Use of Second Life in doctor-patient relationships

Use of Second Life in doctor-patient relationships

After spending a considerable amount of time learning how to move around in Second Life, I do believe that there is great potential for “virtual” doctor-patient relationships. I think the biggest obstacle is just getting the computer “challenged” to become comfortable with the environment. Second Life is mostly being used for education, training, marketing and promotion of health services, and for research, support groups, peer groups etc. While it may have a ways to go in getting the general public to trust and utilize this for any type of real doctor-patient relationship that involves a true “virtual visit” I think this could be ground breaking on many fronts for healthcare as a whole.

I have spent over 15 years working with computers and even I found it a challenge to get used to moving and finding things that I was looking for. It is somewhat of a cross between Sims and Halo for the gaming world. There are many tricks and methods for gaining access to worlds you want to visit and for building your own worlds. For an adult that wishes to interact with their provider I am not sure most would find it a comfortable or trusting environment although I think the explosion of the internet is going to bridge that gap quickly. For a child that has grown up with computers and gaming, I think it might be the perfect situation, especially for psychological/psychiatric encounters with their provider. My guess would be that it takes much of the fear of going to the doctor in a real world environment (sterile, cold, overwhelming) and turns it into more of a game which for most children is very comfortable.

This world is well known to children and young adults and might eliminate much of the fear of talking about abuse, or similar issues with a doctor in Second Life. They might feel more comfortable talking about things in such a world when they are actually in the privacy of their own home. I would think it is easier for a child to open up about things in a “virtual” world then in the real world. This world allows for more anonymity even allowing for the “morphing” of the users voice to hide their identity further.

I also believe there is a potential for “prepping” the patient in this virtual world. Rather than focusing on the actual visit, this world might allow for preparing a patient for procedures, or help them learn about health problems before even visiting their provider. The provider could set up patients with “pre-visit/procedure” scenarios specifically designed for their patient. It could also be used as a platform for preparing a patient for psychological type questions that would be asked in future visits. If they were difficult and or embarrassing type questions, giving them a chance to hear the questions and think about their answers might make it more comfortable when answering them in person(of course in some cases a “psychiatric” visit in general might be much easier in this virtual world as well) . Not being a clinician, it is hard for me to give medically relevant answers but from a patient perspective I find this world fascinating and certainly one I would use if I could rely on security.


It would seem that working with Autism and Aspergers patients might have benefits in Second Life in addition to substance abuse patients and patients with social interaction problems as well. I’m sure I’ve only hit the tip of the iceberg here, but there truly is great potential and I sincerely hope it is allowed to grow and become a viable option for provider-patient relationships in the future.

Ethnic disparities in healthcare

In California, approximately 56% of our state’s 38.2 million people are Latinos, African Americans, Asian-Pacific Islanders, and Native Americans. These groups contribute extensively to California’s economic and social vitality. Therefore, it is in our state’s best interest to insure the health and well being of these populations. My focus for this commentary will be specifically on Native Americans who have a long tradition of inadequate health care despite a legally-based right to health care, which the State of California has not always fulfilled.

Health Disparities:

• In California, AIAN life expectancy is shorter and AIAN death rates are higher than for Whites. The leading causes of death rates for AIAN are different than for Whites. Diabetes, obesity, injuries and psychological distress are a few of the leading health issues for AIAN.
  
• Social and Economic elements such as; lack of transportation and poverty contribute to AIAN health issues. Transportation is an important component of health care access, yet twice as many AIAN homes (14%) had no vehicle available for transportation, compared to Whites (7%). The median family income for AIAN was less than 60% of the median family
  income for Whites (AIAN $38,547 vs. White $65,342) between 1990 and 2000. About 25% of AIAN delayed or did not get a prescribed medication because they could not afford it, compared to 17% of Whites.
  
• Psychological Distress: Twice as many AIAN reported psychological distress (16%) compared to Whites (8%) in the past year.
  
• The prevalence rate of suicide for AIAN is 1.5 times the national rate. AIAN males ages 15 to 24 account for two-thirds of all AIAN suicides. Violent deaths (unintentional injuries, homicide, and suicide) account for 75% of all AIAN male mortality in the second decade of life.
  
• Dental Problems: Twice as many AIAN (8%) report they could not afford needed dental care compared to Whites (4%).

What stands out to me is the suicide rate and psychological distress statistics. This is a sad commentary on our efforts as a nation to combat these problems. California’s termination of Medi-Cal optional benefits (which included adult dental services, podiatry, and many behavioral health services) in 2009 has had a negative impact on the availability of many of the services needed for the treatment of these health disparities in the AIAN population of California.

Recommendations:

• The Medi-Cal and Healthy Families Programmatic Outreach and Enrollment program should be enhanced for AIAN. The federal Medicaid and CHIP programs fund special outreach eligibility programs for AIAN at no cost to states.


• California should restore Medi-Cal ‘Optional’ Benefits that are reimbursed 100% by the federal Medicaid program. As mentioned previously these benefits include behavioral health which in my opinion may be one of the most crucial programs to reinstate. This is a vital need for AIAN and should never have been terminated.


• Integration of Tribal Health Programs and Urban Indian Health Organizations in local systems of Electronic Health Records and Practice Management Systems.
  Tribal and Urban Indian health programs in California are largely focused on primary care, and are more dependent on federal funds to purchase services from non-Indian health care providers that the Indian Health Service cannot provide. The quality of care in clinic-based Tribal and Urban Indian health programs would be greatly improved by the ability to share patient information with their non-Indian referral partners. To facilitate communication among providers of AIAN health care, primary and specialty care, laboratory and imaging services, and hospitals should be required to
  include their local Tribal and Urban Indian programs in the design, governance, and operation of such data sharing systems.


• Telehealth/broadband accessibility. While doing some of my research for this I found one of the recommendations for improving AIAN disparities in health care to be slightly in conflict to what I believe is a more long term realistic solution. Our organization suggests that increased in-home and hospice health services be made more readily available.
  I think this is very true, in that many AIAN live in remote areas, sometimes with little or even no access to electricity. In many cases in-home visits are indeed a necessary form of patient care. However, I think that it might be a better financial investment to work on securing broadband access coupled with computers and providers willing to participate in telehealth visits. In some cases the nearest "center" might be used as the point for broadband/telehealth due to a lack of ability to secure access to remote/rural homes. However even satellite accessibility is possible and in the long term providing patients in rural areas with the ability to be seen through a telehealth visit (when applicable) is far more convenient. The ability for nurses/providers to visit the home is limited and time consuming and few patients could be seen in a day. The cost would be prohibitive and in the long run having an established network for providing telehealth could mean a substantial savings in cost and time and allow for far more patient visits and ultimately better aggregate care. The need for in-home visits would lessen to only that which was a necessity.

Introduction

Hello,
my name is Michael Thompson and this is my Health Informatics blog site. I plan to use this to communicate with other classmates and anyone else interested in health/health informatics.

I am currently employed at the California Rural Indian Health Board as a Technical Systems Coordinator. I manage EHR implementation projects, report writing, SQL database and NextGen application administration etc. and more recently managing the ARRA funding we recently received to improve our reporting to IHS through the use of I2I. CRIHB works specifically with our member tribal health programs, but we will soon be managing the IHS REC for non-RPMS sites.