The,Patient,Doctor,Relationshi health The Patient – Doctor Relationship in the “Digital Health Er

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The UnitedStates are leading the way in terms of technology, software and number ofstart-ups that are contributing to the growth of the e-health sector, one majorfactor being the way in which the American healthcare system works. The AffordableCare Act (ACA) of the Obama Administration has among its objectives toencourage preventive health care and workplace wellness programmes and thusreduce the number of emergency room visits and the costs that come along withit. To support the ACA the administration has introduced a form a sanction forthe hospitals in the US that have issues with patients that suffer fromspecific  chronic diseases and constantlyreturn to the hospitals for readmission. One of the solutions identified by thehospital management that would limit the numbers of returning patients and helpavoid the ACA sanction is telehealth, which is still an emerging trend thathelps doctors stay in touch and monitor the state of their patients fromremote.What about thenormal patient who does not need special treatment and follow-up by a doctor? Herethe key is again, wellness and prevention – in line with the ACA – and the trendis now shifting towards mobile devices, including tablets, giving a great boostto the mHealth sector. For this reasons great amounts of funding are being madeavailable for this fast-rising sector and investors are working with innovativestart-ups to get as much of the market share as possible. According to Halo Report Q1 2013, 60% of businessangel investment deals closed in the in the U.S. targeted internet, mobile,telecommunications and software and the second biggest amount of funds wereallocated to investments in healthcare. Putting two and two together, one candistinguish a very clear path that points to mHealth as being the digital touchthat will change the way healthcare and preventions is dealt with.  The WorldEconomic Forum identified workplace wellness as one of its top priorities thisopened up a whole range of opportunities and a solid argument for health andwellness-monitoring app developers to approach the employers and offer thembetter solutions that will help combat absenteeism, apathy and chronic disease.Emerging trends in eHealthTaking a look atthe emerging trends in eHealth, one cannot help but notice that the number ofhealth-monitoring devices and wellness gadgets are definitely on the rise, withproduction costs going down and the technology constantly being improved andadapted. One such example is Smartex, the intelligent undershirt that monitorsyour heart-rate and respiration, the posture of the body or activity, and anestimation of energy expenditure. This can prove to be very useful for patientsthat need constant monitoring from remote because the shirt comes with anintegrated solution for storing and processing the data made available by thesensors in the shirt. Here the next step would be designing clothes that areable to also track glucose levels and other important metrics in medical care.Of course thesolutions for monitoring your health come in various shapes and sizes, take forexample FitBit One that is now pretty much well-known after going through acouple of years of rework and is among the leading devices of its category. Ittracks the number of steps, the distance and burned calories and is also ableto distinguish between normal walking and stair climbing. When asleep, itmeasures your sleep quality and hours and can also act as a silent vibratingalarm in the morning. Recently Fitbit has also released Flex that has almostthe same functions as One but is missing the altimeter which “reads” whensomeone is going up the stairs. Fitbit is also open to a bunch of third partyapps like Run Keeper, which allows you to sync the data for alternative dataanalysis. Flex’s main competitor is Nike+Fuelband which is rumored to launchthe Nike Fuelband 2 that will include a heart rate monitor and the possibilityto connect with third party apps, which is now one of the main down sides. Tokeep up with the competition Nike has created a tech incubator named NikeAccelerator with the purpose of mentoring and financially sustaining 10 start-ups.The only condition imposed to the beneficiaries is that they would have tobuild upon and integrate the NikeFuel, Nike+ FuelBand or Nike+ Runningplatforms.For now, the mostuseful approach among the emerging trends remains telehealth applied technologyfor monitoring and assisting those patients in need of special treatment fromthe comfort of their homes, thus saving hospitals time and money. On a morepractical note, as a byproduct created instead around the concept of mobile,involving text messaging and photos rather than video there is the mHealthsolution. This gives the user the possibility to have constant access tomedical advice and assistance on their smartphones, both for the healthy peoplewho want to stay informed about how they can continue to lead a healthy lifeand for the ones that have a medical