- Email: [email protected]
iCAP: Harnessing the Power of Technology
CLINICAL PERSPECTIVES
iCAP: Harnessing the Power of Technology Yann B. Poncin,
T
he American healthcare system has seen an explosion of technologic innovations in recent years. From federal mandates to expand the use of health information technology to advancements in infrastructure making highspeed data access the norm, the climate has led to technologic advancement in health care nationally.1-3 As individual practitioners, this technologic expansion has led to dramatic changes in our professional lives. The collaborative process once required a staccato exchange of desktop e-mails and thumb-drive files; today, we can engage in a seamless conversation over wireless messaging and live-updating projects hosted in the “cloud.” This blossoming technology is a benefit and a bane. There remain unresolved and emerging questions about the effects of technology, from issues of privacy and confidentiality to the drain of 24-hour accessibility. Will face recognition and geolocation tagging intrude on the “blank slate” of the psychiatrist as we know it? Given that patients Google your name before the first visit, should you manage your “online presence” more carefully? These are tough questions for our field, and there are others. However, for this piece, let’s focus on simpler issues—and avoid social media here—and look at the practical uses of this technology. Some programs simply provide better ways of doing things that have always been done and have little privacy or patient meaning or philosophical implications. Each of us in child psychiatry—whether we work privately, for a clinic, a university, a state hospital, a detention center, a school, or, as is commonly the case, in these areas and others at once—must manage many tasks; we have our patients, staff, colleagues, supervisors, mentors, students, residents, and fellows beckoning for our time and contact. What applications, software, and programs might help us? There are several instances when emerging technology can help in the day-to-day life of a child psychiatrist and mostly concern the advantages of asynchronous communication and ease of access. Whenever you need to reach more
M.D.
than one person in a hurry about an issue in the here and now, then it may be time for a group text process. For example, the consult liaison service is slammed. You need to rally the troops, get extra support, and communicate regularly with one another, or you find yourself sending the same static information over and over again. Rather than locating the information each time on your desktop, you can have it in the cloud and send it readily from anywhere, and without clicking through subfolders. Worried about losing your presentation on your flash drive? Dropbox has it. The following paragraph describes examples of how I might use this technology in my day. Evernote is a great storage system for documents and other media. I e-mail a note directly from Evernote to a new fellow on call, which outlines on-call responsibilities; that note also has a link to a YouTube video uploaded from ScreenFlow, which I used to demonstrate how to use the electronic medical record. I then work on this article in Dropbox, first at home and then at the office. In the office, I upload training documents into Google Docs. Then, I text the emergency department team using GroupMe to discuss workflow in the emergency department. I check e-mail and see that a family urgently requests a medical authorization for camp. I fill out the form and, using GeniusScan on my iPhone, fax it by e-mail using MyFax. Next on my to-do list is writing an evaluation for a new patient. I dictate this with the i-Script transcription service. Using Fuji ScanSnap, I clear my paper inbox. Each item is now available online wherever I am, accessible with my laptop, smartphone, Windows PC, or Mac. These are some of the ways to use the current technology that can help you be responsive to patients and colleagues and that might help you in your day. If you are completely new to this and not using any of the applications or programs listed in Table 1, you are bound to have an “aha” moment if you dip your toe in. The applications and software listed in Table 1
