How To Approach Social Media as a Physician

Last year, I expressed why I bother blogging as a busy surgeon... but this article is more about how to approach social media as a physician.

There are numerous advice on the web how to get individuals and businesses involved in social media. Though much of this generic advice is applicable to surgeons and physicians, there are unique limitations as well as opportunities that apply only to such healthcare professionals.

I've also reached a few conclusions of my own regarding developing an online social media presence through trial and error since 2006 and certainly 2007 when I developed an overall game plan that has been tweaked over and over as I've gained experience.

1) Mission statement... As korny as this sounds, you need to have focus on what you are aiming for in order to develop a coherent strategy to not only create an online presence but to also grow it. Too often, I've come across physician twitter feeds that talk about literally everything under the sun with continuous commentary on everything and everyone. That's fine if your goal is to be the water cooler hang-out guru, but to have impact on the services you provide as a healthcare professional, focus is important. Focus is a two-edged sword however. With focus, your audience becomes small and encompass only those individuals who are interested in the same topic (or in this case, medical conditions you represent)... but their interaction with you and your healthcare business is much higher than an unfocused huge riotous mass of people with multiple dissimilar interests.

So a mission statement can be as simple as "To provide the best commentary on media topics related to ear, nose, and throat."

A secondary mission statement addendum can be "in order to build up my practice's brand name"... 

2) Really, who are we kidding? We all know that the end goal of any social media presence is to market "you" and your medical services.  Just keep in mind that whatever your persona may be in real life will now be represented by a "virtual" persona of you online and this online persona will potentially be the first time a patient interacts with you, even if you do not yet know they exist. Make sure it's a good impression... which increases the likelihood they will actually utilize your services in real life.

3) Create a blog... There are several free ones available... WordPress, Blogspot, Posterous, etc to name a few.

4) Write on a topic that pertains to your practice. It's VERY hard to come up with original material consistently, week after week, year after year. It's great if you can do it, but I'm just letting you all know that it's hard... and even harder when running your clinical practice at the same time.

So at least what I learned over the years is to "cheat"... I gain inspiration from what is published in magazines, newspapers, TV, etc. I than write about these published articles I find... and I criticize or at least evaluate it from a physician-in-the-know's perspective.

This serves several purposes. 

• I don't have to think about what topic I'm going to write about. I let the journalists do that for me. Believe me... it saves time.

• I write what I would have told patients if they brought this article to my attention during an appointment.

• The medical stuff patients are reading about in public is something they might suddenly start searching for... and gee whiz... wouldn't it be great if YOUR blog article on this very topic popped up. The media brings to the forefront of peoples' minds medical issues they want to talk about. What better time to add your voice to a problem you specialize in!

5) Make sure you link to your practice website from your blog article so that patients know how to reach you if they find you.

6) Make sure you have a good practice website to begin with.... It does not matter if you have a great online presence if your practice website stinks. Social media COMPLEMENTS your practice website. It does not replace it. You need both to have an ultimately successful social media presence that brings patients to your office.

7) Write blog articles often... I find the sweet spot to be about 3 per week. If you aren't actively writing, your social media presence will dwindle and fade away. Think of blog articles like growing a flower.

8) Now that you're writing blogs... how to make potential patients notice? The easiest way is to advertise your blog presence on your practice website. The downside with this approach is that if you don't get a lot of traffic to your website, it's going to be slow gaining an audience for your blog. As such, your blog needs help...

That's where FaceBook and Twitter come in which is where all your potential patients seem to hang out nowadays. These additional accounts should feed into your blog. To make less work for yourself, automate the process such that whenever you post a blog, it will automatically update your Twitter and Facebook accounts.

If all goes well, you will slowly build up a following for your social media accounts with correspondingly increased traffic to your website which ultimately leads to patient visits. It takes time so be patient!

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New Webpage on Bilateral Vocal Cord Paralysis (or Fixation)

We have written up a new webpage discussing the unfortunate situation of bilateral vocal cord paralysis whereby both breathing and vocal quality is adversely affected.

Treatment for bilateral vocal cord paralysis is difficult and there is no perfect solution. Treatment to improve breathing usually makes the voice worse. Treatment to improve the voice usually makes the breathing worse. The best (but not perfect) treatment tries to pick a happy medium to address the breathing while trying not to hurt the voice too much, though some degradation in vocal quality is to be expected. Such treatment includes posterior cordotomy +/- medial arytenoidectomy.

