presentation to hillman cancer center (university of pittsburgh) 2013

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

Harnessing the Power of An Intelligent Health Environment

Friday, September 27, 2013

Founded: February 14, 2005

Entries: 48 hours / minute

8 years / per day

Available in: 54 languages

Reach: 37 % global Internet*

Founded: January 15, 2001

Registered Users: 35,000,000

Available in: 285 languages


* Total Global Internet Users (December 31, 2011): 2,267,233,742


Founded: September 4, 1998

Revenue: $37.905 billion

Distribution: World wide


* Total Global Internet Users (December 31, 2011): 2,267,233,742

Founded: February 4, 2004

Registered Users: 955,000,000

Distribution: World wide



March 1876: The first telephone call

• “Youngest and most wonderful development in means of communicating” - Watson

• “A means for overcoming the limitations of geography”*

1876

Learning from History: Diffusion of Telephone

First telephone call

1889

First public pay phone installed at a bank in

Hartford, Conn.

1891

First Automatic Dialer

*See: Brooks, J. (1975). Telephone: The First Hundred Years.. Harper & Row.Friday, September 27, 2013

What did the prognosticators say?

• “Really a technological toy; no business application”

• “too depersonalized” … word ‘phony’ introduced to describe the dangers of telephone anonymity.

1876

Learning from History: Diffusion of Telephone

First telephone call

1889

First public pay phone installed at a bank in

Hartford, Conn.

1891

First Automatic Dialer

*See: Brooks, J. (1975). Telephone: The First Hundred Years.. Harper & Row.Friday, September 27, 2013

The ques9on was no longer technical, it was sociotechnical.

How could telephones make a difference in business and

rela9onships?

1900Source: www.visualizationeconomics.com

1925 1950 1975 2000Friday, September 27, 2013

http://www.visualizationeconomics.com


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Experiments in value-added “use cases:”

e.g., replace couriers




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Post War Consumerism• “Reach out touch someone”• “Let your fingers do the walking”




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Post War Consumerism• “Reach out touch someone”• “Let your fingers do the walking”

Global competition: Launch of Sputnik




1982 1988

Socioetechnical Perspec9ve:Mediated Communica9on

* Hesse BW, Werner CM, Altman I. Temporal aspects of computer-mediated communication. Computers in Human Behavior. 1988;4(2):147-165..

Irwin Altman, PhDVice President, University of Utah

Carol Werner, PhDPsychology, University of Utah


* Hesse BW, Werner CM, Altman I. Temporal aspects of computer-mediated communication. Computers in Human Behavior. 1988;4(2):147-165..

1982 1988

Can technology bridge spatial

constraints (e.g., telemedicine)?

Can asynchrony be used to overcome

temporal restraints?

How do we create a better fit between

information environment and healthy behavior? How do we improve

human factors: i.e., safety, effectiveness,

patient-centeredness, equity?


19901988* Hesse BW, Sproull L, Kiesler SB, Walsh JP. Returns to science: computer networks in oceanography. Commun. ACM. 1993;36(8):90-101.** Sproull L, Kiesler S. Connections : new ways of working in the networked organization. Cambridge, Mass.: MIT Press; 1991.

Studies of Change in Communica9on Environment (Non Medical)

Found:1.Geographic benefits: e.g., land-

locked oceanographers who were online gained in papers written, funding obtained, and collaborations reported.

2.Temporal benefits: Shift workers in state governments and commercial business gained differential benefits in productivity over day workers.

3.Social benefits: Minority factions in decision groups participated more equally online.


19961989

Motorola’s Consumer Cell Phone

Consumer Internet

See: Boyle, L.F. (1993). Averting PC Headaches: Usability Tests Aim To Find Design Bugaboos Before They Find You. San Jose Mercury News, April 4, 1993,1F & 7F. San Jose, CA.

Apple’s Newton

Cogni9ve Laboratory:User-‐Centered Design(Commercial)


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Internet Users (per 100 people)Rapid Diffusion


http://data.worldbank.org/indicator/IT.NET.USER.P2

http://data.worldbank.org/indicator/IT.NET.USER.P2

http://www.gapminder.org

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How do we accelerate successes against cancer using the affordances of this new

environment?