condition and have unansweredhealth-related questions.mHealth: specific trends The mHealthsector is gaining momentum: Whether you chose to replace your personal trainerwith an app, or you are in search of a medical practice or hospital near you oryou just want to have a doctor that can answer your health-related questions inthe click of a button, the applications for smart-phones can save you a lot oftime and effort.Looking at theavailable studies, the data that emerges from the Parks Associates survey inthe U.S. is that memory improvement apps along with apps that help people tolose weight or to have a proper nutritional intake, have the greatest number orusers. In the same study they also predict that the number of people who willuse online and mobile wellness applications or services will rise from 14million to 29 million by 2016.If one takes alook at the number of medical apps listed in the US App Store the approximatenumber is 19,474 (2.21% of total number of apps) and healthcare and fitnessapps hit 23,784 (2.70% of total number of apps). On the other hand Google Playseems to be a bit lagging behind in the medical app department as it hassomewhere around 8,000 apps even if, according to App Annie, Google Play has a10% higher number of downloads (this is also caused by the fact that Androidhas 80% of the smart-phone market share - according to Strategy Analytics). Allin all the opportunity for start-ups is great given that app economy is predictedto double in the next couple of years, reaching from $72 billion in 2013 USD to$151 billion USD in 2017, according to APPNATION.One of the main usesof the apps, as we have seen previously, is in synergy with thewellness-related gadget, they are very catchy for the consumer and so are theapps that work with them or that have a way of independently help you betterorganize your daily habits.The other use isfor the remote health advice: apps with services vary from just locating adoctor near you or using content-driver symptom checkers that can help youevaluate your health-related issue to offering you the means of chatting withyour personal doctor or with a specialist that does not know your identity. Someapps even offer you the ability to take pictures or videos and share them withthe doctor you are chatting to so that they can give a more informed advice. Inthis case, compared to telehealth which is mainly designed for patient-doctorrelation, the advantage is that the user could stay anonymous, asking even themore private questions that they would not dare make in person to a doctor.Like this, both doctor and patient would be able to text in the moment ofconvenience for them without the daunting task of having to aligning their agendasand setting an appointment.Focus on remote health-advice mobile appsGiven the factthat nowadays the great majority of internet users turn to online search whenit comes to finding medical and health-related information, this also appliesto a high number of smartphone and tablet users. The problem that arises veryoften is that they do not know how to find the reliable sources of informationor there is too much information dispersed all over the web in an unstructuredmanner. This represents a niche for remote health advice applications forsmart-phones, allowing users to chat in real-time with doctors from the comfortof their own smartphone. Who wouldn’t want to be able to ask for information oradvice from a specialist even as they are vacationing or staying at home and takingcare of the children? The U.S.-basedapplication for smartphones, PingMD,was initially created for parents to be able to ask their pediatriciansquestions about their children’s health. Now it has evolved to encompassdoctors of all specializations throughout the U.S. that want to stay in touchwith their patients using their smartphone. If their doctor is not yet listed,the patient can suggest to PingMD that their doctor be contacted in order toinvite him or her to create an account and start communicating with patients.The service is free of costs to both patients and doctors and it is based onpredefined content from which the user needs to choose step by step in order toexplain the health issue that they or their loved ones are encountering. Onecan attach photos or videos before sending a so-called “ping” to his or herdoctor with the possibility to add a written comment in order to better explainthe situation and if needed the doctor can share the ping with otherpractitioners with the patient’s approval. The application is ideal for managing the patient-doctorrelationship outside the practice but what if your doctor does not want to joinPingMD? There should be a solution for people that are in search for answersand don’t have their personal doctor online.The U.S.