In another situation, the patient may have bilateral vocal cord fixation resulting in the appearance of vocal cord paralysis, but is potentially "curable" with normal breathing and normal voice being the goal.

Click here to read more! Video and audio also included.

To read more about UNILATERAL vocal cord paralysis, click here. Treatment is completely different than for bilateral vocal cord paralysis.

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Dr. Chang Publishes New Journal Article "Video Recording the Surgeon's Viewpoint Cheaply"

An avid snowboarder, I purchased one of those helmet-mounted video camcorders in order record my athletic feats over a year ago. The one I purchased was called ContourHD and it can be mounted on the snowboard helmet and set to record by the press of a button.

It was at some point boarding down a black diamond trail that I had an epiphany... Why not use this helmet mountable camcorder in order to record surgical procedures in the operating room?

And... So I did with a few modifications to allow magnified narrow-angle shots... And I wrote a paper on it which was recently published in ENT Journal in March 1, 2011.

In any case, below is a picture of my creation mounted on a surgical headlight.

Read the article here (free registration required). Pubmed link is here.

See the full list of publications by Dr. Chang here.

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What is the Perfect Tablet Computer for Healthcare?

Many would argue (as I have) that the Apple iPad is THE perfect tablet computer for healthcare professionals. And for many of the mundane tasks of looking up or inputting information into an electronic medical records, that may be true. (Watch a video using the iPad to access MediTech as well as PACS here.)

However, there is a vast area of healthcare that the iPad just does not work at all.

That area is connecting to surgical equipment. Especially in the ENT world, there is a lot of microscopic and endoscopic work that is done. The software that records imagery from such devices are ALL based on the windows platform. Yes... we can record on to a CD, DVD, USB Memory Drive, etc and transfer the file to the iPad for viewing, but there's a lot of steps involved with that:

1) Record the video/image
2) Transfer to media of choice (CD, DVD, USB memory stick, etc)
3) Transfer file to PC/Mac
4) Move it iTunes/iPhoto
5) Synch with iPad

Geez louise!!!

I am currently aching for a highly portable tablet computer to connect to my JedMed Digicam in order to video-record fiberoptic endoscopy, ear work under the microscope, etc. The software the Digicam works with is only Windows compatible (and from my conversations with JedMed, there's no plans to make it work on any other platform in the foreseeable future).

As such, at this time, the Windows (and not iPad) world is the current way to go to address this deficiency. Not Google Android, iPad, Blackberry, etc.

In my mind, the best tablet for video work in the healthcare setting must have the following properties:

1) Windows 7 operating system for compatibility with surgical hardware
2) USB port
3) 10" Tablet for portability
4) Cheap (comparable to iPad)
5) Fast boot (SSD drive)

And WOW... I was amazed at the plethora of tablets introduced at the 2011 CES Convention Jan 6-9, 2011 in Las Vegas.

There were over 80 tablets that were introduced from big name companies to nobodies. Surely, there will a be a few which fits the bill?

Sadly, there were only a few that may fit my needs.

These include:

1) Samsung Note PC Series 7
2) Motion CL900 Windows Tablet

The Dell Inspiron Duo may possibly work, but the swinging screen just looks way too fragile.

What do others think? I'm pinning my hope on the Samsung model as the Motion tablet price is a bit much. The Samsung tablet is suppose to go on sale in March 2011 with a price tag around $699.

Watch a video the demonstrates the Samsung Note PC:

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Should You Have Surgery Far From Home???

I am in the fortunate position of seeing patients who live locally as well as a handful who travel across one or more state lines to see me on a weekly basis, as well as the sporadic few who come from even other countries.

When patients travel great distances to see a doctor, this puts the physician in a particularly humbling position. However, it also places additional strain on how care can be provided efficiently and reasonably when geography logistically makes it difficult.

To begin, why would a patient even want to travel great distances to see a doctor? The basic answer is due to the perception that they would receive better care than can be obtained locally. If true, such long distance travel is justified. After all, if you have thyroid cancer and there are no surgeons who can remove this cancer, than by all means, travel is merited.

However, too often, I see patients travel great distances to see a surgeon due to the perception that this one particular doctor is better than the one found locally, EVEN if the local surgeon is quite competent. Here is where the decision to travel becomes... well... less logical, especially if the surgery is for a routine problem.

