consumer and connected health: a new day in health and healthcare?

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Bradford W. Hesse, PhD Chief, Health Communication and Informatics Research Consumer & Connected Health A New Day in Health & Healthcare? Tuesday, September 24, 2013

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Presentation given at the Health 2.0 Pittsburgh meet-up on September 24, 2013.

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Page 1: Consumer and Connected Health: A New Day in Health and Healthcare?

Bradford W. Hesse, PhDChief, Health Communication and Informatics Research

Consumer & Connected HealthA New Day in Health & Healthcare?

Tuesday, September 24, 2013

Page 2: Consumer and Connected Health: A New Day in Health and Healthcare?

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

Page 3: Consumer and Connected Health: A New Day in Health and Healthcare?

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

Page 4: Consumer and Connected Health: A New Day in Health and Healthcare?

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

Page 5: Consumer and Connected Health: A New Day in Health and Healthcare?

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

Page 6: Consumer and Connected Health: A New Day in Health and Healthcare?

Institute of Medicine’s “Crossing the Quality Chasm” report

Tuesday, September 24, 2013

Page 7: Consumer and Connected Health: A New Day in Health and Healthcare?

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

Page 8: Consumer and Connected Health: A New Day in Health and Healthcare?

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

Page 9: Consumer and Connected Health: A New Day in Health and Healthcare?

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

Page 10: Consumer and Connected Health: A New Day in Health and Healthcare?

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

Page 11: Consumer and Connected Health: A New Day in Health and Healthcare?

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

Page 12: Consumer and Connected Health: A New Day in Health and Healthcare?

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

Page 13: Consumer and Connected Health: A New Day in Health and Healthcare?

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

Page 14: Consumer and Connected Health: A New Day in Health and Healthcare?

How effective is the patient’s information environment?

Confusion is Rising

Tuesday, September 24, 2013

Page 15: Consumer and Connected Health: A New Day in Health and Healthcare?

Create a self-improving healthcare system, with patients as partners

Oncology as information science: “The Learning Health Care System”

Tuesday, September 24, 2013

Page 16: Consumer and Connected Health: A New Day in Health and Healthcare?

I.T. accounts for productivity growth in most sectors, but not Health

Friends of the NLM Meeting

2009

Tuesday, September 24, 2013

Page 17: Consumer and Connected Health: A New Day in Health and Healthcare?

But initial deployment is disrupting workflow

Tuesday, September 24, 2013

Page 18: Consumer and Connected Health: A New Day in Health and Healthcare?

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

Page 19: Consumer and Connected Health: A New Day in Health and Healthcare?

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

Page 20: Consumer and Connected Health: A New Day in Health and Healthcare?

But, with resistance ...

The Case of Hugo

Tuesday, September 24, 2013

Page 21: Consumer and Connected Health: A New Day in Health and Healthcare?

But, with resistance ...

The Case of Hugo

Tuesday, September 24, 2013

Page 22: Consumer and Connected Health: A New Day in Health and Healthcare?

But, with resistance ...

The Case of Hugo

Tuesday, September 24, 2013

Page 23: Consumer and Connected Health: A New Day in Health and Healthcare?

Stimulating the market for consumer-facing apps

Tuesday, September 24, 2013

Page 24: Consumer and Connected Health: A New Day in Health and Healthcare?

Tuesday, September 24, 2013

Page 25: Consumer and Connected Health: A New Day in Health and Healthcare?

How do we communicate at “point of need,” not just “point of

care?”

Tuesday, September 24, 2013

Page 26: Consumer and Connected Health: A New Day in Health and Healthcare?

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

Page 27: Consumer and Connected Health: A New Day in Health and Healthcare?

Health Information National Trends Survey (HINTS) Data show uptick in asynchronous communications.

Tuesday, September 24, 2013

Page 28: Consumer and Connected Health: A New Day in Health and Healthcare?

Use new infrastructure to ensure equitable treatment across populations

Meaningful Use Phase 3 will emphasize

population health

Tuesday, September 24, 2013

Page 29: Consumer and Connected Health: A New Day in Health and Healthcare?

Take advantage of appropriate channels

Tuesday, September 24, 2013

Page 30: Consumer and Connected Health: A New Day in Health and Healthcare?

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

Page 31: Consumer and Connected Health: A New Day in Health and Healthcare?

Where are the opportunities?

Tuesday, September 24, 2013

Page 32: Consumer and Connected Health: A New Day in Health and Healthcare?

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

Page 33: Consumer and Connected Health: A New Day in Health and Healthcare?

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

Page 34: Consumer and Connected Health: A New Day in Health and Healthcare?

•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

Page 35: Consumer and Connected Health: A New Day in Health and Healthcare?

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

Page 36: Consumer and Connected Health: A New Day in Health and Healthcare?

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

Page 37: Consumer and Connected Health: A New Day in Health and Healthcare?

Tuesday, September 24, 2013

Page 38: Consumer and Connected Health: A New Day in Health and Healthcare?

Funding Opportunity Announced: NSF / NIH

Tuesday, September 24, 2013

Page 39: Consumer and Connected Health: A New Day in Health and Healthcare?

Working Together for a New Day

Tuesday, September 24, 2013