Communication is what it’s all about in medicine — learning from colleagues and journals, and sharing insights about what works and what doesn’t. One way to exchange information quickly and efficiently is by using the power of social networks and online services. Doctors are joining physicians-only networks like Ozmosis and Sermo, and using Twitter to recommend journal articles to their peers and even to issue real-time reports on the progress of a surgery.
Robert Wood Johnson Medical School has taken its first step to enhance digital communication with its new Mobility Initiative, using iTunes U, Google calendar, and Twitter in combination to share academic content and scheduling information with medical students via an iPhone or iTouch. The initiative started with medical students and is now moving on to faculty. “We want to make sure everyone can stay connected in novel ways,” says Alex Izaguirre, director of information technology at the medical school. “This is one piece of a bigger puzzle that will make us more competitive.”
The Mobility Initiative uses modular components to distribute content in different ways. One application is a clerkship activities tracking system. Medical students are required to document what they see in every patient encounter as they pass through different clinical rotations — without of course recording any identifying information about the patients they see. They document the diagnosis provided, procedures used, skills developed, and any other relevant information through an application on their iTouch or iPhone. This application gives faculty opportunities to provide immediate feedback to students. “We have up-to-the-minute information on how students are doing on their rotations — something we couldn’t address in the past until weeks after the rotation was over,” says Izaguirre.
To handle student calendars, the medical school uses Google calendars. The calendars, which the students can link to through iTouch, include their course schedules and locations, with any changes instantly available.
The initiative’s audience response system, accomplished through a subscription with ResponseWare, allows lecturers to include interactive questions in PowerPoint presentations to which students can respond immediately through their iPhones. These quick interactions can provide professors with immediate feedback on any misperceptions.
A special Twitter account enables immediate contact with students, for example, if a room is changed or a lecture canceled.
What made the Mobility Initiative possible is a new, more flexible approach to technology adopted by the school in 2007, not long after Izaguirre came on board. Previously most organizations, the medical school included, would adopt a specific technological platform to respond to a list of organizational requirements. Typically such turnkey systems, created to satisfy very specific needs, follow a life cycle that ends in their obsolescence. “Many times the technology doesn’t evolve with the changing needs of the organization,” explains Izaguirre.
When a technology is first introduced, usage lags as the population is gaining familiarity with the product. As people get accustomed to a new system, usage is optimal, eventually reaching a peak. But then the problems begin. “What tends to happen after that is you get people wanting to do different things,” says Izaguirre. “Either the requirements of an organization are changing, or the technology is changing, or people start using the technology for different things that it was not designed for.”
Summarizing the problem with turnkey systems, Izaguirre explains, “When you are talking about homegrown or custom applications — billing, course management, medical records — if the technology doesn’t evolve with the needs, you end up with a technology that gets out of date and doesn’t supply as great a return to end users as expected.”
In a move toward systems that are more flexible and can evolve with changing needs, Robert Wood Johnson Medical School has put in place a number of modular technologies, that they call “the core technologies.”
One technology is iTunes U, which allots academic institutions up to one terabyte of hard-drive space to provide online digital content to their students and other constituencies. To enable access to this material, computers are coming installed with iTunes.
The medical school is using iTunes U as a core distribution technology, with both a public and a private side. The public side includes items like press releases and information on the H1N1 flu virus. The private side comprises information to be shared within the university, like course content.
For medical students, whose time is scarce, the ability to listen to an audio file for an immunology course at any time or place, as long as they can access a wireless network, may translate to a few more minutes of sleep at night or for time to assimilate more information more quickly. The Apple iPhone or iTouch used to access this content is another core technology, one that enables mobility.
Once the core technologies are in place, Izaguirre and his team build applications that use these core functions to fulfill a particular need. “This allows flexibility in how a product can evolve,” he says. “If we stop using iTunes U, maybe in the future we can make the shift with relative ease.” Another organization that is tied to a turnkey system, he adds, might have to completely abandon millions in investments.
Whereas the initiative uses a server to compress files so they can be posted as podcasts on iTunes U, a turnkey system might be designed specifically to record a lecture, compress a file, save it, and post it on a website — a system that works well as long as it is doing exactly what it is intended to do. But what if users want to make those videos available to researchers in another location as part of secure environment? Whereas the turnkey system will not be able to do that, his department would build an application to link up with a podcast producer, then take the files and either put them on the web, burn them to a DVD, or post them on iTunes U. This modular system allows his department to adjust to whatever best suits the needs of his researchers, educators, and clinicians.
Izaguirre graduated from Rutgers in 1995 as a biology and psychology major, with a minor in mathematics. In 2002 he received his doctorate in viral immunology from the University of Medicine and Dentistry of New Jersey. As a student, he always ended up helping people with computer issues and was eventually recruited by the microbial and molecular genetics department in Newark to do this professionally. In 2006 he came to his current position to work on the new medical school initiatives and at the same time to join the faculty as an assistant professor in the department of microbiology, where he teaches immunology to graduate and medical students. In May he received an MBA from Rutgers .
Although information is critical to good medicine, revenues are what keep hospitals, as well as the school’s medical group in business. In an effort to increase critical care income, Izaguirre’s department is just starting to implement an iPhone application for its medical group. With Patient Keeper physicians will be able to capture every encounter with patients immediately, which will help ensure revenues for each visit. “Anytime a physician doesn’t fill out a form, that’s a potential revenue loss,” explains Izaguirre. Previously they would have had to wait until they could log into computers.
This new initiative is part of the effort to use technology to cure more patients to either be cured or to help them live longer and with a higher quality of life. Sometimes all it takes may be a tip from a doctor who shares a promising new treatment for an orphan disease, or more regular monitoring of patients.
Izaguirre’s department is also at work on a new initiative in translational research called HealthFace, whose end goal is realizing discoveries made in the laboratory at the patient’s bedside. “We’re looking to facilitate collaboration between basic science researchers and physicians, students and anyone interested in healthcare,” he explains.