IF there's a local competent surgeon, I feel it is ALWAYS better to get the surgery done locally. Why? Because if there's any problems after the surgery, it can be easily addressed quickly and with minimal fuss. If the surgery was done hours away, think of the travel, expense, missed time from work, etc NOT just for the surgery, but for any post-operative problems that develop. Oftentimes, the patient concern ends up being unfounded and only reassurance is required, but in order to make that determination, the surgeon needs to do an exam. Imagine the frustration of the patient when a surgeon requests a visit before answering a question about a post-surgical concern... hours of driving to the office, waiting in the exam room, being seen by the surgeon for a few minutes only to hear that everything is fine and normal, and finally driving hours back home.

Even in the hands of the BEST surgeon, problems can arise after surgery. Is the surgical wound becoming infected? Where is that fever coming from? There's a little drainage occurring... is that normal? Why is the skin red? There's a lot of pain and his medications aren't working.

To complicate things further, narcotic pain killers can NOT be called in by federal rules. A hardcopy prescription is required. Now, wouldn't that be mighty inconvenient if a patient (who mind you is in pain), needs to drive hours to the surgeon's office just to pick up a hardcopy narcotic prescription.

The logistical difficulties of dealing with post-operative care after patient discharge is tremendous for both the surgeon as well as the patient if the distance between the two is large.

Now when should a patient travel to have their surgery done?

DO travel to see a surgeon when your local surgeon feels it imperative that you do so either due to the complexity of the problem or inexperience. Especially, if the local surgeon is well-respected and honest. This serves two purposes... you get the surgery done by the best possible... AND, if any problems develop after surgery, your local surgeon is in the loop and can probably handle most routine post-surgical concerns.

I should state that I HAVE performed surgery in patients who live hours away (some even an airflight away) but I ALWAYS encourage patients to try and get the surgery done locally if at all possible due to the reasons stated above. If a competent local surgeon is not available, than that's fine. But if competent local surgeons are present... I do my best to steer patients to get the surgery done locally as it IS for the patient's best interest.

I have also referred patients to other surgeons a long drive away due to one reason or another, even if the patient desperately wants me to do the surgery. I'll be the first to admit if I lack experience to address a given problem. I also follow-up in stating to the patient that if there's any problems that occur after the surgery, to please return to see me rather than making a long-distance trip as there's a good chance I'll be able to address the concern. Everyone wins this way.

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Dr. Chris Chang Mentioned in a Medical Blog

Dr. Chris Chang and his blog was mentioned in an article in another medical blog "Dr. John M" on December 14, 2010.

"---One of the best ways to know something well is to teach it. Dr Chris Chang from the blog of the Fauquir ENT Consultants of Virginia writes about why he keeps a blog. His first reason is that it keeps him highly informed. No doubt about that. Could we bloggers get some CME credit, please?"

 Click here to read the whole story!

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Physician Marketing Using Groupon

For those not in the know, Groupon is a website that offers coupons and other savings on local merchandise and services. Groupon also has recently rejected a takeover bid by Google.

I recently encountered this amazing deal on Groupon offered by an ENT colleague, Dr. Ghaheri:

"$149 for Four Laser Hair-Removal Treatments at The Center for Aesthetic Medicine at The Oregon Clinic (Up to $1,000 Value)"

I wonder if such marketing and medical discount offerings like this will become the future. Clearly, procedures and other types of medical treatments that are not covered by insurance will be applicable.

For example... here are some medical treatments/services I am considering to discount on Groupon:

1) Injection snoreplasty for snoring
2) Botox injections for facial wrinkles
3) Hearing services and products including hearing aids
etc

Click here to check out Groupon and create an account!

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Making Twitter Work for a Specialty Medical Practice (Like ENT)

I've been asked by a few ENT colleagues how I got Twitter to work for my practice and how in the world I managed to get more than a few dozen followers.

I've been at it for about 1 year now (up to 355 followers @FauquierENT) and here are a few tips to making it work for a medical practice... Just an opinion... And it may not apply to everyone...