JOURNAL OF THE AMERICAN ACADEMY OF C HILD & ADOLESCENT PSYCHIATRY VOLUME 52 NUMBER 7 JULY 2013
www.jaacap.org
667
Applications and Software
Item
www.jaacap.org
Online storage and document sharing Dropbox
Evernote
Type
online storage and document sharing
Platform
Cost
PC, Mac, Linux desktop clients; free 5 GB Android, iPhone app (¼ 300,000 pages of MS Word files)
online storage and sharing PC, Mac, desktop clients; Android, iPhone app
Upgrade
100 GB, 200 GB, 500 GB starting at $9.99/mo
$45/y
free
upgrade for more storage
JOURNAL
free
OF THE
AMERICAN ACADEMY OF C HILD & ADOLESCENT PSYCHIATRY VOLUME 52 NUMBER 7 JULY 2013
Google Docs and online storage and Google Drive document sharing
Messaging, texting, communicating GroupMe Google Voice
Dictation i-Script
accessible from multiple browsers
Comments
You save a file to a specified, Dropbox, folder on your computer and that file becomes available online or on any other computer or smartphone you use. You can also share and collaborate. Dropbox eliminates the need for USB flash drives or e-mailing files back and forth. More of a “storage” and “filing system,” excellent for saving materials for easy or future referral. It uses OCR and can search stored PDFs by keyword in seconds. It also uses a tagging system. I have tags for work, home, family, etc. I use Dropbox more for active documents and Evernote for stored documents. For example, I keep my CV in Evernote and just pull it up any time I need it; keep articles for easy search and access; I store pictures I took of a recently built emergency room and my kids’ report cards (for nostalgia in 20 y). You can share “Notebooks” for team collaboration. Google Docs and Drive and Dropbox have similarity. You can give edits or view only permissions when sharing documents, and you can create a desktop folder (Google Drive) for files to sync automatically with your Google Docs. Files automatically save as you work.
group texting application free phone number for cell, PC calling
all phones, not just smartphones free all phones, not just smartphones free
N/A N/A
Allows you to send text messages to a group. A call to a Google Voice number forwards to any phone; sends texts alerts; transcribes voicemail.
call in dictation service; online storage
upload dictated files to Internet browser or call into 1-800 number
higher cost for faster turnaround
Allows you to access files from a Web browser and to download them.
starts at 9¢/line
PONCIN
668
TABLE 1
JOURNAL OF THE AMERICAN ACADEMY OF C HILD & ADOLESCENT PSYCHIATRY VOLUME 52 NUMBER 7 JULY 2013
TABLE 1
Continued
Item
Type
Platform
Cost
Upgrade
Comments
Faxing online MyFax
online faxing service
online browser; smartphone app available
starts at $10 per month $20 and $40 plans Receive and send faxes via email.
iPhone and Android appsa GeniusScanª
PDF scanner
smartphone app; iPhone and Android iPhone and Android
free $4.99
iPhone and Android
free
iPhone
$2.99
smartphone app; iPhone
$4.99
GoodReader
PDF reader app
ePocratesª
drug, disease, diagnostic information shows height, weight, BMI percentages for children access files on a shared drive
Growth Chartsª FileBrowserª Studying and search Brainscapeª
Productivity Fuji ScanSnapª Writing and research RefWorksª
allows you to create “index” any Web browser or iPhone cards for review online app or by app
free
scans documents onto computer
models range from $199 to $900
compatible with Mac and PC
Web-based information and any browser management
varies depending on product
Allows for syncing and backup of files through iTunes.
N/A
Great for creating your own or using the Brainscapeª database.
N/A
Author uses model S1300; $280. Easily transported.
Several uses, e.g., easy formatting of manuscripts and bibliographies.
669
CLINICAL PERSPECTIVES
www.jaacap.org
Note: app ¼ application; BMI ¼ body mass index; CV ¼ curriculum vitae; GB ¼ gigabyte; MS ¼ Microsoft; OCR ¼ optical recognition technology; N/A ¼ not applicable; PC ¼ personal computer; PDF ¼ portable document format; USB ¼ universal serial bus. a These are applicable mostly for the iPhone because the iPhone is more secure and, hence, used by the author.