This latest phase of the information revolution will change the way we create health and deliver health care … if we are smart enough to know how to use it.

— Francis Collins, Director NIH


CognitiveSciences

Cogni9ve Evalua9on MethodsUser-Centered Design Process

Source: Brinck T, Gergle D, Wood SD. Designing Web sites that work : usability for the Web. 1st ed. San Francisco: Morgan Kaufmann Publishers; 2002.

Requirements Analysis

ConceptualDesign

Mockups andPrototypes Production Launch

User Evaluation

1 2 3 4 5

!


Requirements Analysis

ConceptualDesign

Mockups andPrototypes Production Launch

1 2 3 4 5

•Market scan•Goal setting

•Audience analysis•Interviews

•User panels•User survey

•Contextual inquiry•Usage log analysis

•Search log analysis•Usability tests

•Expert review

•Site Mapping•Brainstorming

•Card sorting•Task analysis

•Storyboarding•Info. architecture

•Function specs•Integrate with marketing plans

•Design guidelines•Expert review

•Templates•Paper prototypes

•Wire frames•Focus groups

•Interviews•Usability testing

•Behavioral coding

•Usability checklists•Design guidelines

•Template use•User testing


•Usage log analysis•Bounce-back Surveys

•Remote usability Testing•Expert review


User-Centered Design Process

!

Cogni9ve Evalua9on MethodsCognitiveSciences

•Market scan•Goal setting

•Audience analysis•Interviews

•User panels•User survey

•Contextual inquiry•Usage log analysis

•Search log analysis•Usability tests

•Expert review

•Site Mapping•Brainstorming

•Card sorting•Task analysis

•Storyboarding•Info. architecture

•Function specs•Integrate with marketing plans

•Design guidelines•Expert review

•Templates•Paper prototypes

•Wire frames•Focus groups

•Interviews•Usability testing


•Usability checklists•Design guidelines

•Template use•User testing


•Usage log analysis•Bounce-back Surveys

•Remote usability Testing•Expert review


CDC Web 2001National Breast & Cervical Cancer

Early Detection ProgramSource: Hesse BW, Shaikh A, R., Toward JI, Edgar T. Final Report of the CDC Main Web Site Evaluation. Atlanta, GA: Centers

for Disease Control and Prevention; April 2002.


ANTICIPATED

Percent Consumers to CDC Web CognitiveSciences


ANTICIPATED

ACTUAL

Percent Consumers to CDC Web CognitiveSciences


Bounceback Survey

Health care providers16%

Policymakers7%

Scientists7%

Media reps1%

Student22%

Librarian1%

Educator7%

Not related to Occupation15%

Other24%General Consumers

Bounceback Survey

Health care providers16%

Policymakers7%

Scientists7%

Media reps1%

Student22%

Librarian1%

Educator7%

Not related to Occupation15%

Other24%General Consumers

Who were visitors? How referred?CognitiveSciences


Email Analysis

Public health3%

Policymakers0%

Scientists5%

Consumers18%

Educators7%

Other24%

General Consumers

CDC0%

Media reps1% Students

20%

Providers22%

Email Analysis

Public health3%

Policymakers0%

Scientists5%

Consumers18%

Educators7%

Other24%

General Consumers

CDC0%

Media reps1% Students

20%

Providers22%



WHO4% (n=58,147)

travel.state.gov4% (69,247)

News Sites5% (n=88,772)

hss.state.ak.us0% (n=7,029)

NLM1% (n=19,606)

Search Engines86% (n=1,406,964)

WHO4% (n=58,147)

travel.state.gov4% (69,247)

News Sites5% (n=88,772)

hss.state.ak.us0% (n=7,029)

NLM1% (n=19,606)

Search Engines86% (n=1,406,964)


Content Analysis


How did this change strategy?

