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Future of Consumer Healthcare

Lisa Gualtieri, PhD, ScM, Course DirectorTufts University School of Medicine

July 22, 2011

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“The internet saved my life”

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It isn’t easy to find pictures of bat’s teeth

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“Armed” with information, Diana educated the people who treated her

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e-patient Dave

• “Nothing beats a smart partner who listens to you and wants you to do well.”

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Janice Adams: “I asked our doctor if I should look something up on the Internet and he said, ‘No. Come and ask me; it’s too frightening if you read the wrong things.’ And we do.”

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Volker Wulf: “My sister is a doctor.”

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Scott Bateman and Adrian Reetz

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Scott’s feet

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Anja Habas-Korbar: “It was easier to get information from the Internet than from doctors… being in pain is motivating.”

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Lynda’s story

• Linda has vertigo– “I go online all the time”– Specialists have blinders• Ear, nose, and throat doesn’t talk to allergist• Impact of seasonal allergies

– Not alone - others have it worse

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Nancy Flournoi: “I looked up side effects for my husband’s medication and one was ‘stops breathing’. The doctor didn’t bother to tell him that.”

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Ron Perkins: “I don’t find credible sources. Maybe they’re all sponsored by the drug companies?”

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What is typical for online health seeking?

• Is it Diana?• Is it Dave?• Is it Janice?• Is it Scott?• Is it Anja?• Is it Nancy?• Is it Ron?

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People’s use of the web for health

• Different frequencies• Different reasons• Different contexts• Different skills• Different needs• Different health literacy skills

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Some commonalities

• People generally look on their own• Common triggers– Pain– Economic– Immediacy– Determine if doctor needed– Learn what doctor didn’t say– Learn what didn’t ask

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Healthcare is changing

• Use of the Internet for healthcare directly impacts far more people today than EHRs

• Potential to bridge disconnect– Concierge medicine– Shared medical appointments (SMAs)– Walk-in clinics– Telehealth– Home visits

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“Don’t ask, don’t tell”

• Technology becomes a cognitive prosthetic device for many

• Are patients less likely to ask their doctor questions because they plan to look it up?

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Interventions can avoid “don’t ask,

don’t tell”

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Easy to have eye contact with a barista

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Technology can get in the way

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Patients

TechnologyPhysicians

Idealistic scenario

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Technology can be a partner

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Take a historical perspective

• Pre-internet…

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Marcus Welby brought medicine into our homes

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Democratization of medical information

Usenet

AOL

Brochureware

Web, social media, mobile

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Incredible opportunities!!!

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And many pitfalls

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Pitfalls include

• People using the web instead of a doctor• People using poor quality or deceptive

information – the barriers have dropped• People misusing or misunderstanding

information• People obsessively searching• People who are scared to death• People confronting their doctors or not telling

their doctor about their Dr. Google diagnosis

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Patient centeredness - AHRQ

• Patient centeredness– Healthcare that establishes a partnership among practitioners,

patients, and their families– To ensure that decisions respect patients' wants, needs, and

preferences– Patients have the education and support they need to make decisions

and participate fully• Patient-centered care

– Encourages patients to comply with treatment regimens– Can reduce the chance of misdiagnosis due to poor communication– Has been shown to reduce underuse/overuse of medical services– Can reduce the strain on system resources and save money by

reducing the number of diagnostic tests and referrals– Can sometimes increases providers' costs, especially in the short run

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Patients

TechnologyPhysicians

How can the pitfalls be avoided

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Better health literacy skills

Better training of healthcare professionals

Better health website design

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Better health literacy skills

• How to search• What to look for –

dates, authors, seals• How to communicate

with a physician• What to believe

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Better training of healthcare professionals

• What and when to ask patients about Internet use

• What and when to recommend websites• Which sites to recommend• How to increase health literacy skills

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Better health website design

• Test on real users with mixed health literacy skills in context

• Conduct formative evaluations from the start• Have clear health goals and measure success

at achieving them• Use better imagery• Clear branding and accreditation

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Quality of health websites

• Annals of Oncology found nearly 50% of 32 most popular web sites on Complementary and Alternative Medicine for cancer are not good quality– 3 qualified as "outright dangerous“

• Action plan proposed: cancer organizations and other impartial interest groups should investigate websites and create and administer a ‘seal of approval’, for safety and reliability, such as the HONcode

• This fundamental study should raise patients’ awareness on the variability of the quality of web sites on CAM for specific diseases.

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Accreditation

• Works when – Accreditation exists– Processes are transparent– Processes are not criticized– Healthcare consumers know to look

• Happens in other domains• Is there a better way in healthcare?

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Patients

TechnologyPhysicians

Intermediaries

Introduce intermediaries

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Do intermediaries exist now?

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Which resources have you used to obtain information on a health-related question?

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Pharmaceuticals HealthWholesalers

HealthProviders Consumers

Pharmacy

MedicalEquipment

OtherEquipment

HealthInsurance

Government &Policy Makers

R&D Laboratories

Healthcare network: Where could the intermediaries be?

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Intermediaries help patients

• How to search and what to search for• How to identify the quality of websites• How to detect the quality of expert-generated

content• How to use user-generated content• When to contribute user-generated content• How to communicate with physicians about

web use

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Intermediaries help physicians

• What their patients are doing online• What resources their patients need• How to communicate with patients about web

use

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Patients

TechnologyPhysicians

Intermediaries

Toward a better future