PONCIN
are what I have found to be most useful, that is, a “10 out of 10” in frequency of use or utility. There is no affiliation with any of the vendors. This is highly individualized, and some readers may have a more sophisticated approach or other, “better” applications. If you are new to this, I can recommend you stop using universal serial bus keys and stop e-mailing documents back and forth for editing and sharing. Use the cloud for this type of work. Some final notes: DO NOT put patient information in the cloud; Dropbox and Evernote, among others, currently are not compliant with the Health Insurance Portability and Accountability Act. Self-care and self-restraint in matters digital also are important; consider turning off the e-mail push feature. To stay on top of technology, TechCrunch, Endgadget, and Mashable, the 3 most widely read technology news sites, each have tags for “medicine.” For a longer list than in Table 1 for applications considered useful, please use the following link, which will allow you to view a shared Dropbox document: http://goo.gl/JZotF. &
Accepted April 29, 2013. This article was reviewed under and accepted by assistant editor Laura M. Prager, M.D. Dr. Poncin is with the Child Study Center at Yale School of Medicine. The author thanks Rizwan Parvez, M.D., of Connecticut Valley Hospital, and Eric Arzubi, M.D., of the Child Study Center at Yale School of Medicine, for their contributions. Disclosure: Dr. Poncin reports no biomedical financial interests or potential conflicts of interest. Correspondence to Yann B. Poncin, M.D., Assistant Professor, Child Study Center, Yale School of Medicine, P.O. Box 207900, New Haven, CT 06520-7900; e-mail: [email protected] 0890-8567/$36.00/ª2013 American Academy of Child and Adolescent Psychiatry http://dx.doi.org/10.1016/j.jaac.2013.03.020
REFERENCES 1. National Broadband Plan. Chapter 10: Healthcare. Federal Communications Commission, National Broadband Plan Web site. http://www.broadband.gov/plan/10-healthcare/. Updated 2010. Accessed May 23, 2012. 2. 2004 Executive Orders Disposition Tables. National Archives Web site. http://www.archives.gov/federal-register/executive-orders/ 2004.html. Updated 2005. Accessed May 23, 2012. 3. National Broadband Plan. Executive Summary. Federal Communications Commission, National Broadband Plan Web site. http:// www.broadband.gov/plan/executive-summary/. Updated 2009. Accessed May 23, 2012.
JOURNAL 670
www.jaacap.org
OF THE
AMERICAN ACADEMY OF C HILD & ADOLESCENT PSYCHIATRY VOLUME 52 NUMBER 7 JULY 2013
iCAP: Harnessing the Power of Technology Yann B. Poncin,
T
he American healthcare system has seen an explosion of technologic innovations in recent years. From federal mandates to expand the use of health information technology to advancements in infrastructure making highspeed data access the norm, the climate has led to technologic advancement in health care nationally.1-3 As individual practitioners, this technologic expansion has led to dramatic changes in our professional lives. The collaborative process once required a staccato exchange of desktop e-mails and thumb-drive files; today, we can engage in a seamless conversation over wireless messaging and live-updating projects hosted in the “cloud.” This blossoming technology is a benefit and a bane. There remain unresolved and emerging questions about the effects of technology, from issues of privacy and confidentiality to the drain of 24-hour accessibility. Will face recognition and geolocation tagging intrude on the “blank slate” of the psychiatrist as we know it? Given that patients Google your name before the first visit, should you manage your “online presence” more carefully? These are tough questions for our field, and there are others. However, for this piece, let’s focus on simpler issues—and avoid social media here—and look at the practical uses of this technology. Some programs simply provide better ways of doing things that have always been done and have little privacy or patient meaning or philosophical implications. Each of us in child psychiatry—whether we work privately, for a clinic, a university, a state hospital, a detention center, a school, or, as is commonly the case, in these areas and others at once—must manage many tasks; we have our patients, staff, colleagues, supervisors, mentors, students, residents, and fellows beckoning for our time and contact. What applications, software, and programs might help us? There are several instances when emerging technology can help in the day-to-day life of a child psychiatrist and mostly concern the advantages of asynchronous communication and ease of access. Whenever you need to reach more
M.D.
