A Physicians Guide to Online Medical Communities

Online Medical CommunitiesHow Online Collaboration is Changing the Way We Practice Medicine

A Physician’s Guide to

Presented by

By Kelli Cleary, Content and Programming Manager, Physician Engagement and Social Media, Best Doctors, Inc. | [email protected]

and Eric Glazer, Vice President, Physician Engagement and Social Media, Best Doctors, Inc. | [email protected]

BEST DOCTORS and the STAR-IN-CROSS logo are registered trademarks of Best Doctors, Inc. Used with permission.

2

Physician Contributors

Garry Choy, MDRadiologist, Division of Emergency Radiology and Teleradiology Mass General Hospital - Boston, MA@GarryChoy

Miguel Perales, MDDeputy Chief, Adult Bone Marrow Transplant ServiceDirector, Adult Bone Marrow Transplantation Fellowship ProgramMemorial Sloan-Kettering Cancer Center - New York, NY

@DrMiguelPerales

A Game-Changer in Collaborative Medicine

Imagine your next patient is a challenging case. They’re not improving, and you’re not sure why.

You could email a few colleagues for their opinion, but opinions will be siloed and disjointed and attaching images with email can be bulky and unsafe.

Or, you could build your network and collaborate with them in near real time with an online medical community:

• Your case is uploaded and stored securely

• The case is studied by physicians across complementary specialties

• You receive diagnostic and/or treatment recommendations collaboratively

• Collaborators provide biographical and academic/professional appointment information, so you can vet their expertise

• The case becomes a teaching tool in the advancement of the field of medicine

“When doctors share and comment on cases in a secure,

online environment, they pool their collective knowledge

and offer unprecedented access to information

unbounded by restrictions of time or geography.”

– Faculty member, Johns Hopkins University School of Medicine

8 Benefits of Effective Medical Communities

1. Build a convenient, virtual extension of your peer network

2. Showcase members’ biographical information, including academic and professional appointments, published articles, research projects, etc.

3. Share files and diagnostic images easier and more securely than with email

4. Gather medical experts together, free of scheduling and time constraints

5. Augment the professional community you already have

6. Improve patient outcomes by considering differential diagnosis and treatment recommendations from various experts

7. Build an open-source library of medical information

8. Gain discourse from a community of experts on your most challenging cases

“Medical communities help advance the wisdom of the crowd, so when you share your opinion, it strengthens the collective knowledge of the community.” – Faculty member, MD Anderson Cancer Center

8 Benefits of Effective Medical Communities

High-Yield Clinical CollaborationParticipation in tumor boards, grand rounds and clinical curbsides is more productive with online communities because they:

- Keep discussion focused and on-task with streamlined commenting

- Connect physicians in relevant and complementary specialties so the discussion remains appropriate for the case

- Vet collaborators and allow you to build connections with a network of highly-qualified physicians

- Organize asynchronous case feedback into an orderly comment stream

- Hone your collaboration network for future case collaborations, so that you are spending less time finding the right peer

Mainstream Online Community Platforms

Twitter

– Pros: Ask questions and make connections with the entire world in 140 characters or fewer

– Cons: 140 characters limits in-depth case discussion, and Twitter is a public forum

LinkedIn

– Pros: Network with peers and professionals

– Cons: Not designed for image or case information sharing, even in private messaging

Sermo

– Pros: A physicians-only network

– Cons: That network is often anonymous and random, meaning you’ve no way to vet the information you receive; Physicians are often solicited for polling by site sponsors; The majority of the dialogue is non-clinical

7 Key Elements of a Successful Online Community

The online medical community you create or choose should enable networking and peer collaboration, and include the following:

- Data security: Your patient’s data is safe, so you can focus on their outcomes

- Medical image viewer: Diagnostic images are sharp and clear

- Mandatory profiles: Advice comes from peers you can trust, not anonymous users

- Thoughtful workflows: An efficient workflow means you get the answers you need quickly

- Sub-group creation to allow for special interest committees such as tumor boards

- Learning tools such as pertinent PubMed articles and a library of great cases

- Freedom from commercial interests, bias or advertisements

Connect, Network, Share Ideas

“I see it as a great tool for networking. You can put a question out there to a group of people from around the world, and it creates this web of networking that can help facilitate patient care.” – Ryan Madanick, MD, University of North Carolina Chapel Hill

“By networking (online)…doctors are sharing ideas and gaining medical insights with others across the globe.” – Ronan Kavanagh, MD, MRCP, Western Rheumatology, Galway, IE

“Online communities connect doctors, which is especially powerful when working on difficult cases. When we communicate with each other around these cases, collaboration can produce better clinical outcomes, and an online platform can make that really easy.” – Dr. John Aloizos, AM, MB BS, FRACGP, FAICD, Garden City Medical Services Pty Ltd; Inala Primary Care Ltd, Brisbane, AU

THE CASE:Mr. K was in his early seventies and had a history of hypertension and obesity (BMI 34). A few weeks after suffering pericarditis, he developed a persistent cough and a chest radiograph (CXR) showed left lower lobe (LLL) pneumonia, which was treated with flouroquinolone.

