Texting medical trainees: “You don’t hear pagers going off any more.”

Texting is the most common means used to communicate with residents and trainees, a small study of surgeons at a major Canadian teaching institution has shown.

While almost all of these surgeons reported using texting for patient related communications, the majority were not using encrypted devices and many were not aware if their hospital has a policy on texting.

The study from the University of Toronto, Women’s College Hospital and the University Health Network (UHN) is one of the first to shed some light on how a dominant means of communications in the modern world is being used in a medical setting.

The results were described by first author Mohammed Firdouse, a medical student, in a poster presentation at the recent Canadian Conference on Medical Education held in Montreal.

In the study, 98 general surgeons at UHN were asked to complete a 39-question online survey about their use of texting for patient-related communications and their awareness of regulations concerning the practice.

Approximately one third of those polled (33) responded to the survey.

More than 90% said they used texting for patient related communications and 60.7% said it was the most common way used to communicate with residents and trainees. However, only 14.3% of these staff surgeons said the used texting to communicate patient-related information with other staff.

The respondents identified speed and convenience as their main reasons for using texting.

Responses with respect to privacy and confidentiality with texting were more problematic.

Almost two-thirds of respondents (62.1%) said they did not have encrypted phones or did not know if their phones were secure while texting and 48.3% said they did not know if their hospital had a policy on texting. Even more respondents (72.4%) said they did not know if texting patient information is addressed in the Personal Health Information and Privacy Act.

These findings do not come as a surprise to Dr. Chris Simpson, past-president of the Canadian Medical Association and chief of cardiology at Queen’s University and Kingston General Hospital.

“You don’t hear pagers going off anymore,” he noted in an online interview.

“My sense – anecdotally, is that electronic communications (especially text) are commonplace between attending doctors and residents; between residents themselves, and less so between doctors and other health professionals.”

“Texting is fast, easy and accurate,” he said.

“Privacy is important but the horse is already out of the barn on this issue.”

“It will always be the responsibility of health care providers to safeguard the privacy of patient information that they have in their possession – this is true. But I am not convinced that texting info poses any greater risk to privacy that currently endorsed communication practices like faxing.”

“The challenge is for us all to find ways to enhance our ability to use electronic technologies in as low risk a way as possible – to establish a best practices culture that minimizes risk of privacy breaches. The answer can’t be and shouldn’t be an outright ban on texting,” said Dr. Simpson

Dr. Matthew Bromwich is an Ottawa pediatric otolaryngology surgeon and founder of Clearwater Clinical Limited and he has a keen interest in the development of mobile apps and the implications for patient privacy.

In an interview, he said, texting now has “100% penetration” in the health care sector and is an invaluable tool due to its convenience.

However, he expressed concerns that hospitals are still paying for pagers for staff that they do not use rather than tackling the issue of making their networks secure for mobile phone use and texting.

Bromwich said while clinicians and trainees can protect patient confidentiality by taking some care in how they frame texts, it would be far better for hospitals to address the issue especially as texting is particularly prone to illegal access.

 

Mind the gap: social media and #meded

Two small but intriguing Canadian research studies have documented the wide gap between teachers and students and educator users and non-users in their perceived value of social media as learning tools in medical and health education.

The studies were presented at this year’s annual meeting of the Canadian Conference on Medical Association (#CCME16) and the research involved two leading physicians in the social media and digital health world in Canada, the University of Ottawa (uOttawa)’s Dr. Aliraza Jalali and the University of British Columbia (UBC)’s Dr. Kendall Ho.

The uOttawa study conducted by medical education researcher Dr. Safaa El Bialy with Jalali evaluated feedback from 72 medical professors and 63 second-year medical students on their use of popular social networking sites (Twitter, Facebook etc.).

The UBC study presented by second-year medical student Karan DSouza evaluated feedback from 270 health educators at 8 global institutions on their attitudes towards the use of social media in teaching.

The uOttawa study found the medical students were about three times more likely to use the social networking sites for medical education than the professors (67% vs. 23%).

While 94% of students said they felt the sites facilitated learning, only one third of the professors said they used such sites in their teaching practices.

Despite established social media platforms being more than a decade old, El Bialy and Jalali noted “some of the educators did not even know about social media use for educational purposes” and many expressed concerns that such sites were distractions and promoted time wasting.

Just as the uOttawa study documented the gap between medical students and professors, so the UBC study showed sharp differences in perspectives between educators who use social media in the classroom and those who do not, in a variety of countries.

That study documented that health educators globally have concerns about the lack of guidance and support for using social media for educational purposes and also the lack of evidence showing the value of such tools. Even among those using social media in teaching, only 11% said they had received training in using social media for teaching.

DSouza and Ho also echoed the uOttawa study in their introduction when they noted “students have already adopted social media informally to share information and supplement their lecture-based learning.”

They also documented that adoption of social media is not consistent within faculties, even at the same institution.

Both research teams provided suggestions on how the use of social media in the classroom could be encouraged and facilitated.

(Artwork by @Aga_ta_ta on display at CCME16)

 

To the EMR … and beyond

For a conference that was about health information technology, it was all about health IT.

Allow me to explain.

The annual meeting of the Canadian Agency for Drugs and Technology in Health (@CADTH_ACMTS) is a showcase for health technology assessment (HTA) and the mission of the organization is to provide credible, impartial advice and evidence-based information about the effectiveness and cost-effectiveness of drugs and other health technologies.

What was noteworthy about this year’s meeting in Ottawa –  the largest yet for the organization with about 750 attendees – was the number of times electronic records (either EMRs or EHRs) were referenced as an essential feature for both gathering and for disseminating credible information to support evidence-based medicine.

Physician speakers repeatedly noted the need to have easy, point-of-care access at the time of the patient encounter, and to all of them this meant embedding that information in the electronic record.

More than one family doctor talked about being overwhelmed with guidelines and best practices and the need to integrate this information into the physician workflow to be useful – and EMRs as the natural place to do this.

The Canadian Association of Radiologists creates world-class clinical practice guidelines, but as Dr. Martin Reed, a pediatric radiologist from Edmonton told the meeting, one of the problems with these guidelines is that it is very hard to get people to use them.

He said there is now a feeling in the medical imaging community that the best way to do this is to integrate the guidelines into CPOE (computerized physician order entry) systems.

Given that some Canadian physicians still do not use EMRs and some (many?) hospitals are not using CPOE this could raise concerns about the quality of care being delivered.

On this information gathering front, the new focus on real-world data has placed an increased emphasis on the value of EMRs or EHRs to gather useful information to evaluate the effectiveness of drugs and technologies, the meeting was told.

“The starting point is having an EHR covering all of the caregivers. At that point the world is your oyster,” said Dr. Murray Ross (@murrayrossphd), leader of the Kaiser Institute for Health Policy in Oakland, CA.

Dr. C. Bernie Good (@CBGood23) who holds numerous roles with the US Department of Veterans Affairs gave numerous examples of how the extensive database gathered on VA patients through EHRs has helped support evidence-based drug prescribing.

And it does not end there.

As Anil Arora, assistant deputy minister in the Health Products and Food Branch, of Health Canada told the meeting it is not just the information being gathered in patient records that will need to be taken into consideration in the future – but also the wealth of patient data now being collected through wearables and other devices as well as through social media.

Given that we have by no means maximized the value of EMRs to gather this information in Canada, the challenges of extending the information sources to other digital repositories of patient information is currently problematic to say the least.

(Picture – Anil Arora. Courtesy CADTH)