20

Internet is Transformational •  Demassified •  Decentralized

•  Adaptable •  Asynchronous

•  Interactive •  Interconnected

Traditional Communication Traditional Communication Channels Channels

CDC

State and Local Health Officials

Media

Policymakers Researchers & Practitioners

Public CDC


Media

Policymakers Researchers & Practitioners

Public CDC


Media Policymakers

Researchers & Practitioners

Public

Internet Enabled Channels Internet Enabled Channels

CognitiveSciences

See: Hesse BW. Harnessing the power of an intelligent health environment in cancer control. Stud Health Technol Inform. 2005;118:159-176.


CDC adapts

“CDC used to be in the wholesale

business of providing information to

state and local health departments.

We are now in the business of

providing health information directly

to individuals.”

- Dr. J. Gerberding, 2003

CDC Director Julie Gerberding, MD MPH

CognitiveSciences

2012 Statistics:• 746,222,316 page views• 2,970,449 views - CDC en Español

Most Popular Topics on CDC.gov• STD FACTS• CDC Homepage, Search, A-Z• Vaccines• Health Statistics• Travelers' Health• Seasonal Flu


25

Redesigned with Consumer Appeal, 2004

Link to live help

Link to Clinical Trials

Front Page Access to Descriptions

Communicating Science to the Public

Spanish SiteLaunched2006

NIH -‐ NCI AdaptsCognitiveSciences


Surveillance

July 27, 2012

CognitiveSciences

See also: Hesse BW, Nelson DE, Rutten LF, Moser RP, Beckjord EB, Chou W-YS. National Health Communication Surveillance Systems. In: D. K. Kim ASGLK, ed. Global Health Communication Strategies in the 21st Century: Design, Implementation, and Evaluation. New York, NY: Peter Lang; In Press.

.

Health Situa9onal Awareness


SurveillanceCognitiveSciences

*NIH Nominee to White House for “Open Science Champion,” May 14 2013.

Data BriefsStatisticalGuides

Peer Reviewed Publications

Web Platform for Participation*

Health Informa9on Na9onal Trends Survey (HINTS)



HINTS Brief #1: Trust in channels and cancer informa9on seeking

Source: Hesse BW, Nelson DE, Kreps GL, et al. Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey. Arch Intern Med. Dec 12-26 2005;165(22):2618-2624.



Where would you prefer to go for cancer informa9on?




Where did you go for cancer informa9on?



How do Survivors get their cancer informa9on?


Source: Hesse BW, Arora NK, Beckjord EB, Finney Rutten LJ. Information Support for Cancer Survivors. Cancer. 2008;112(11S):2529-2540.

Neeraj AroraNCI

Cancer Survivors


How do Survivors get their cancer informa9on?


Source: Hesse BW, Arora NK, Beckjord EB, Finney Rutten LJ. Information Support for Cancer Survivors. Cancer. 2008;112(11S):2529-2540.

Neeraj AroraNCI

Cancer Survivors

Patient to Survivor: Lost in Transition?


Source: Hesse BW, Moser RP, Rutten LJ. Surveys of physicians and electronic health information. N Engl J Med. Mar 4 2010;362(9):859-860.

SurveillanceCognitiveSciences Trends: 2002-‐2003, 2005, 2008



HITECH* Act passed in 2009*Health I.T. for Economic & Clinical Health Act

Health I.T. as Foundation for Evidence

Implementation

Source: Hesse BW, Ahern DK, Woods SS. Nudging best practice: the HITECH act and behavioral medicine Translational Behavioral Medicine. 2011;1(1):175-181.


Source: Jamoom E, Beatty P, Bercovitz A, Woodwell D, Palso K, Rechtsteiner E. Physician adoption of electronic health record systems: United States, 2011. NCHS data brief. Jul 2012(98):1-8.


Supply Side


Source: Jamoom E, Beatty P, Bercovitz A, Woodwell D, Palso K, Rechtsteiner E. Physician adoption of electronic health record systems: United States, 2011. NCHS data brief. Jul 2012(98):1-8.

