Background To compare screening referral recommendations made by remotely located ophthalmic technicians with those of an ophthalmologist examining digital photos obtained by a portable ophthalmic camera system powered by an iOS handheld mobile device (iPod Touch). Methods Dilated screening eye exams were performed by ophthalmic technicians in four remote districts of Nepal. Anterior and posterior segment photographs captured with a Paxos Scope ophthalmic camera system attached to an iPod Touch 6th generation device were uploaded to a secure cloud database for review by an ophthalmologist in Kathmandu. The ophthalmic technicians' referral decisions based on slit-lamp exam were compared to the ophthalmologist's recommendation based on the transmitted images. Results Using the transmitted images, the ophthalmologist recommended referral for an additional 20% of the 346 total subjects screened who would not have been referred by the ophthalmic technician. Of those subjects, 34% were referred to the retina clinic. Conversely, among the 101 patients referred by the technician, the ophthalmologist concurred with the appropriateness of referral in more than 97% of cases but thought eight (2.8%) of those patients had variants of normal eye pathology. Conclusion An ophthalmologist who reviewed data and photos gathered with the mobile device teleophthalmology system identified a significant number of patients whose need for referral was not identified by the screening technician. Posterior segment pathology was most frequently found by the remote reader and not by the technician performing dilated slit lamp examinations. These results are promising for further clinical implementation of handheld mobile devices as tools for teleophthalmic screening in resource-limited settings.
JOURNAL OF MOBILE TECHNOLOGY IN MEDICINE VOL. 7 ISSUE 2 SEPTEMBER 2018 51 Background: Despite the prevalence of HIV and hepatitis C virus (HCV), many people in the United States have never been screened for these infections. Mobile phones could educate patients about screening recommendations and “nudge” them to request screening from their physicians. There is a need for studies to understand patients’ perspectives on this campaign strategy.
A previously healthy 37 year old man, with no risk factors, sustained a cardiac arrest whilst running a half marathon. During the event, he was using a fitness tracking device (Fitbit Surge, Fitbit Inc. San Francisco). The time and location of the arrest was determined from the Fitbit data when the pace fell to zero, indicating a lack of movement (Figure 1). Interestingly, at the time of the arrest the heart rate decreased but did not fall to zero as expected. These heart rate inaccuracies may be related to cardiopulmonary resuscitation (CPR) interference.
Results: Length of hospitalization was longer in the control group than in the CareLink group (4.04 vs. 2.21 days). Notably 91.3% of physicians preferred the use of CareLink Express over standard interrogation methods. Patients reported shorter wait time for device results with CareLink Express and “felt less anxious” compared to standard interrogation methods with corresponding p-values of 0.009 and 0.01. Control group arrival to interrogation time ranged from 91-3,022 minutes while the CareLink group ranged from 18-1,551 minutes. Significantly less time was required for interrogation in the CareLink group (422 min) than that of the Control group (1150 min, p < 0.001).
9 JOURNAL OF MOBILE TECHNOLOGY IN MEDICINE VOL. 7 ISSUE 1 MARCH 2018 Web-based technological innovations are increasingly being utilized to enhance the quality of healthcare. The UCLA Behavioral Health CheckupTM (BHC) is an innovative real-time, cloudbased behavioral health assessment and clinician decision making tool. This paper examines the implementation and acceptability of the BHC within the UCLA Health System. The BHC was successfully integrated into seven UCLA Behavioral Health Associates (BHA) behavioral health collaborative care settings. Components of successful integration included training of administrative and clinical staff in use of the BHC platform, including how best to introduce behavioral health screening and measurement to patients and caregivers. BHA adult patients and caregivers of BHA youth patients reported positive experiences with the BHC. As the BHC delivers results to providers in real-time, it provides a unique occasion to engage patients through immediate discussion of patient responses and to use results for guiding and customizing clinical care. In addition, the integration of BHC results into a primary care system’s health record framework facilitates the coordination of care over time, providing an opportunity for measurement based treatment to target and treatment quality improvement.
BACKGROUND:Racial and ethnic minorities face disparities in receiving the influenza vaccination. A text message intervention could deliver personalized and timely messages to counsel patients on asking their physician for the vaccination.AIMS:We assessed whether patients would be receptive to influenza vaccination text messages.METHODS:Participants were recruited from a sample of low-income, racial and ethnic minority primary care patients. Participants completed a self-administered survey. Descriptive statistics were used to analyze the data.RESULTS:There were 274 patients who participated and answered the questions of interest, of whom 70% were racial and ethnic minorities and 85% owned a cell phone. Thirty-six percent reported they had never received an influenza vaccination recommendation from their physician. However, 84% would be comfortable asking their physician for the influenza vaccination. Of cell phone-owning participants who would be comfortable asking their physician about the influenza vaccination, 80% would also be comfortable receiving a text message reminder.CONCLUSION:Text messages may be an acceptable channel to prompt patients to discuss the annual influenza vaccination with their physicians. Text messaging is a feasible tool to engage patients in their health and improve annual influenza vaccination rates among low-income, racial and ethnic minority patients.
Methods: Forty neurologically stable adult patients were recruited. We excluded patients who were non-English speaking, had intellectual disability, lacked caregiver availability, or had unstable neurological conditions. After each telemedicine visit a patient standardized satisfaction survey was completed, comprising 11 questions assessing patient willingness to participate, technical issues, and satisfaction with the clinic experience and medical provider. A provider satisfaction survey was obtained at the end of the study.
There is widespread evidence of an association between reduced health literacy and an increased risk of poor medical outcome. Patients with poor medical education experience significantly higher emergency room costs and up to double the hospital admission rates compared to patients with sufficient medical education. Lack of medical literacy is particularly important in the ageing population, due to increased burden of chronic illness and the increasingly complex management of progressive chronic conditions. To address this, various smartphone and tablet medical applications have been developed to improve patient health literacy and monitor chronic illnesses. We propose the need to examine the technological literacy of elderly patients, who are most likely to benefit from these applications.
JOURNAL OF MOBILE TECHNOLOGY IN MEDICINE VOL. 7 ISSUE 2 SEPTEMBER 2018 27 Background: In recent years, smartphone use in professional settings has been increasing, particularly with physicians. There are benefits and drawbacks that result from this increase. Despite this, there is relatively limited peer-reviewed medical literature on the subject. Thus, suitable guidelines for smartphone use in the health care setting is needed.