• When you tweet something, always back it up with a useful link to a webpage using a link shortner like bit.ly or goo.gl.
• Tweet about topics that the LAY-PERSON would find interesting. Twittering about "Outcomes of Vascularized Bone Graft Reconstruction of the Mandible in Bisphosphonate-Related Osteonecrosis of the Jaws" is NOT going to garner you fans even if you personally as an ENT find it riveting reading. An example of a good tweet I recently posted is "Do Cell Phone Makers Secretly Know Cell Phones May Cause Health Problems? http://ht.ly/3bBUZ"
• Follow people you find interesting. They will follow you back typically and their followers will slowly start to follow you. Given I twitter about ENT topics, I make it a point to follow ALL otolaryngologists, respected medical journalists, and health related newspapers.
• Write a blog and use twitter to "advertise" your blog article.
• ADVERTISE on your website that you have a twitter account.
• Be active with tweets. Potential followers will not be that excited to follow you if you have something interesting to say only once every few weeks.
• IF you come across something interesting in a medical journal, tweet it, and support it with a link.

So there you have it... Now go sign up with twitter and don't forget to follow my tweets!

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Wearable Camcorders for Video-Recording Surgeries From the Surgeon's Viewpoint?

An avid snow-boarder, I had the bright idea of using the ContourHD wearable camcorder I purchased to record snow-boarding runs... to instead video-record surgical cases. This wearable type of video-recording has many advantages over traditional camcorders which requires an assistant to shoot the video.

First, the angle of a wearable camcorder is from the surgeon's viewpoint and has minimal distraction impact. Having an assistant video-recording over the surgeon's shoulder during a surgical case is not ideal on both these points.

Second, the surgeon has complete control over what is being recorded rather than depending on a 3rd party making that decision.

Third, when these wearable cameras are attached... it is incredibly secure. It will NOT fall off accidentally or otherwise. When an assistant is doing the recording... there is always the chance they may drop the camera into a sterile surgical field which would be a disaster. Here is a picture of me with the camcorder attached:

There is also the cost factor... These consumer wearable camcorders are around $275 or less on Amazon.com. Compare that with dedicated surgical headlight camera systems like the MicroLux® DLX by Integra which cost way more.

SO... how well did the ContourHD camcorder work? Not too good...

Unfortunately, the focal length of these camcorders are set to 2 feet to infinity resulting in blurry videos when shooting at closer distances, like dissecting out a parotid tumor (believe me... I tried). These wearable camcorders also are not focus-adjustable.

Hopefully, a manufacturer will address this key shortcoming and make one with either an adjustable focus OR enable the user to swap out the lens set to different focal lengths OR designing an adapter over the built-in lens that would adjust the focal length. Here is a concept of what I have in mind:

It would be pretty cool to record surgical cases with as much "pop" and detail as this snowboarding video (not mine).

Wearable camcorders I am monitoring (hoping) for such innovation that is usable in the operating room theater include ContourHD and GoPro Camera.

There are other wearable camcorders such as the Looxcie which is not as well-suited for recording surgical fields. The main problem with such "social" camcorders like the Looxcie is that it can only record (the previous) 30 second video snippets and is not in HD quality. Read more about Looxcie here.

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As A Busy Physician, Why Do I Even Bother Blogging?

As a busy ENT surgeon in private solo practice (read about me), there are several reasons why I blog (FauquierENT) even though I am already quite busy in my medical practice. As some of my readers have pointed out, it is not unusual to see blogs posted by me at all hours of the night and more commonly, early in the morning on weekends. So what motivates me?

To stay up to date. There are two aspects to this statement. The first is that I am always reading journals and enjoy sharing interesting research/findings that may be of interest to the lay reader. The second is that patients are researching their symptoms on the Internet and bringing the results of their research to their appointment. By being an active blogger, I often read the same stuff patients are and am already familiar with the sources and content even BEFORE they approach me about it. If interesting enough, I myself will write a blog article to either lend further support or to actively dismiss it.

Marketing. The more I write, the more "webpages" there are with my practice affiliation. The more webpages there are, the better the search rankings when people search for information. It is as simple as that. Oh yeah... and it's free unlike yellow pages listing, newspaper ads, etc.

Internet medical reliability. Let's face it. There is a lot of garbage on the Internet when it comes to medical information. By writing what I hope are accurate information on medically interesting subjects (at least on ENT topics) that is understandable AND useful for the lay public, I feel I am doing what small part I can to combat the garbage out there. I've also been very disappointed with information disseminated by reliable sources including WebMD, eMedicine, etc. In these websites, the information is sometimes so nebulous and non-specific to the point of being useless. As such, I try to include information that lay-readers may want to know, specifically details that may be lacking elsewhere.

