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Modern technology makes it possible for us to do more work in a day than any previous generation of clinicians ever did. Faster, smarter apps make prescribing safer, remind us of the right dose, update us on new FDA warnings, and cross-check interactions among dozens of drugs in seconds. Electronic access to old records, lab results, and imaging accelerates the speed of care. The three-device model of the last decade – pager + PDA + phone – is quickly morphing as clinicians adopt newer devices. Two years ago, half of U.S. clinicians were using smartphones; now the figure is 72% and is expected to reach 81% by next year.¹

When it comes to office visits, the irresistible pull of modern communications technology has had surprisingly little effect on the current model of face-to-face encounters and occasional phone calls. Privacy concerns, reimbursement, documentation, medical liability and other issues immediately leap to mind. If all the logistics were solved, what percentage of the follow-up patients you see in a typical day could have been appropriately cared for through an email, instant message, or video chat?

A recent report¹ revealed that 39% of physicians email, secure message, or instant message their patients – 14% higher than in 2006. Dermatologists and oncologists were the specialists most likely to communicate with their patients online, followed by neurologists, endocrinologists, and infectious disease specialists. In one recent study,² instant messaging communications from a psychotherapist performed surprisingly well against traditional face-to-face cognitive behavioral therapy for patients with depression.

Full-on telemedicine is no longer limited to remote and underserved areas like the Australian outback, Antarctica, or the international space station. An increasing number of medical centers are using video technology to facilitate long distance consultative expertise during patient encounters. Monitoring data from the ICU or obstetrics ward can be transmitted straight to a smartphone. The Veterans Administration has developed telehealth centers with sophisticated exam cameras, monitors, digital stethoscopes and other diagnostic equipment that can save some patients the expense of a long trip to a referral center.

We would like to hear how you are leveraging modern technology in your practice. Contact us at docalert@epocrates.com.

¹ Physicians in 2012: The Outlook on Health Information Technology, Manhattan Research

² Therapist-delivered internet psychotherapy for depression in primary care: a randomised controlled trial. Kessler et al. Lancet. 2009 Aug 22;374(9690):628-34.

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Editor's Pick
Anne Meneghetti, MD
Director, Clinical Communications, Epocrates

Short Cuts

All you need to read in the other general journals

[Two Self-management Interventions to Improve Hypertension Control: A Randomized Trial. Bosworth et al, Ann Intern Med 2009]

Home monitoring plus telephone support works best for people with hypertension

We already know that regular blood pressure monitoring at home can help people control their hypertension. One recent trial suggests it works better when combined with telephone advice from a nurse. The nurses called every two months for an individually tailored discussion about diet; smoking; drinking; exercise; drugs; salt intake; and relationships with friends, family, and health professionals. At the end of two years, patients allocated the calls combined with home monitoring three times a week had significantly lower blood pressure than those allocated usual care (difference in systolic blood pressure –3.9 mm Hg, 95% CI –6.9 to –0.9; difference in diastolic blood pressure, –2.2 mm Hg, –3.8 to –0.6).

They were also more likely to have adequately controlled blood pressure. The two interventions seemed synergistic even though nurses making the calls had no access to patients’ home blood pressure measurements. Patients allocated home monitoring alone, or telephone support alone, did no better than controls.

The authors recruited people with treated hypertension from two academic primary care clinics in the US. Three quarters of recruits had reasonable blood pressure at the start of the trial, and the overall mean blood pressure at baseline was 121/71 mm Hg. Participants were 66% female, with a mean age of 61.

BMJ 2009;339:b4165
© 2010 BMJ Publishing Group Ltd.

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Q: Dr. M. wrote, "Lysteda hasn't been added to the database. Why is that?"

A: The content you requested is already scheduled for entry into the Epocrates Rx® database. However, we do not add drugs to our database as soon as the FDA approves them. Rather, we wait until such time as they are made available to the marketplace. This is done in order to avoid confusion with our subscribers, who might otherwise prescribe medications that are actually unavailable. We feel that it is a disservice to our subscribers when we include products in our database that are not available to be prescribed to their patients.

Once the FDA approves a product, it often takes weeks to months or, in some cases, years for the manufacturer to actually release the product to market. During this time, we continually remain in contact with pharmaceutical manufacturers to update their expected launch dates for new products and add monographs as soon as we can thereafter. Content for Lysteda will appear in Epocrates after its release to the marketplace.

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