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FEBRUARY 2014 VOLUME 5 • ISSUE 2 WWW.UBCMJ.COM &2/80% 6+ ,$ , ,7 0 5 ( ' % , ) & 2 $ / < 7 - , 2 6 8 5 UBC 5 ( 1 9 , $ 1 / 8 P - 6 ,1&( UBC Medical Journal By Students, For the World DIGITAL MEDICINE & SOCIAL MEDIA FEATURE ARTICLES: > Key Trends in eHealth to Propel Health Transformation and Education > Extending the Reach of Medical Care for Remote First Nations Communities ALSO INSIDE: Interview with Kevin Pho, founder of Kevinmd.com UBCMJ | MARCH 2014 5(2) | www.ubcmj.com PLEASE RECYCLE THIS PUBLICATION EDITORIAL Medicine 2.014 – The Digital Age of Medicine 4 Alvin Ip, Terry Chu, Ryan Rawski, Lingsa Jia, Alexandra Cole FEATURE Key Trends in eHealth to Propel Health Transformation and Education 6 Kendall Ho Extending the Reach of Medical Care for Remote First Nations Communities: 9 Beyond Technology John Pawlovich, Marie-Pierre Dallaire CASE AND ELECTIVE REPORTS Evolutionary Medicine: An Academic Elective 12 Cory Weissman COMMENTARIES Three Concrete Tips for Teaching Clerkship Medical Students 14 Neil Dinesh Dattani A Tip to Pre-Med Students: Don’t Put All Your Eggs in the Science Beaker 16 Michael J. Horkoff Cosmetic Psychopharmacology: The Ethics of Antidepressant Therapy 17 Fareed B. Kamar The benefits of open source electronic medical record (EMR) systems: OSCAR McMaster as 21 a case study Matthew Toom Smartphone Use in the Emergency Department 24 Kerry E. Walker NEWS AND LETTERS Medicine in the Fast Lane 26 Shelly Fan Maintaining Professionalism Online: An Interview with Dr. Kevin Pho 27 Kiran Dhillon Telehealth: Connecting with BC Physicians Online 29 Pretty Verma On the Future of Open-Access 30 Kabir Toor Developing Digital Educational Tools for Medical Students: An Interview with Dr. Stan 31 Bardal on the UBC Formulary App UBCMJ Staff GLOBAL HEALTH Dispatch: Waiting at the Doorstep - Learnings from India 32 Saama Sabeti UBCMJ | FEBRUARY 2014 5(2) | www.ubcmj.com 3 EDITORIAL Medicine 2.014 – The Digital Age of Medicine Alvin Ipa, BKin; Terry Chua, BSc; Ryan Rawskia, MSc; Lingsa Jiaa; Alexandra Colea, BSc aVancouver Fraser Medical Program 2016, Faculty of Medicine, University of British Columbia omputer technology and social media have dramatically screening and monitoring of autoimmune diseases, cancers, changed the way that people spend their time, interact and strokes5. The ability to monitor patient health using Cwith others, and acquire knowledge. In the Digital Age technology as ubiquitous as a smartphone represents a novel that we live in now, we have seen the advent of “big data” tool for health care providers, but with it comes the ethical with the newfound ability to manipulate massive amounts and logistical challenges that come with such easy access to of information. Global networks facilitate communication personal health information. between geographically distant communities. The influence This issue of the UBC Medical Journal (UBCMJ) of these technologies on clinical medicine, termed “digital highlights the increasing use of technology in the field medicine”, has been defined as “the transformation of health of medicine, and the potential impacts of utilizing social care that is coming about as computer technology is used in the media as a means of health care communication. Our feature creation and application of medical knowledge”1. articles explore the potential for electronic health strategies Digital medicine impacts three broad areas of health to optimize patient care and physician competency (Ho), and care: patient care, communication, and patient empowerment. highlight the importance of medical technology as a means of With the capabilities of medical researchers to leverage transformative change (Pawlovich). Our other articles include “big data”, the discovery of monogenic diseases gleaned an insightful interview with Dr. Kevin Pho (founder of www. from sequencing entire genomes has made it possible for kevinmd.com) that provides recommendation for physicians prenatal screening of various inherited disorders, including on maintaining an online presence (Dhillon), and the use of disorders of hemoglobin, which affect thousands of children in developing countries2. The way that doctors care for patients are also changing, as medical care is starting to be delivered digitally. Medeo.ca is a prime example of digital medicine that is emerging for residents in British Columbia; using a computer, iPhone, or iPad, patients can log in to a secure video-conferencing platform and have a provincially- insured virtual visit with a licensed physician3. Technological advances are also empowering patients to manage their own health. Fitbit® is one of many electronic devices that enables users to monitor biometrics, such as physical activity, giving them the