I like to write. It used to be journal articles and book chapters... But now blogging is so much more gratifying. And to tell the truth, the audience is so much larger than anything achievable through traditional academic publications. It's a nice creative outlet as well.


It is a big time commitment to stay updated. I probably spend several hours a week reading news articles, tweets, blog articles, etc. followed by another few hours writing my own tweets and blog articles. More recently, I've started to make a few ENT videos I've uploaded onto YouTube.

• YouTube
• Twitter
• Facebook
• Blog (you are reading it now)

I am not the first, nor the last I hope. Perhaps the most influential medical blogger that has been a role model for me is Dr. Ves Dimov at his CasesBlog site. Check his blog out! Very nice blog with a more general medicine view than my blog. KevinMD is also another popular general medicine blog I follow.

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Humor: Breast Surgeon vs. Pathologist [video]

There has been a plethora of cartoon animated videos made thru xtranormal regarding how physicians sometimes interact with each other exaggerated to a humorous degree. Here's one regarding a breast surgeon (which can apply to any surgeon including ENT) interacting with a pathologist.

There was an earlier blog post of an orthopedic surgeon vs anesthesiologist here.

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Dr. Chris Chang... The Ex-Cellist...

I've had plenty of patients ask me about my musical background given my Eastman School of Music Diploma in Cello Performance hanging in my waiting room.

First off... I graduated from the Community Education Division of Eastman School of Music... Not the undergraduate or graduate program. However, it was a very fine education I received there which lasted from 1987-1992 (started playing the cello at age 5 until 24).

In order to receive this diploma (or perhaps a better term would be certificate), I had to complete a specified curriculum including music theory (levels 1-3), composition, music history, piano, chamber music, as well as the dreaded solo performances in Kilbourn Hall and Howard Hanson Hall... not just once, but several times a year.

While attending Eastman, I took private lessons from three awesome teachers including Polly Hunsberger, Ingrid Bock, and David Ying. I was pleased to see my first two teachers still playing with the Rochester Philharmonic Orchestra. Prior to Eastman, I took private lessons at a SUNY Geneseo college with Prof James Kirkwood.

Orchestra-wise, I participated with the Rochester Philharmonic Youth Orchestra, Greater Buffalo Youth Orchestra, and the New York All-State Orchestra. In college, I continued to play the cello with the Yale Symphony Orchestra as well as various chamber groups. I believe I played in my last concert in 1998 after which I pretty much stopped playing.

Some of my favorite cello pieces I played include Cello Concerto No. 1 by Saint-Saens and Cello Concerto in D minor by Lalo. The last cello piece I was working before "retiring" was Cello Concerto No. 1 by Haydn.

My most exciting moment playing the cello is perhaps Overture to Candide by Bernstein with the New York All-State Orchestra.

Another fine moment was Russian Easter Overture by Rimsky-Korsakov with the Greater Buffalo Youth Orchestra.

And yes... the picture posted here is my very own trusty cello... which usually hangs out in my closet, but opened up briefly for the purposes of this blog.

Here's my complete musical CV here.

Will I ever play again??? Well maybe... someday...

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The Perfect Computer for Healthcare and Electronic Medical Records

So I've been using computers in the healthcare setting for over a decade now. First at Yale than Duke. I've been thru the Veteran's Affairs Medical Center using Vista (New Haven, CT; Durham, NC; Asheville, NC; and Portland, OR). I've been at 5 different community hospitals on both the West and East Coasts. I've used all the different flavors of electronic medical records (EMR) in all these different locations/settings. I'm now using (not by choice) NextGen, Meditech, Rcopia, and PACS currently in the office, hospital operating suites, and inpatient settings.

Throughout this time period, I've used desktop computers, handhelds, laptops, netbooks, and tablet computers. I've even tried to cobble together a semi-functional iPad able to access all the different EMRs I need on a daily basis (read blog about this here).

What I discovered is that the perfect system (in my mind) is ALMOST there... just not quite yet. Maybe in the next few years, it will exist because all the pieces now exist! The bad news is that it does not exist RIGHT now.

