consumer and connected health: a new day in health and healthcare?
DESCRIPTION
Presentation given at the Health 2.0 Pittsburgh meet-up on September 24, 2013.TRANSCRIPT
Bradford W. Hesse, PhDChief, Health Communication and Informatics Research
Consumer & Connected HealthA New Day in Health & Healthcare?
Tuesday, September 24, 2013
Two antiquated cultures inmodern times -- the mechanisticand humanistic world views -- areleading to a “hidden epidemic” oferror and chaos.
- Kim Vicente,The Human Factor
Tuesday, September 24, 2013
Competing World ViewsMechanistic World View• Actors: Engineers, biological scientists• Question: How can we create new
technologies?• Focus: Physical Object
Vicente KJ. The human factor : revolutionizing the way people live with technology. 1st ed. New York: Taylor and Francis Books; 2003.
Humanistic World View• Actors: Social scientists, physicians• Question: How can we create new
people?• Focus: Person
Tuesday, September 24, 2013
RESULT
S
Competing World ViewsMechanistic World View• Actors: Engineers, biological scientists• Question: How can we create new
technologies?• Focus: Physical Object
Vicente KJ. The human factor : revolutionizing the way people live with technology. 1st ed. New York: Taylor and Francis Books; 2003.
Humanistic World View• Actors: Social scientists, physicians• Question: How can we create new
people?• Focus: Person
Tuesday, September 24, 2013
Mechanistic World View• Actors: Engineers, biological scientists• Question: How can we create new
technologies?• Focus: Physical Object
Humanistic World View• Actors: Social scientists, physicians• Question: How can we create new
people?• Focus: Person
Competing World Views
Tuesday, September 24, 2013
Institute of Medicine’s “Crossing the Quality Chasm” report
Tuesday, September 24, 2013
How do we design a sociotechnical system to achieve IOM’s quality goals?
Source: Hesse BW, Shneiderman B. eHealth research from the user's perspective. Am J Prev Med 2007;32(5 Suppl):S97-103.
Ben Shneiderman
Tuesday, September 24, 2013
Source: Van Den Bos J, Rustagi K, Gray T, Halford M, Ziemkiewicz E, Shreve J. The $17.1 billion problem: the annual cost of measurable medical errors. Health Aff (Millwood). Apr 2011;30(4):596-603.
Errors of Commission
Tuesday, September 24, 2013
Errors of Omission
Source: Leyden WA, Manos MM, Geiger AM, Weinmann S, Mouchawar J, Bischoff K,Yood JG, Taplin SH (2005). Cervical cancer in women with comprehensive health care access: Attributable factors in the screening process. JNCI, 97(9), 675-683.
Eligible Cases833
Eligible Cases833
FAILURE TO SCREENNo Pap
464 (56%)
FAILURE TO SCREENNo Pap
464 (56%)
FAILURE TO DETECT1st Pap Normal
263 (32%)
FAILURE TO DETECT1st Pap Normal
263 (32%)
FAILURE IN FOLLOW-UP1st Pap abnormal
106 (13%)
FAILURE IN FOLLOW-UP1st Pap abnormal
106 (13%)
Chart review: Pap results 4-36 mos prior to dx
Tuesday, September 24, 2013
Restructuring the decisional architectures of medicine*
Hospital Based EHR Data
Hospital Based EHR Data
Health Information Exchange
MedicalTeam
Patient &
FamilyHospital System
DecisionSupportNeeds
Subjective• Chief complaint• Patient Reported Outcomes
• Risk modeling• Diagnostic support • Treatment selection • Guideline adherence• Error detection/correction
Medical Researcher
• Situational awareness• Population health• Continuity of care• Identify side effects• Inform discovery
Objective• Clinical measures• Laboratory findings • Sensor data
Assessment• Diagnosis• Categorical reporting• Prognosis
Plan• Treatment planning• Self-care planning• Post treatment• Surveillance
Source: Hesse BW. Decision Architectures. In D Bowen, M. Diefenbach, S. Miller (Eds.) Handbook of Health Decision Making. Springer Verlag, New York, NY (in press).
Meaningful Use
Safety, efficiency
Consumer engagement
Continuity of care
Population health
Privacy
Tuesday, September 24, 2013
Creating new decision architectures
Source: Friedberg MW, Coltin KL, Safran DG, Dresser M, Zaslavsky AM, Schneider EC. Associations between structural capabilities of primary care practices and performance on selected quality measures. Ann Intern Med 2009;151(7):456-63.
Tuesday, September 24, 2013
Bringing patients into the quality control process
Source: Friedberg MW, Coltin KL, Safran DG, Dresser M, Zaslavsky AM, Schneider EC. Associations between structural capabilities of primary care practices and performance on selected quality measures. Ann Intern Med 2009;151(7):456-63.
• 92% of patients opened notes
• 60% reported better medication compliance
• 77% reported being in greater control of care
• 86% agreed that open notes would be factor in choosing care
• 99% wanted open notes to continue
Tuesday, September 24, 2013
How often is medicine “evidence-based”?