The cough persisted despite further treatment with predisone and albuterol, and despite an initial improvement in LLL opacity. He was admitted to hospital a month later with right lower lobe (RLL) consolidation, suggestive of aspiration, and a diffusely patulous esophagus.

Treatment and testing continued, including barium swallow, esophageal manometry and endoscopy. By the time the case was referred for online collaboration, Mr. K had visited the ER on three occasions, had been admitted to the hospital twice with pneumonia and was presenting with imaging consistent with ongoing aspiration.

His cough persisted and was largely unresponsive to benzonatate and pherergan with codeine. His diagnosis was diffuse esophageal spasm and he was continuing to take metoclopramide and bethanecol.

Case Study #1: 70-75 year old male with history of hypertension and obesity

Real Patient, Real Results

When a treating physician faced a patient with recurrent pneumonia causing repeat hospitalization, he presented his case to an online medical community for their opinions.

DIAGNOSIS & TREATMENT RECOMMENDATIONS:Consulting physicians challenged the diagnosis of diffuse esophageal spasm and suggested the problem was reflux disease leading to aspiration and aspiration pneumonia. They considered the drugs metoclopramide and bethanechol were probably doing more harm than good and recommended they should be discontinued.

They noted that Mr. K was already on maximum dose of PPI and was not a good candidate for anti-reflux surgery. His recommendation was that Mr. K should be strongly encouraged to undertake a serious weightloss program as his weight was exacerbating the reflux problem. Mr. K’s cough, laryngeal edmema and recurrent pneumonia were very likely the result of chronic aspiration from uncontrolled acid reflux.

OUTCOMES:Mr. K discontinued the drugs that were exacerbating his gastroesophegeal reflux and undertook the recommended weight-loss program. He lost 20 pounds and has not had any recurrence of the pneumonia or hospitalization since.

Case Study #1: 70-75 year old male with history of hypertension and obesity

The treating physician consulted trusted gastroenterologists and pulmonologists in the community, who helped make an astute differential diagnosis.

Real Patient, Real Results

Real Patient, Real Results

THE CASE: 70-75 year old woman with CAD, Type II DM, hypertension, hyperlipidemia and osteoporosis who has had 5 episodes of itching followed by near-syncope or syncope in the last 5 years. Most recently, she developed acute onset itching of her hands and feet, followed by flushing of her face and ears, then diarrhea. Rising from the toilet, she fainted.

Immediately following this, she was evaluated in an ER setting. Her exam showed a BP of 80/40, but was otherwise unremarkable. Lab testing and EKG were negative for any acute process. She was hydrated and given IV Benadryl there and her itching resolved.

Case Study #2: 70-75 year old woman with episodes of itching, flushing,

fainting and diarrhea

A physician in Maryland sought help treating a 70-75 year old woman with unexplained syncope episodes.

TREATMENT RECOMMENDATIONS:

A bone marrow biopsy and aspiration are recommended for this patient to look for evidence of mastocytosis or monoclonal mast cell activation syndrome. The bone marrow biopsy should be stained for CD117, tryptase and CD25, and the aspirate should be reviewed carefully for spindle shaped hypogranular mast cells. Aspirate should be sent for c-kit D816V mutation.

In addition, in order to confirm mast cell degranulation as the cause of the events, a tryptase level within 4 hours of a future episode should be obtained and compared to the baseline tryptase level. An increase of tryptase during the acute event confirms the mast cell etiology of the attacks.

OUTCOMES:

The treating physician was appreciative of the recommendations, which were “concise, informative and full of details which were easy to follow through on.” She is recommending a bone marrow biopsy to the patient, to be discussed at their next appointment.

Community members identified the patient’s symptoms as highly suggestive of a systemic vasoactive mediator release, such as seen in anaphylaxis or mastocytosis.

Real Patient, Real ResultsCase Study #2: 70-75 year old woman

with episodes of itching, flushing, fainting and diarrhea

5 Tips for Success in an Online Medical Community

Move your special interest committees, like tumor boards, within the platform to increase participation and negate scheduling conflicts

Support your opinions with literature references, and ask your peers to do the same

Teach medical students and residents with the cases posted to your online community

Invite peers with whom you usually email to join your community: case collaboration with them will be easier, and the community will benefit

Provide the level of detail in your own profile you’d like to see in others’

“The best physicians know what they don’t know - remember that the community is there to support learning.”

– Faculty member, Stanford University School of Medicine

For more information, contact Eric Glazer, Vice President, Physician EngagementP: 617.226.3623 / E: [email protected]

Medting™ is the leading physician connectivity software, enabling clinicians to seamlessly share data and knowledge securely on the cloud. Medting, powered by Best Doctors, provides clinicians a private, branded forum to easily exchange insights, diagnostic images and other files. The platform is widely used by life sciences organizations, hospital systems, medical associations and medical schools around the globe.

Founded in 1989 by Harvard Medical School professors, Best Doctors delivers answers and improved outcomes for patients and their treating physicians by channeling top medical expertise to consult on difficult clinical cases. Our products and services include Medting, ExpertConsult, InterConsultation and Find a Best Doctor. Often our services are seamlessly integrated into the benefit programs and health care offerings of larger employers and health insurance companies.

Clinical Collaboration, Simplified