So, here's my dream machine and the reasons. I hope some computer company is paying attention!

To understand how this all fits together, one needs to envision how my office works right now. There's a desktop computer in each exam room. Patients are taken back by a nurse and information inputted into the desktop computer. Than the computer is locked and the nurse leaves. The physician than soon follows, unlocks the computer, and then proceeds with further history, exam, and plans treatment which all gets documented in the computer. If tests are ordered (ie, hearing test, blood draw), the doctor leaves and sees another patient while the tests gets done before coming back. As such, the computer stays in the room with the patient. One can envision that there is a lot of back and forth into and out of an exam room movement of nurse, doctor, and patient. The computer gets locked every single time. Furthermore, I need EMR access when seeing patients in the hospital as well as during surgery.

First the Hardware:
• A tablet touchscreen (with no physical keyboard) 12 inches diagonal. That size hits the sweet spot. Any larger and the size itself becomes unwieldy to constantly move around as well as heavy by the end of a day. Any smaller and the screen real estate becomes so small to become inefficient. 12 inches diagonal also allows the possibility of an actual full-size virtual keyboard on the screen with adequate screen left-over to see what's going on.

My experiences with the iPad virtual keyboard was mixed (given it is somewhat smaller than full-size). I CAN do it and I did do it... I just didn't like it to the point I relied on a wireless bluetooth keyboard.

• Bluetooth technology and WiFi are a MUST because...

• With this tablet computer, one can dock it without wires or connector pins (similar in concept to Motion Computing JR3400 with its FlexDock). The docking station allows for use of regular USB keyboards and mouse along with direct ethernet wired connectivity. My dream machine docking station and tablet would communicate with each other using bluetooth or some other alternative short-range wireless technology which makes direct physical connection unnecessary. This is important, because I would have the docking station in each exam room. When I leave the exam room, I would have the option of taking the tablet (and therefore the screen) with me. The constant connecting and disconnecting of current docks is quite the pain given it requires an actual physical connecting port as well as precise placement. With the constant connecting and disconnecting, it opens the possibility for breaking as well.

What would be even cooler would be if the tablet charges when in its docking station using inductive charging similar to how a Philips Sonicare Toothbrush recharges.

Why do I even want a docking station? Several-fold. Ergonomics... I like the screen at my eye level. Also, I can still see the patient while typing away. If I depended on the virtual keyboard like on the iPad, I'm looking down which is not patient-friendly as well as a pain in the neck (from looking down). Also, though I guess I can learn to type fast on a virtual keyboard, I think I would still prefer the physical full-sized keyboard if given a choice. Furthermore, though wireless WiFi for all internet connectivity is nice in principal, it does introduce potential security problems as well as speed issues (wired ethernet in my experience is still the most reliable and fastest way of communication along with being secure).

However, WiFi connectivity is still important as pretty much every medical setting has WiFi and so one does have continuous high speed wireless access. Also, it would allow me to read a little bit of what's going on with a patient before walking into an exam room (I would load up the patient's chart using the touchscreen before walking into the exam room and docking the tablet). I just do not want to always DEPEND on WiFi.

A WiFi tablet touchscreen like the iPad is also great as one can BRING your office with you where-ever you go like the hospital and operating room without bringing a keyboard, mouse, etc. It's all self-contained. It's intuitive. It's all neatly packed into a simple, elegant tablet touchscreen that's highly portable and usable.

• Proximity security whereby the computer tablet "knows" you are right there. When you are no longer around the computer, it automatically locks. When you come back, it recognizes you and it automatically unlocks, all occurring invisibly to me without requiring me to actually do anything. I HATE the fact that I have 4 different userids with 4 different passwords to access the various EMR programs. Though I try to, I do not always remember to lock the computer 100% of the time. It should be all automatic. Does the technology exist? It sure does... It's called Single Sign-On for one userid and password that unlocks it all. And Xyloc by Ensure Technologies to allow for proximity recognition using RF technology. All I ask is that this technology be built-in to the hardware!

In a clinic where I'm constantly moving around where the tablet may not always be with me, due to HIPAA and HITECH, the computer needs to be secured. Though I try, I can not always remember 100% of the time to lock the computer. And same goes for my medical assistants. The security should be automatic, invisible, and secure.

The problem with biometric verification like fingerprint scanning or even ID card swipes is that I have to REMEMBER to do it. And the mere fact of doing it is aggravating because I would have to do it SO many times in a given day.