opportunity to set self-directed health improvement goals and have a digital record of activity they can discuss with their health care provider4. Digital medicine is altering the way researchers’ further our understanding of the human body, the way clinicians deliver medical care, and how patients are able to interact with the medical system. In this evolving climate of digital medicine, it is particularly important to stay informed about existing breakthroughs, and to continue looking forward to the next advancement. One particularly notable development in digital medicine is a bloodstream nanosensor that communicates with your smartphone. The nanosensor chip is injected into the blood to constantly monitor for early markers of a heart attack, and uses wireless capabilities to send alerts to a smartphone5. The possibilities of nanosensor surveillance are endless, including Correspondence [email protected] 4 UBCMJ | FEBRUARY 2014 5(2) | www.ubcmj.com EDITORIAL open-source software in medicine (Toom). In addition, Dr. We hope this issue of the UBCMJ adds to the expanding Stan Bardal sheds light on the UBC Formulary App and its wealth of knowledge in this area of medicine and offers our potential in the context of medical education and patient care readers some insight into the technological advancements (UBCMJ Staff). that aim to improve quality of patient care through changes at Health care professionals are expected to engage in the system and provider levels. lifelong learning; therefore, it is necessary to evolve and follow the trajectory of technological advancements in society. In today’s digital age of medicine, health care professionals must REFERENCES be resourceful and humble enough to accept the limitations 1. Bushko RG. Future of Health Technology. IOS Press. 2002; 200. of personal knowledge. Physicians need to be effective 2. Weatherall D, Clegg J. Inherited Haemoglobin Disorders: An team players in order to use communication technology to Increasing Global Health Problem. Bulletin of the World Health collaborate with other physicians and involve patients in more Organization. 2001;79(8):704-12. aspects of their care as they are empowered by technology to 3. Medeo [Internet]. [cited 2014 Jan 16]. Available from: https://medeo. do more for their own health. Health care workers must also ca/ 4. Fitbit® Official Site [Internet]. [cited 2014 Jan 16]. Available from: be able to adapt and embrace changing practice paradigms and http://www.fitbit.com/ technologies. However, it is important to note that in many 5. Eric Topol on How to Prevent Heart Attacks with Nanosensors cases, technology does not replace older tools, but rather [Internet]. [cited 2014 Jan 16]. Available from: http://www.qmed. augments them (eg. the function of laboratory tests and imaging com/mpmn/medtechpulse/eric-topol-how-prevent-heart-attacks- is complementary to a thorough history and physical exam). nanosensors Therefore, we must continue to use our knowledge, talents, and efforts in combination with the new tools of digital medicine to keep patient care at the forefront of medical practice. UBCMJ | FEBRUARY 2014 5(2) | www.ubcmj.com 5 FEATURE Key Trends in eHealth to Propel Health Transformation and Education Kendall Hoa, MD, FRCPC aProfessor of Emergency Medicine; Director, eHealth Strategy Office, University of British Columbia KEYWORDS: mobile health, social media, telehealth, electronic health records, eHealth INTRODUCTION their patients. Computers, mobile phones, and tablets can serve as decision support aids for clinicians to exercise their best judgment ccess, quality, and affordability of health care for in the management of patients. Medical websites such as Up-to- citizens—not only for patients living in urban, but Date (www.uptodate.com) and essential evidence plus (www. Aparticularly for those living in rural and remote areas— essentialevidenceplus.com), and stand-alone mobile phone–based have been increasingly brought into focus over the last decade by guidelines (www.bcguidelines.ca) developed over the past decade governments, health organizations, health professionals, and health can help physicians to rapidly search for answers to their clinical consumers themselves in all countries. Canada is no exception, as questions while interacting with patients. reflected by major health reports by leading Canadian figures such Health systems are increasingly using EHR to support 1 as the Romanow Report that speaks to the need for eHealth, and health system–based decision support, linking literature-based the tracking of progress in telehealth and electronic records by the evidence with real-life practice experiences. For example, 2 Health Council of Canada. having computerized physician order entry (CPOE) as part With the rapid evolution of