eOffice 2002 Getting the Most Out of the Internet

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eOffice 2002Getting the Most Out of the Internet

• Andy Spooner, MD, FAAP
• Joe Schneider, MD, FAAP

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A Day in the Office on the Net

• Options for connections
• Secret features of web browsers
• Establishing a web presence
• Secure patient messaging
• Totally on-line CME
• The best of the web for pediatricians
• AAP web resources

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Options for Connecting

• Dialup via modem
• slow to start, slow to load
• ties up phone line
• cheap (maybe)
• Broadband Cable or DSL
• always-on, fast downloads (100Kb/sec)
• might need new wiring
• can share signal among many computers
• pretty cheap, even for businesses

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High-speed Internet
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Cable Internet Example
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Secret Features of Web Browsers

• Joseph H. Schneider, MD, FAAP
• AAP NCE, October 2002
• With the assistance of Andy Spooner, MD

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Our Goal In This Mini-Talk

• To provide some tips and tools to make your
  browsing more efficient and fun

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Expert (ek-sprt) n.

• A person from afar
• carrying lots of colorful slides
• whose degree of expertise is measured
• by the distance traveled.

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Types Of Secrets Covered

• Keyboard shortcuts for the mousephobic
• The mystery of the right click
• Toolbar tips
• Working with Acrobats
• Cookies and temporary files (Handout)
• Auto-completion (Handout)

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Keyboard Shortcuts For The Mousephobic

• Lots of em
• Far quicker than the mouse (usually)
• Some almost intuitive (e.g., Ctrl-P)
• Lists in handout by searching for "Internet
  Explorer Shortcuts"

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Selecting, Copying and Pasting An Entire Web Page
(Right Click and "Select All" is the same as
Ctrl-A)
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"Control-F" is for "Find"
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"Control-H" is for "History"
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"Control-N" for New Windows
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"Control-O" is for "Open"
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"Control-P" is for "Print"
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"Control-R" is to "Refresh"
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"Control-Z" is for EraZing Errors
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The Mystery of the Right Click
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The Great Google Toolbar
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Adding Even More Toolbars
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Adding Links To The Toolbar
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Working with Acrobat
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drjoes_at_pol.net
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Patient Education on the WebWhat do patients and
parents want?

• Endorsement of health education sites by their
  doctor?
• A web site created by their doctor?
• A web site edited by their doctor?
• One-on-one communication via the Internet with
  their doctor?

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Endorsement?

• Those who use the Net for health information
  consider doctor recommendation the most important
  factor in trusting a web site
• Only 4 of the doctors of these people
  recommended a site
• Source Cyber Dialogue, Inc.

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Web Site Created by Doctor?

• Only 9 of users are aware of a web presence for
  their doctor
• Only 6 have accessed a web site created by their
  doctor
• Source Cyber Dialogue, Inc.

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Web Site Edited by Doctor?

• Vanishingly rare phenomenon
• Not realistic for most practitioners
• One-on-one communication even less realistic

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Medem AAP Sponsored
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Medem Results after 10 minuteshttp//www.rpg.med
em.com
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Secure Patient-Physician Communications

• Joseph H. Schneider, MD, FAAP
• AAP NCE
• October 2002
• With the assistance of Ed Fotsch, MD

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Pt-MD Electronic Messaging Is Popular With
Patients

• 2002 66 Of US Households Use Internet
• Patient reasons for wanting online access
• "I forgot to ask all the questions in the visit"
• "I want something that doesnt require an exam"
• One site reports 10,000 patients/mo.
• scheduling appointments, requesting refills
• reviewing their medical records

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Top Uses Of Pt-MD Electronic Messaging
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Pt-MD Electronic Messaging Is Less Popular With
MDs

• 2002 23 using clinical electronic messaging, up
  only 4 points from 2001
• 54 waiting for reimbursement

Medem/ Medical Society Survey Data
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MDs Might Use Electronic Messaging If They Get
Paid
Source Medem
Q4 01 Medem Survey Data
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Patients Might Pay For Online Consults

• of online patients willing to pay
• 2001 25-30
• 2002 37 (41-45 with income 50K)
• Average amounts patients would pay
• 5-7 per message or 6-10 per month

• MDs want 57 for 15 min.

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Financial Benefits Of Online Consults

• Little to no additional overhead
• Speed increases with templates
• Collection rate 100

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Some Challenges With Electronic Messaging/OC

• Confidence of MD patient
• Ease of use
• Patient MDs computer skills
• Liability
• Security confidentiality

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Other Challenges

• Payor contracts Probably not billable with
  capitation
• Billing/payment Some payors piloting
  reimbursement
• Data storage medical record issues

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Is This The Future?
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Why Cant I Use Standard e-Mail?