• Sturdy construction. The tablet is going to move around... a lot... It needs to stay working after being dropped from at least a height of 3 feet.

Which Brings Me to the Software:
What can I say? I LOVE the intuitive and simple interface of the iPad. Now, there's a few things I would tweak about it to make it MORE relevant in the healthcare setting.

• Multi-Tasking is a must. As I literally use Meditech (hospital EMR), NextGen (clinic EMR), Rcopia (electronic prescribing software), and PACS (radiology viewing software) all day long swapping back and forth even with a single patient encounter, I need to be able to easily jump between all these programs without shutting down the others. From what I understand, this functionality on the iPad will soon be reality with the release of the iOS4 operating system later June 2010.

• I constantly move back and forth among Meditech, NextGen, Rcopia, and PACS all day long. As such, having a few physical programmable buttons on one side of the screen on the edge would be wonderful which I could just press and it would take me immediately to my program of choice. Keyboard shortcut works, but imagine what touch-strokes would be required when I'm using it in pure tablet touchscreen mode...

• Apps already exist to connect via Citrix, Remote Desktop Connection, or screen mirroring... so I would just use those programs. If I was prone to unrealistic wishful thinking, I would ask for a single EMR program that incorporates Meditech, Nextgen, Rcopia, and PACS, but I do not forsee anything like that happening for decades (if ever). So, I'm going to stick with what is possible.

• A "tablet pen" is 100% optional and not necessary for use... Tablet touchscreen would be used predominantly using a finger(s) just like on the iPad. Personally, I do not foresee myself ever using a tablet pen. It's just one more thing that can get lost.

That's pretty much it! Is that so much to ask for???

Related iPad and MediTech Blog Articles:
6/12/10 iPad Use In the Medical Clinic and/or Hospital For the Surgeon Doctor
9/8/10 Dr. Chang Featured in Magazine Article on Using iPad with MediTech EMR
9/20/10 UPDATE: iPad and MediTech Electronic Medical / Health Records
10/12/10 UPDATE #2: iPad and MediTech Electronic Medical / Health Records
10/25/10 New Video Produced on Using MediTech on the iPad!

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iPad Use In the Medical Clinic and/or Hospital For the Surgeon Doctor

To read what I consider the perfect computer for healthcare, click here.


UPDATE 10/25/10: Watch video of using MediTech on the iPad

To give a little background, I am a ENT (otolaryngology-head and neck surgeon). I see patients in all sorts of environments including the hospital, operating room, and outpatient clinic. In the hospital, I use MediTech and PACS while in the clinic I use NextGen. Admittedly, I was not entirely convinced the iPad would ever be useful in this varied medical setting which utilized different EMR platforms when it first came out earlier this year.

However, several developments have occurred that has since changed my mind due to the ingenuity of app developers and other progressive technology that allows the iPad to connect with hospital and outpatient clinic electronic medical records (EMR) regardless of operating system and security settings.

The information provided here is based on using an Apple iPad 16GB model with WiFi only ($499).

Software

Foremost of these evolutions is the iPad/iPhone apps now available that allows for EMR access. To give some background, I use MediTech and PACS in the hospital and NextGen in the outpatient clinic. In order for me to access all electronic health records, two iPad apps are necessary:

1) LogMeIn: Wonderful app that allows the iPad to remotely control a Windows (or Mac) desktop computer anywhere in the world. The iPad app itself is $29.99. The LogMeIn desktop software (free) also needs to be downloaded to any desktop you want to access/control with the iPad. In essence, the iPad takes control of the desktop which you can see on the iPad screen. As such, any software including EMR programs like MediTech, NextGen, or indeed any other application (via Citrix) on the desktop, can be opened and visualized on the iPad. Click here to download this program.

The pictures below show MediTech as well as PACS being opened on the iPad using LogMeIn. The keyboard you see is a bluetooth keyboard wirelessly connected to the iPad (more on this below).

Of course, this method produces a slow response time as one is jumping through different networks to obtain medical records access (iPad --> LogMeIn --> Desktop --> Citrix --> Medical Records).

A more elegant solution would be direct Citrix/VPN access to the medical records (iPad --> Citrix/VPN --> Medical Records). Unfortunately, the hospital/clinic would need to upgrade their software in order to make this happen (which has not yet happened at my hospital). For those curious, the iPad software is called Citrix Receiver and is a FREE app download! Click here.