National Ambulatory Medical Care SurveySurveillanceCognitive

SciencesSupply Side


Health Information National Trends SurveyDemand SideSurveillanceCognitive

Sciences


SurveillanceCognitiveSciences Understanding the digital divide

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.

Lila RuttenMayo Clinic

Rick MoserNCI

Ellen BeckjordU of Pittsburgh

Med School


Understanding knowledge or belief gaps



What about “Web 2.0?”SurveillanceCognitiveSciences

Source: Chou WY, Hunt YM, Beckjord EB, Moser RP, Hesse BW. Social media use in the United States: implications for health communication. J Med Internet Res. 2009;11(4):e48.

Wen-Ying (Sylvia) ChouWeb 2.0: Platforms for Participation



Wen-Ying (Sylvia) ChouWeb 2.0: Platforms for Participation

What about “Web 2.0?”



Gary Kreps Paula Kim

Agreement between NCI (Bradford Hesse) and Health Ministry of China (Mao Qu’nan) to cooperate in areas of Health Communication & Informatics Research

-George Mason University, March 29

Can we learn from comparisons across cultures?

Wen-Ying (Sylvia) Chou


HINTS China AllianceSurveillanceCognitiveSciences

U.S. Death RatesACS Cancer Facts & Figures


HINTS China Alliance: PilotSurveillanceCognitiveSciences


Surveillance on Communica9on Environment

44


Iden9fying System Level Needs / Strategies

State of the Science & PracticeFebruary 14, 2011

Synthesis of Systematic ReviewsAugust 20, 2012

Blueprint: Uniting Systems through Communication Science

Late summer, 2013

• Health Impact Framework (CDC)• Targets across continuum• Affordable Care Act

• Health Information Technology for Economic & Clinical Health:HITECH

• Technology Mediated Social Participation (Health 2.0)

• Dissemination and Implementation Science

• Agenda-aligning communications

Surveillance System Sciences

CognitiveSciences


http://www.cancer.org/


http://cancer.gov/

http://cancer.gov/

NSF: Technology Mediated Social Par9cipa9on

Surveillance Health 2.0CognitiveSciences

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.


CognitiveSciences


Courtesy of Oracle Systems

See: *Nelson DE, Hesse BW, Croyle RT. Making Data Talk: Communicating Health Data to the Public, Policy, and the Press. New York, NY: Oxford; 2009. **Shneiderman B, Plaisant C, Hesse BW. Improving Healthcare with Interactive Visualization. In: Catherine P, Bradford WH, eds. IEEE Computer. Vol

462013:58-66.

May 2013**


CognitiveSciences

May 2009*

Communica9ng Evidence


Transforming Cancer Research and Prac9ce

Bill Chismar Abdul Shaikh

Source: Chismar W, Horan TA, Hesse BW, Feldman SS, Shaikh AR. Health cyberinfrastructure for collaborative use-inspired research and practice. Am J Prev Med. May 2011;40(5 Suppl 2):S108-114.


CognitiveSciences


ASCO’s Blueprint, 2011

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

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

See: Hesse BW, Ahern DK, Woods SS. Nudging best practice: the HITECH act and behavioral medicine Translational Behavioral Medicine. 2011;1(1):175-181. Hesse BW, Croyle RT, Buetow KH. Cyberinfrastructure and the biomedical sciences. Am J Prev Med. May 2011;40(5 Suppl 2):S97-102.




MedicalTeam

Patient &





Medical Researcher






CognitiveSciences


Are we really partnering with pa9ents?

Hugo Campos




MedicalTeam

Patient &





Medical Researcher






CognitiveSciences


Pa9ents Char9ng the Way

Dr. Susan Love Jamie HeywoodPatients Like Me


CognitiveSciences


Partnering Against Cancer Today


Partnering Against Cancer Today




http://cancer.gov/

http://cancer.gov/

presentation to hillman cancer center (university of pittsburgh) 2013

Health & Medicine

total global internet

temporal benets

languages reach

hesse bw

walking global competition

world wide reach

temporal aspects of

use cases