• Not encrypted or authenticated
• Can be used by anyone
• No "terms of service"/disclaimers
• No charge capture function
• No template/medical record links
• Not compliant with HIPAA

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Features To Look For In Secure Messaging/OC

• Templates for frequent questions
• Easy links to patient ed materials
• Print function for medical record
• Patient-by-patient "privilege-granting"

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Features To Look For In Secure Messaging/OC

• Credit card-based billing
• MD sets fees incl. "no charge"
• HIPAA eRisk Compliant
• Terms of Service clear to patient to minimize MD
  liability

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Set Up Should Be Easy Flexible
MD sets the price, rules, grants access on an
individual basis
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Patient Choices Should Be Clear
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The MDs Inbox Should Be Well Organized
MD sees messages waiting other requests
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The Patient Request Should Have Helpful History
Matilda Lee
10/07/50
Female
No
Concerns about hormone replacement therapy
I have been reading about hormone replacement
therapy and how it can help my bones and heart as
I get older. But with my mom having had breast
cancer and my older sister- 59y/0- just being
evaluated for a lump in her breast, I have some
concerns. What are my options?
Message contains some medical history
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The Reply Should Allow Use Of Links And Templates
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The Future? Digital Photos Movies
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The Future? EMR Personal Health Record Links
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Some Secure Messaging Companies
Source HIRC, 2001
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Why This Could Make Sense
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Conclusions I

• A growing number of patients are online want
  quality electronic healthcare access
• Liability payment issues are evolving in a
  positive direction
• Standard e-mail is not secure should be
  discouraged

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Conclusions II

• Look for programs that fit your style and that
  integrate well with your patients practice,
  including your medical records system
• Watch for more information from SCOCIT in the
  future

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drjoes_at_pol.net
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Stanford SKOLAR

• Multi-mode search
• On-line CME
• Content
• Drug Databases
• Bibliographic
• Guidelines
• Full-Text Journals
• Evidence-Based Medicine
• Patient Education
• Coding Tools

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Whats OldPowerpoint at the Beach
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Whats Wrong Traditional CME

• Davis DA, et al. Changing physician performance
  A systematic review of the effect of continuing
  medical education strategies (JAMA
  1995274,700-705)
• Review of 99 RCTs of CME interventions
• Educational materials
• Formal CME programs
• Outreach visits
• Local opinion leader
• Patient-mediated interventions
• Audit with feedback
• Reminders

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Traditional CME

• What works
• Academic detailing
• Chart audit with feedback, perhaps
• Patient handouts
• Reminders
• What does not
• Conferences
• Educational materials (handouts to learner)

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Old Ed, New Tech RATT Model
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RATT Model, contd
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RATT, contd BaylorCME.org
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BaylorCME Technology Barrier
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MD ConsultCME
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New Concepts in CME ABP
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ABP, contd
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Pedialink
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Stanford SKOLAR

• Multi-mode search
• On-line CME
• Content
• Drug Databases
• Bibliographic
• Guidelines
• Full-Text Journals
• Evidence-Based Medicine
• Patient Education
• Coding Tools

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Stanford SKOLAR
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SKOLAR, contd CME
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SKOLAR, contd Notebook
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uptodate.com
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The Best Of The Web For Pediatricians Some
Classic Sites You Dont Want To Miss

• Joseph H. Schneider, MD, FAAP
• AAP NCE
• October 2002
• With the assistance of the SCOCIT members

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(No Transcript)
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Overview

• "Best" is a personal judgment
• Many of you might know these
• Split sites into categories
• Clinical Databases More
• Patient Information/Tools
• Office Tools
• A few not on handout ?
• CME AAP sites covered separately

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Clinical Databases For Docs

• OMIM
• Searchable genetic disorders
• Pub Med
• Dermatology Image Atlas
• GeneralPediatrics.com

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www.ncbi.nlm.nih.gov/omim/
Quick access Type "OMIM" in www.google.com
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http//pubmed.gov
Quick access Type "PubMed" in www.google.com
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www.dermatlas.org

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www.dermatlas.org
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www.generalpediatrics.com
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More Clinical Resources For Docs

• Merck Medicus Free MDConsult, Nelsons, Red Book,
  Harriett
• eMedicine
• Heart Sounds
• Pediatric News/Journal Summaries
• Online Magazines
• Am. Academy Family Physicians
• Good resources, plus section on practice
  management computerization

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www.merckmedicus.com
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www.emedicine.com
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www.wilkes.med.ucla.edu/intro.html
Quick access Type "Heart Sounds" in
www.google.com
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www.pediatriclinx.com
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www.contpeds.com
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www.aafp.com
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Patient Information Sites

• Pew Study (2002)
• 37 discussed online info with MD
• 79 of those found MD was interested
• 18 used Internet to self-diagnose
• 50 dont check sources or dates on sites
• 39 of online MDs consider Web useful for patient
  education

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Info Tools For Patients

• Your own web site
• Medline Plus
• Medline Plus Spanish
• Kids.gov

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www.yourname.medem.com
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http//medlineplus.gov
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http//medlineplus.gov/esp/
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www.kids.gov
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Everyday Office Tools

• Merriam-Websters Dictionary
• Merriam-Websters Medical Dictionary (on
  Intellihealth)
• Google (Awesome Search Engine)

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www.m-w.com
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www.intellihealth.com
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www.google.com
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drjoes_at_pol.net
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AAP Web Resources

• Pedialink On-line CME home
• eQIPP CME for practice improvement
• Medem Web-based patient service
• HIPAA Manuals (Members Only Channel)

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The End