2) WinAdmin or Jump: Of course, if one is able to access medical records using terminal services (rather than citrix, VPN, etc), there's a perfect app for that called WinAdmin or Jump. Just punch in the same info you do to open terminal services on Windows and viola... the remote desktop appears on your iPad! Both  apps are iPad optimized and costs $8.99 for WinAdmin or $19.99 for Jump. Click here to download WinAdmin or here to download Jump. You can see a screenshot (to the right) where NextGen Master IM was opened up on the iPad using WinAdmin app.

The difference between Jump and WinAdmin are several-fold. Jump has better mouse usage controls (there's a mouse!), better virtual keyboard (including Tab, Esc, Function keys), and allows for external keyboard text entry. WinAdmin does not (so far). But I guess you get what you pay for! Having used both, I personally prefer Jump (originally purchased WinAdmin because it was cheaper).

SO, I basically use Jump to access NextGen which is accessible via terminal services and I use LogMeIn to access MediTech (as well as PACS viewer). As soon as direct Citrix access is available (should the hospital upgrade their Citrix software), I would change to Citrix Receiver instead of LogMeIn in a heartbeat.

Hardware

The keyboard is essential as I do a great deal of free-typing which is not easy (to type very fast) when using the iPad's virtual keyboard. As such, a bluetooth wireless keyboard is important for me to allow fast touch-typing. There are plenty of wireless keyboards out there... the one I use is the Apple Wireless Keyboard. However, this keyboard isn't perfect as the keyboard is bigger than the iPad and as such, needs to be carried around separately. I never even bothered getting the iPad Keyboard Dock as one MUST orient the keyboard vertically (in order to dock the iPad) which is not preferable when I used the iPad for accessing electronic medical records. For just that reason, I always keep the iPad screen locked in horizontal orientation.

As such, for me, the next piece of the iPad implementation for medical use is hardware. Here, I am most eagerly awaiting for the ClamCase which is supposed to be available for sale in Fall 2010. The "ClamCase" offers the perfect package in my mind:

• A nice case for the iPad for transportation

• A wireless bluetooth keyboard for freetyping

• Full use of the iPad as a standalone device in case I don't want to use the keyboard

• Keyboard fits within the case where you want it (so it can be opened up like a laptop)

What the ClamCase does that no other device offers is a wireless bluetooth keyboard BUILT-IN to the iPad case in a single beautiful package!

Here's a YouTube video showing the full features of the ClamCase:



Hopefully, it will live up to its hype and I will be basking in heaven using the iPad to do pretty much everything whether in the hospital, operating room, or clinic. Once multi-tasking becomes available with the next OS Upgrade (iOS4) later this month, that will be most awesome as than I can have NextGen, MediTech, and Safari up with Rcopia (the electronic prescribing program I use) all up and running simultaneously and I will be able to just switch among the programs without losing anything.

For now, I'm trying it out on a limited basis before ditching the old system (desktop computer in each exam room) and using iPad exclusively.

Will keep those interested updated on my experiences over time...

In meantime, read what I consider the perfect computer for healthcare here.

Related iPad and MediTech Blog Articles:
6/19/10 The Perfect Computer for Healthcare and Electronic Medical Records
9/8/10 Dr. Chang Featured in Magazine Article on Using iPad with MediTech EMR
9/20/10 UPDATE: iPad and MediTech Electronic Medical / Health Records
10/12/10 UPDATE #2: iPad and MediTech Electronic Medical / Health Records
10/25/10 New Video Produced on Using MediTech on the iPad!

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Fauquier ENT Social Media Update

I have had a few readers comment that our office should offer twitter, have a facebook page, or some other social media outlet...

My answer is that we actually already do! So here's the full list along with subscribers (as of June 8, 2010) for each and link.

YouTube Channel (1,865 Subscribers)
http://www.YouTube.com/FauquierENT

We get about 250,000 hits a day on YouTube!!!

Facebook Page (80 Friends)
http://www.facebook.com/FauquierENT

Twitter (267 Followers)
http://twitter.com/fauquierent

Blog (~35 Subscribers)
http://fauquierent.blogspot.com



Thanks to all who follow/friend/subscribe already!!!

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