freely available online (at no cost), so there is no need to give a website your details, like your email address. If you must submit personal information, check what will happen with your details first.

Look for the website’s Privacy Policy: this tells you how a website or organisation manages your personal information. You may want to know if your data will be sold or provided to other organisations. A Disclosure Notice informs you if a site receives funding or accepts forms of paid advertising, sponsorship, or paid topic insertions.

More information

A rule of thumb: Don’t rely on one source. Try to find other reliable websites or sources confirming a message or claim about a product or service. Ask an AHPRA-registered doctor or health professional if you’re not sure.

If you would like to know more about finding reliable health information online, have a look at this 16-minute tutorial by the US National Library of Medicine.

Sources:

7 online eSafety tips for doctors

It is good to see that social media and eHealth are becoming mainstream topics at national health conferences. At the recent GP Education & Training Conference in Perth (GPET13) I attended two workshops about our professional online presence.

The first one was about the benefits of social media and was attended by GP supervisors, registrars and students. The second one, sponsored by a medical defence organisation, warned about the dangers of the online world, and interestingly there were mainly GP supervisors in the room.

Before I continue I must declare that I was one of the presenters at the first workshop. But it was good to be reminded by professor Stephen Trumble about what can go wrong. His excellent presentation created a lively discussion. Here are seven random points I took home from the workshop:

Tip #1

Doctors should be careful when looking up patients online, eg via Google. In general this is only acceptable if doctors are acting in the interest of patients, for example when trying to find contact information in an emergency.

Tip #2

Privacy settings of Facebook and other social media tools may change or fail, therefore: do not trust these settings. Assume that everything posted online, even in private networks and groups, is public. I have blogged about the elevator test, which is one way to check if something is suitable before posting.

Tip #3

Taking pictures of patients or their body parts is fine as long as the patient has been made aware of the purpose and who will see the picture, has given consent prior to taking the picture and has been de-identified. When doctors publish the picture online, consent must be noted within the publication. If the picture is later used for other purposes, the patient must again give consent.

Tip #4

When doctors collect patient information on their mobile devices, eg when taking a picture with a smart phone or when using a transcription service, these devices must be protected from misuse, unauthorised access, alteration or disclosure. The simple passcode on iPhones is generally deemed insecure (but can be made more secure in the phone settings). If patient information is stored overseas on cloud systems, local security laws apply and they may not meet Australian standards.

Tip #5

Old smart phones, even if factory settings have been restored and the data erased, still contain information. This is of course also true for USB sticks, practice computers, photocopiers with a hard disc etc.

Tip #6

I have blogged about the issues with Skype in patient care. From the handout: “Skype is not recommended for telehealth consultations but has not been deemed ‘unsuitable’. There are privacy, confidentiality and quality issues and many doctors who start with Skype end up upgrading to commercial systems.”

Tip #7

Last but not least: email is not suitable to transfer patient information. Encrypted email is the preferred option.

It is sad that the eHealth practice incentive payments (PIP) by the government are only paid to practices taking part in the PCEHR. As a result costly software, system and security upgrades will not be a budget priority for many practices.

Sources:

  • Online communication for education: risks, responsibilities and rewards. Workshop by Prof Stephen Trumble, Ms Nicole Harvey. GPET 13 Conference, Perth
  • General professionalism online – handout by MDA National
  • Informed consent and Telehealth – handout by MDA National
  • Telehealth tips – handout by MDA National

Don’t google yourself?

“Don’t google yourself,” is the advice from a Medical Defence Organisation in the Medical Journal of Australia, “because you’ll probably find something that you don’t like.”

That’s fascinating. It’s a bit like screening for cancer in people without symptoms. Sometimes screening tests are abnormal even when there is no cancer. This is more likely to happen when the probability of cancer is low.

The topic of the MJA article was reputation management. So I wonder, if an MDO tells us not to screen our online reputation, does that mean the probability of finding something we don’t like is low? Or is it because we can’t do anything about the unpleasant things we may find?

The same article mentions:

But the past 12 months have seen medical defence organisations (MDOs) experience a sharp rise in concerns about growing online threats to individual doctors’ and practice reputations.

In that case, telling doctors not to Google themselves is like saying to someone with a strong family history of diabetes: “Don’t test for diabetes, because you’ll probably find an elevated blood sugar level.”

When I blogged about the MJA article earlier this week, Dr Ewen McPhee commented:

Interested to know why you wouldn’t google yourself, how will that protect your reputation?

I think he is right. Isn’t it in the interest of the doctor and the practice to know what’s out there on the web? Especially since the concerns about online reputation are rising? In this case it is also right to screen because there is a ‘treatment’ available.

Google has a simple tool, called Me on the web. It can be activated via the Google dashboard, and the service lets you know when new online information appears about you or your practice. If you have concerns about the information or you feel it is incorrect, the content can in some cases be removed with Google’s help.

Find more information about how to manage your online reputation with Google.