Second Life in Health Care

Peter Yellowlees, MD, Director of the Health Informatics Graduate Program at UC Davis,  author of Your Health in the Information Age — How You and Your Doctor Can Use the Internet to Work Together, and instructor for an online UC Davis Extension course, has asked the class to consider Second Life and its role in the doctor-patient relationship. Second Life is a cyber-world where participants basically interact with others using an "avatar" or digital character and move through the land of Second Life by teleporting to different islands--many exclusive and requiring invitation. The potential of Second Life as a tool for health care is interesting in that patients can interact with the provider as two avatars "talking" and not have to look each other in the eye and without the input of nonverbal communications which could influence the conversation. Perhaps its benefit will be in reaching patients that don't enter the system now because they feel discriminated due to appearance, age, sex, sexual orientation or simply cannot show up in the office. This approach may get these patients connected to the health care system.


Interacting via Second Live might free a patient to discuss difficult topics that he might not otherwise want to bring up in person. With headphones and a microphone the avatars can speak or participants can use a chat field to type communications. The disadvantage for the practitioner is not being able to visually assess the patient. Another consideration is that if this method would allow patients to be more open, would it also get providers to be more open? Could this create new relationships with patients where in the past, clinicians are taught to keep a professional distance and demeanor?  Perhaps providers, too, could find the part of themselves that wants to be in connection with other human beings. 


There is potential for patient education where providers could send patients to a virtual simulation class so that they could understand an upcoming procedure and perhaps go through a simulation. Claustrophobic patients might be able to desensitize through MRI or CT simulations. There are many possibilities for extending care and communications using Second Life. There are just as many issues about using it including trusting who is at the keyboard, i.e. who is running the avatar? Another concern at the moment (technology changes quickly) is the learning curve to have an avatar and find your way around Second Life. I have spent about 3 hours reading guides and entering Second Life. Luckily, I knew a friend who offers Writing as Healing classes in Second Life so I was able to call him (first on a land line) and then our avatars walked around together and he showed me the ins and outs of the cyber world including a tour of the virtual hallucination clinic that Dr. Yellowlees and his colleagues created so avatars can experience what it is like to have schizophrenia.


Not having any gaming background nor interest in virtual worlds made this more awkward and I would be hesitant to meet my doctor in this space until I had some mastery of it. Perhaps future versions will be easier to use. A classmate's avatar happened to fly by and we were able to bumble around together which made it less boring and upsetting of an experience. It's interesting how landing in this new world brings up familiar experiences of being new at school and having to meet people.


Will it improve relationships or make health care more accessible or affordable or higher quality?   Who knows but considering all that is happening in health care, we need to look at everything that we can.
  

Charge Coders Practice Medicine w/o a License

The laws are quite clear on scope of practice. They identify which initials after a name allow the practitioner to do what. Even in nursing there are levels of practice between LVNs and RNs and APNs and NPs. Its all quite confusing. And then there is the ubiquitous tug of war between doctors and nurses. What consumers don't realize is that there is another party practicing medicine, making decisions and they don't have a license. They can also determine what treatment you do or don't get with a computer key stroke. Seems a little like practicing medicine. Lately I've run into a few walls trying to get patients scheduled for needed treatments. When all the dust settled in the bullpen of insurance authorization and we'd wrangled every which way, we realized the snorting bull in all this was coding. There was no code to allow the patient to have all the parts of a medically necessary procedure. Everyone jumped out of the pen and said, "Sorry, we don't have a code for that." Bottom line is that someone creating charge panels didn't understand a complex procedure so they left out part of the procedure and no one was willing to fix it. They did offer an alternative to this missing piece but it costs 15x as much and is more invasive for the patient and it didn't require any authorization.

I'm no expert in the world of insurance authorizations, coding, charging etc. so I might be using incorrect terminology but I do know what its like to be a health care provider on the receiving end of a string of computer code. I'm a nurse wanting her patient to get the right care having to fight the absolute world of coding.

Abundance in Health Care

A change in viewpoint is in order some days. It's been easy to complain about the problems of health care and I spend my share of hours griping. A word that I need to add to my vocabulary is ABUNDANCE. When I look around, I really do see a full and amazing health care system. At the core is the issue of sharing/distributing the largess. I'll save that topic for another post.

This post is about looking at all that we do have. The minister of Christ Unity Church in Sacramento spoke about abundance one Sunday. He wanted us to look at our lives and not see the deficits but to see what is there. When I shifted my focus and considered my nursing job, I saw the abundance. Every time I go into the store room, it is full with all of the supplies that I need. There is medicine and syringes in every size with needles to match. We have warm blankets, gurneys, monitoring devices, staff, computers, information and technology that can do amazing things. It's really an abundant place to work. And amidst the suffering and pain, there is much love and caring for the patients, from family members. Its quite amazing when the view shifts. I was prompted to write this post because of the article linked below. The article is about a county hospital in Des Moines, Iowa (the city where I went to nursing school) that has transformed itself. One of the keys in their transformation according to the author, is moving from a "poverty mentality to an abundance mentality." I wonder what health care could look like if we started seeing the greatness in our health care instead of focusing on the deficiencies.

tp://www.businessrecord.com/main.asp?SectionID=38&SubSectionID=101&ArticleID=11026&TM=40250.36

Ethan Zuckerman: Listening to global voices | Video on TED.com

This is a stunning look at our global connectively and the tendency and ability to remain in our own worlds and comfort zones. We're studying health disparities and this video speaks volumes and it's short at less than 20 minutes.

Ethan Zuckerman: Listening to global voices | Video on TED.com

Nicholas Christakis: How social networks predict epidemics | Video on TED.com

Nicholas Christakis: How social networks predict epidemics | Video on TED.com

Why this Blog? This name?

This blog is an assignment in a course called, "The Internet and the Future of Patient Care." It's also something that has been on my to-do list for many months. Besides working as a clinical oncology nurse, I facilitate writing groups for patients, staff and caregivers affected by serious illness. I see story as an important part of my nursing work. Through writing, participants get to freely pen their experiences and be heard and through this process, they sometimes see something different for themselves or know that they're not alone.

Coming of Computer Age

Call me old school but I like paper. I was a newspaper writer and a magazine editor and there was nothing like writing a story in the morning, watching the guys in the back paste up the waxed copy blocks and then heading to the press room and pulling a freshly printed newspaper from the end of the press. All smiles and smeared hands, I'd eagerly devour the other news and clip out my story. Gone are the days of writing a magazine article about holiday foods in July due to production schedules which required a several-month lead time to get 8 million copies printed.

Today, there is something to be said for the silver box that I cart around that's a portal to all the information that I need. I have to admit that I love my MacBook and iPhone and instant connectively to information. The question is how do we distinguish the truth, the objectivity in this world of megabytes instead of picas? Where are the Lou Grants of the internet? In the past I had Lenny Ingrassia and David Jordan as guides, both editors of entirely different publications who shepherded their staffs of writers and reporters and made us justify each word that would take up precious real estate in their publications.

The "Publish Post" button sits at the bottom of this page and its that easy to send these words out. With one click, I'll turn on to the computer age.