-based HealthTap has an integrated approachfor its website, widget and mobile/tablet applications and it addressed theneeds of the users by including the possibility to search for doctors by name,specialty, topic or location. After browsing the list of doctors available onecan choose to ask a question to a specific doctor for the sum of $9.99 orinstead go for the free option which allows you to write up to 150 charactersand gets you answers from the available doctors at that time. For the fee of$0.99 – allocated to charity - one can add an urgent component to the initiallyfree question. Also there is the possibility to fill in a form and fix anappointment with a doctor of your choice. The website and application offer a rangeof tools with predefined content in order to help users stay informed regardingmedication, diseases, symptoms, medical procedures and others, including aranking of other medical applications available in the online mobile stores. Thedoctors are ranked according to an algorithm that also takes into accountpeer-recognition, thanks and recommendations from patients, years ofexperience, studies and training etc. Heath Tap offers a pretty complete usersexperience providing multiple choices for people that are in search of reliableanswers and opinions from certified specialists. iTriage is created to helpdirect users towards the closest most suitable caretaker available: afterassisting the users in evaluating their problems using a symptom checker toolthat gives both visual and written content, the application offers varioussuggestions based on the issue that it helped identify. One can then browsethrough the list of doctors, practices, hospitals, drugstores or emergencyrooms available near the user’s location. The service is available free-of-cost for patients whereas forcaretakers, hospitals, urgent cares and employers they can ask to test a demoversion of the services they can be provided with – there is no price availableon the official website for services offered to caretakers. Just like HeathTap, iTriage comes with a widget that can be embedded on a websites in order tobring added value for the users and caretakers can also chose make available(for a fee) an appointment form that potential patients can compile whenbrowsing for doctors. ZocDoc, always U.S.-based,offers mainly the same free services like iTriage, although lacking the symptomchecker and the implicit suggestions for what type of caregiver one needs tocontact for the previously identified health issues. Taking a lookacross the ocean, the Italian-based websiteMedicitalia manages to provide a searchable database of Italian doctors bylocation, specialty and rating, also allowing users to ask questions for freein a forum-like manner (the question alongside the answers are available to theusers of the website). The downfall is that one cannot choose to talk to aspecific doctor and most of the doctors listed have not been active in morethan three months. Moreover the site does not come with an application forsmartphone and tablet. As seen above,the previous services were targeted mostly at patients as end users but thenext application is very useful for medical practices in managing theirafter-hours calls from patients. Ringadocprovides caretakers with the means of receiving, archiving and answering in anorganized manner to after-hour calls, without losing track of any detail. Theservice costs $49 per month and doctors can manage their calls and messageseither from the Ringadoc website, smartphone application or standard phone. Onthe basis of their target segment, TruthOn Call addresses the needs of various industries that are in search ofexpert-approved medical content or information in order to use it fordeveloping products or in other processes. The cost of these services is confidentialand cannot be found on their official website.There is still room for improvement  Theremote-health app market is certainly on the rise and there is room for muchimprovement in the quality and services available for users, as demonstrated by the above analysis. After taking alook at the U.S. best practices there are still some points that can beimproved in order to render the whole experience more effective for the user ofthe application. The first one consists in offering complete anonymity to theuser - the existing applications manage more or less to do so in the sense thatmany rely on publicly displaying the question but hiding the real identity ofthe user. This approach works to a certain degree but the issue of privacy,nowadays, gives rise to more and more concerns and the solution of a privatechat with doctors is able to solve that issue. Add to this crowd-power when itcomes to the responses given by qualified doctors to a user’s health questionand you have an easy to access source of knowledge and information for people totap in, when in need of quick answers directly on their devices. Last but notleast, when one is faced with a real health issue and wants to find the bestmedical specialist available in a certain location the internet offers youdisorganized and even outdated information. Thus, people should be able toaccess a database which allows them to search by location, specialty and levelof expertise of the doctors – this implies the creation of a relevant andaccurate system of rating based on reviews coming from patients and peers andother relevant factors.