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  • Writer's pictureAaron Neinstein

From “Pull” to “Push”: A Transformation in Medicine

Weitzman et al just published a very interesting article in JAMA Internal Medicine called “Participatory Surveillance of Hypoglycemia and Harms in an Online Social Network.”  They looked at using the online social network, TuDiabetes, as a method for surveillance for hypoglycemia.  You can read their very novel article here.

I was flattered to be asked to write a commentary on this article.  Below are the first few paragraphs of my commentary and a link to the full text PDF for download here: JAMA Internal Medicine, Feb 2013, Aaron Neinstein, From “Pull” to “Push”: A Transformation in Medicine: Comment on “Participatory Surveillance of Hypoglycemia and Harms in an Online Social Network.

Consider the words we use to describe what a physician does when she or he sits across from a patient to perform a history. Take. Obtain. Elicit.

These words all conjure images of physicians extracting information from patients. We pull information not just from our patients but also from our information sys- tems, calling up vital signs and laboratory results when we want them, on our time and our terms. However, this is rapidly changing, as information will be coming to us from the patients themselves to create “push” medicine. Are we ready? Not yet, but with some pivoting and some preparation, we can be.


Several synergistic technological and cultural trends are leading us toward “push” medicine. Increasingly ubiquitous technologies such as broadband Internet, smartphones, and cloud computing have created fertile ground. There is increased focus on patient-centered decision making. Patients are increasingly well-informed; nearly 60% of adults have looked online for information about health topics.1

Data are coming from many new sources. Mobile applications enable patients to actively create data, such as by answering symptom questionnaires, or allow wireless sensing devices to semipassively generate data like heart rate or physical activity. Other mobile applications use your calendar, text messages, and e-mails to passively generate meaningful health information, such as mood or quality of life.2 The realm of data collected in the home is expanding beyond blood pressure and glucose log books to tracking daily pain and functioning scores for rheumatoid arthritis. Patients are also contributing data through social networks and personal health records and by direct entry into the electronic health record. Patients are increasingly requesting their personal genomes—and to do so they need only curiosity, an Internet connection, and a credit card. These activities are increasingly common, and 27% of Internet users, or 20% of all adults, have tracked their health online.1

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