than one person in a hurry about an issue in the here and now, then it may be time for a group text process. For example, the consult liaison service is slammed. You need to rally the troops, get extra support, and communicate regularly with one another, or you find yourself sending the same static information over and over again. Rather than locating the information each time on your desktop, you can have it in the cloud and send it readily from anywhere, and without clicking through subfolders. Worried about losing your presentation on your flash drive? Dropbox has it. The following paragraph describes examples of how I might use this technology in my day. Evernote is a great storage system for documents and other media. I e-mail a note directly from Evernote to a new fellow on call, which outlines on-call responsibilities; that note also has a link to a YouTube video uploaded from ScreenFlow, which I used to demonstrate how to use the electronic medical record. I then work on this article in Dropbox, first at home and then at the office. In the office, I upload training documents into Google Docs. Then, I text the emergency department team using GroupMe to discuss workflow in the emergency department. I check e-mail and see that a family urgently requests a medical authorization for camp. I fill out the form and, using GeniusScan on my iPhone, fax it by e-mail using MyFax. Next on my to-do list is writing an evaluation for a new patient. I dictate this with the i-Script transcription service. Using Fuji ScanSnap, I clear my paper inbox. Each item is now available online wherever I am, accessible with my laptop, smartphone, Windows PC, or Mac. These are some of the ways to use the current technology that can help you be responsive to patients and colleagues and that might help you in your day. If you are completely new to this and not using any of the applications or programs listed in Table 1, you are bound to have an “aha” moment if you dip your toe in. The applications and software listed in Table 1
JOURNAL OF THE AMERICAN ACADEMY OF C HILD & ADOLESCENT PSYCHIATRY VOLUME 52 NUMBER 7 JULY 2013
www.jaacap.org
667
Applications and Software
Item
www.jaacap.org
Online storage and document sharing Dropbox
Evernote
Type
online storage and document sharing
Platform
Cost
PC, Mac, Linux desktop clients; free 5 GB Android, iPhone app (¼ 300,000 pages of MS Word files)
online storage and sharing PC, Mac, desktop clients; Android, iPhone app
Upgrade
100 GB, 200 GB, 500 GB starting at $9.99/mo
$45/y
free
upgrade for more storage
JOURNAL
free
OF THE
AMERICAN ACADEMY OF C HILD & ADOLESCENT PSYCHIATRY VOLUME 52 NUMBER 7 JULY 2013
Google Docs and online storage and Google Drive document sharing
Messaging, texting, communicating GroupMe Google Voice
Dictation i-Script
accessible from multiple browsers
Comments
You save a file to a specified, Dropbox, folder on your computer and that file becomes available online or on any other computer or smartphone you use. You can also share and collaborate. Dropbox eliminates the need for USB flash drives or e-mailing files back and forth. More of a “storage” and “filing system,” excellent for saving materials for easy or future referral. It uses OCR and can search stored PDFs by keyword in seconds. It also uses a tagging system. I have tags for work, home, family, etc. I use Dropbox more for active documents and Evernote for stored documents. For example, I keep my CV in Evernote and just pull it up any time I need it; keep articles for easy search and access; I store pictures I took of a recently built emergency room and my kids’ report cards (for nostalgia in 20 y). You can share “Notebooks” for team collaboration. Google Docs and Drive and Dropbox have similarity. You can give edits or view only permissions when sharing documents, and you can create a desktop folder (Google Drive) for files to sync automatically with your Google Docs. Files automatically save as you work.
group texting application free phone number for cell, PC calling
all phones, not just smartphones free all phones, not just smartphones free
N/A N/A
Allows you to send text messages to a group. A call to a Google Voice number forwards to any phone; sends texts alerts; transcribes voicemail.
call in dictation service; online storage
upload dictated files to Internet browser or call into 1-800 number
higher cost for faster turnaround
Allows you to access files from a Web browser and to download them.
starts at 9¢/line
PONCIN
668
TABLE 1
JOURNAL OF THE AMERICAN ACADEMY OF C HILD & ADOLESCENT PSYCHIATRY VOLUME 52 NUMBER 7 JULY 2013
TABLE 1
Continued
Item
Type
Platform
Cost
Upgrade
Comments
Faxing online MyFax
online faxing service
online browser; smartphone app available
starts at $10 per month $20 and $40 plans Receive and send faxes via email.