• Medicine gets it right 54.9% of the time*
• Pernicious incentives divert from evidence-based treatment**
• Explosion of information makes it impossible to stay abreast of field
• Historical premium on opinion-based care
* McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med 2003; 348(26):2635-45 (June 26).** Brawley OW, Goldberg P. How we do harm : a doctor breaks ranks about being sick in America. 1st ed. New York: St. Martin's Press; 2012.
Tuesday, September 24, 2013
How effective is the patient’s information environment?
Confusion is Rising
Tuesday, September 24, 2013
Create a self-improving healthcare system, with patients as partners
Oncology as information science: “The Learning Health Care System”
Tuesday, September 24, 2013
I.T. accounts for productivity growth in most sectors, but not Health
Friends of the NLM Meeting
2009
Tuesday, September 24, 2013
But initial deployment is disrupting workflow
Tuesday, September 24, 2013
National Research Council 2009 Report
Computational Technology for Effective Health Care advocates re-balancing the portfolio of investments in health care IT
• Greater cognitive support for physicians, patients, and caregivers
• Observing user-centered design principles
• Accelerating research related to health care in the computer and social sciences and in health/biomedical informatics
Tuesday, September 24, 2013
Eric Topol, a cardiologist who directs the Scripps Translational Science Institute in San Diego, says apps that monitor blood pressure or glucose rates can be more valuable than prescriptions to keep these conditions in check.
"When we use a medication, we don't know if it's going to work or not. It's much better when a person's taking their blood pressure on a frequent basis," says Topol.
"The average person looks at their smartphone 150 times a day, so all of a sudden they're able to diagnose if their blood pressure's adequately controlled and what are the circumstances when it's not."
Patients lead the way
Tuesday, September 24, 2013
But, with resistance ...
The Case of Hugo
Tuesday, September 24, 2013
But, with resistance ...
The Case of Hugo
Tuesday, September 24, 2013
But, with resistance ...
The Case of Hugo
Tuesday, September 24, 2013
Stimulating the market for consumer-facing apps
Tuesday, September 24, 2013
Tuesday, September 24, 2013
How do we communicate at “point of need,” not just “point of
care?”
Tuesday, September 24, 2013
Creating Evidence-Based Care
Source: Zuboff S, Maxmin J. The support economy: why corporations are failing individuals and the next episode of capitalism. New York: Viking; 2002.
Technologies focusing on the long term rela3onship with a customer contribute to business success*
Move away from a “transactional”
model to a “relationship” model
Tuesday, September 24, 2013
Health Information National Trends Survey (HINTS) Data show uptick in asynchronous communications.
Tuesday, September 24, 2013
Use new infrastructure to ensure equitable treatment across populations
Meaningful Use Phase 3 will emphasize
population health
Tuesday, September 24, 2013
Take advantage of appropriate channels
Tuesday, September 24, 2013
Enable communication “beyond where the technology ends”
Did you use the Internet to look for medical information for yourself?
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Less than high school High school graduate Some college (AA) College graduate(BA/BS)
Education Level
Perc
en
tag
e
2003
2005
2008
The Digital Divide
See: Rutten LF, Moser RP, Beckjord EB, Hesse, BW, Croyle RT. Cancer Communication: Health Information National Trends Survey. Washington DC: National Cancer Institute. 2007.
Tuesday, September 24, 2013
Where are the opportunities?
Tuesday, September 24, 2013
Participate in Rebooting Health & Healthcare
Source: Hesse BW. Time to reboot: resetting health care to support tobacco dependency treatment services. Am J Prev Med. Dec 2010;39(6 Suppl 1):S85-87.
Tuesday, September 24, 2013
Enable par*cipa*on within the new ecosystem
Source: Hesse BW, Hansen D, Finholt T, Munson S, Kellogg W, Thomas JC. Social Participation in Health 2.0. IEEE Computer. 2010;43(11):45-52.
Tuesday, September 24, 2013
•Improve quality of care for individual patient
•Engage patients in their own care
•Create infrastructure for clinical studies
•Improve population-based knowledge
•Develop new tools for medicine
•Increase administrative efficiency
Health I.T.: Realizing the Full Poten3al of H.I.T to Improve Healthcare
Realizing Potential of Health Information Technology:
December 2010
Tuesday, September 24, 2013
Recommendation: The Federal Government, under the leadership of NSF and Health and Human Services (NIH, ONC, AHRQ) … should invest in a national, long-term, multi-agency research initiative on NIT for health that goes well beyond the current national program to adopt electronic health records.
NITRD: Designing a Digital Future, Federally Funded R&D
Networking and Information Technology R & D:
December 2010
Tuesday, September 24, 2013
Source: Hesse BW, Ahern DK, Woods SS. Nudging best practice: the HITECH act and behavioral medicine Translational Behavioral Medicine. 2011;1(1):175-181.
Crea*ng a new pla6orm for evidence integra*on: Nudging best prac*ce
Tuesday, September 24, 2013
Tuesday, September 24, 2013
Funding Opportunity Announced: NSF / NIH
Tuesday, September 24, 2013
Working Together for a New Day
Tuesday, September 24, 2013