iPhone and Android appsa GeniusScanª
PDF scanner
smartphone app; iPhone and Android iPhone and Android
free $4.99
iPhone and Android
free
iPhone
$2.99
smartphone app; iPhone
$4.99
GoodReader
PDF reader app
ePocratesª
drug, disease, diagnostic information shows height, weight, BMI percentages for children access files on a shared drive
Growth Chartsª FileBrowserª Studying and search Brainscapeª
Productivity Fuji ScanSnapª Writing and research RefWorksª
allows you to create “index” any Web browser or iPhone cards for review online app or by app
free
scans documents onto computer
models range from $199 to $900
compatible with Mac and PC
Web-based information and any browser management
varies depending on product
Allows for syncing and backup of files through iTunes.
N/A
Great for creating your own or using the Brainscapeª database.
N/A
Author uses model S1300; $280. Easily transported.
Several uses, e.g., easy formatting of manuscripts and bibliographies.
669
CLINICAL PERSPECTIVES
www.jaacap.org
Note: app ¼ application; BMI ¼ body mass index; CV ¼ curriculum vitae; GB ¼ gigabyte; MS ¼ Microsoft; OCR ¼ optical recognition technology; N/A ¼ not applicable; PC ¼ personal computer; PDF ¼ portable document format; USB ¼ universal serial bus. a These are applicable mostly for the iPhone because the iPhone is more secure and, hence, used by the author.
PONCIN
are what I have found to be most useful, that is, a “10 out of 10” in frequency of use or utility. There is no affiliation with any of the vendors. This is highly individualized, and some readers may have a more sophisticated approach or other, “better” applications. If you are new to this, I can recommend you stop using universal serial bus keys and stop e-mailing documents back and forth for editing and sharing. Use the cloud for this type of work. Some final notes: DO NOT put patient information in the cloud; Dropbox and Evernote, among others, currently are not compliant with the Health Insurance Portability and Accountability Act. Self-care and self-restraint in matters digital also are important; consider turning off the e-mail push feature. To stay on top of technology, TechCrunch, Endgadget, and Mashable, the 3 most widely read technology news sites, each have tags for “medicine.” For a longer list than in Table 1 for applications considered useful, please use the following link, which will allow you to view a shared Dropbox document: http://goo.gl/JZotF. &
Accepted April 29, 2013. This article was reviewed under and accepted by assistant editor Laura M. Prager, M.D. Dr. Poncin is with the Child Study Center at Yale School of Medicine. The author thanks Rizwan Parvez, M.D., of Connecticut Valley Hospital, and Eric Arzubi, M.D., of the Child Study Center at Yale School of Medicine, for their contributions. Disclosure: Dr. Poncin reports no biomedical financial interests or potential conflicts of interest. Correspondence to Yann B. Poncin, M.D., Assistant Professor, Child Study Center, Yale School of Medicine, P.O. Box 207900, New Haven, CT 06520-7900; e-mail: [email protected] 0890-8567/$36.00/ª2013 American Academy of Child and Adolescent Psychiatry http://dx.doi.org/10.1016/j.jaac.2013.03.020
REFERENCES 1. National Broadband Plan. Chapter 10: Healthcare. Federal Communications Commission, National Broadband Plan Web site. http://www.broadband.gov/plan/10-healthcare/. Updated 2010. Accessed May 23, 2012. 2. 2004 Executive Orders Disposition Tables. National Archives Web site. http://www.archives.gov/federal-register/executive-orders/ 2004.html. Updated 2005. Accessed May 23, 2012. 3. National Broadband Plan. Executive Summary. Federal Communications Commission, National Broadband Plan Web site. http:// www.broadband.gov/plan/executive-summary/. Updated 2009. Accessed May 23, 2012.
JOURNAL 670
www.jaacap.org
OF THE
AMERICAN ACADEMY OF C HILD & ADOLESCENT PSYCHIATRY VOLUME 52 NUMBER 7 JULY 2013