Health care found to be better with online help - Nice localization of the landmark Group Health study on managing hypertension using Web services, from the Seattle PI.

So…if the study and the community agree that this kind of care is better, and there is data to show that diagnosing “white coat” hypertension is cost-effective, and payers already have reimbursement policies for ambulatory blood pressure monitoring (and older type of technology to figure this out), why not create more modern policies for home blood pressure monitoring?

This is the data we have today, can we do better? From the well-done Deloitte 2008 Consumer Survey

Ideas requested….

In the patient-centered technology world, there are a lot of different measures that various organizations use to show the size / accessibility of their online services. The challenge of all these numbers is that when someone tries to figure out who the leader in this space is, or where they are more likely to have access and involvement, it’s unclear. Everyone uses the numbers that capture the data they have (and by extension that are the most optimistic sounding - it’s human nature).

Some measures use number of patients on a provider’s web site (”We have 86,000 patients verified for use of our portal”), some use percent penetration (37 % of adults enrolled or that receive care here are online - that’s the one I used). These numbers can be confused by different denominators (adults only? all enrollees?) and services offered (access to what? claims data? e-mailing doctors? lab results?). One metric we began using at Group Health was, “% lab results reviewed online by patients” - this crosses primary care and specialty care practices, and since the assumption is that most patients want the results of their tests, may be a good measure of how much a provider promotes access to clinical data, other things being equal.

Why is it useful to figure out?

As I mentioned in a previous post, we currently measure penetration of electronic health records in practices (it’s scarily low still); however, this doesn’t say very much about the value to the patient, the customer. So:

1. If a patient can compare organization x / provider y in terms of the accessibility of the data - through whatever channel - there may be better incentive to compete on something that matters a lot - involvement in care and partnership.
2. If a supporting organization is working to promote patient access across a constituency, they can understand which organizations need more assistance quickly.

Agree? Disagree?

Throw out some ideas for a measure - is it a combination of what is offered (scope of content), how many people are actually using what’s offered (satisfaction with content, priority of the organization in supporting services), and service measures (messages responded to in a timely manner, test results shared)?

Kaiser Permanente provides one example that I am using with permission. As the probable largest personal health record in the world currently, there were 2,140,017 members with access to secure features as of the end of Q1-2008, out of 8.7 million members, and 63.6 % of registered members signed on two or more times in the past 12 months. There are a suite of services on kp.org that include messaging your doctor, access to lab test results, after visit summaries, and a comprehensive health encyclopedia.

This does matter to patients today, like me, as Jen McCabe Gorman pointed out in this post on her blog. She also pointed to a comment on my twitterfeed as well: I am, and I won’t.

Health 2.0 is participatory healthcare. Enabled by information, software, and community that we collect or create, we the patients can be effective partners in our own healthcare, and we the people can participate in reshaping the health system itself.

Matthew Holt recognizes this as the latest definition out there. As I mentioned in my comments on previous posts about this , I started this process out of necessity. I needed to describe health 2.0 in a presentation to the Board of the California Healthcare Foundation. I did use the definition above, and what I was/am happiest about it is that it’s something I would not have come up with in my physician state of being (as patient focused as I am), and that it was finalized and approved by a patient.

We’re talking about a definition this time; isn’t this a metaphor for how any health system improvement should happen from now on?

Remember that I started the defining in anticipation of talk I am giving? That talk is happening next week, in collaboration with the California Healthcare Foundation, who are working to foster next generation ideas for health care.

Based on the comments I’ve read to date, here’s what I put together:

Health 2.0 is participatory health care. The combination of content and community enables the patient to be an active partner in their own health care and the citizen to be an equal partner in improving the health system.

Here’s a summary of the improvements suggested:

Dave: add “When patients meet Web 2.0″
Andre: add “Social Media”
Jen: “Content and Community” (commerce coming)
Deborah: “Strike transition, promote participation”
Lodewijk: “Not a transition; Health 2.0 defines the combination of health data and health information with (patient) experience through the use of ICT, enabling the citizen to become an active and responsible partner in his own health and care pathway”
Gilles: ” Add ‘and equal’, add ‘informed’”
Dave: “Lodewijk + is the combination of new Web tools, health information, and patient awareness, enabling the citizen”
Susannah (offline) : “Participatory medicine”
Matthew: “Good luck”

Here’s the original:

Health 2.0 is the transition to personal, participatory health care. Everyone is invited to see what is happening in their own care and in the health care system in general, to add their ideas, and to make it better every day.

Better? Easy to discuss in an elevator, or on your way to a walking meeting?

A lot.

When I first read this story: Slashdot | U. of Chicago Law School Blocks Internet Access, and followed the comments, I realized that this is a symptom of a much larger issue. Notice especially what people say they are doing with their laptops while their professors are droning on. It might seem alarming, but I think it’s just a variant on what generations of students, young and older, have been doing for generations - doodling, playing pong, thinking, dreaming, daydreaming, you name it. This is incredible creative energy, all being wasted.

This story is playing out in adult education, medical education, and the business world in a big way.

The question asked in the Slashdot article and in every other space is, “should people pay attention better, or should there be something better to pay attention to?”

I think the latter question is the better one to ask. If we have known for a very long time that continuing medical education is largely ineffective (at enormous cost to US taxpayers who are subsidizing the travel deductions), we have a great opportunity to innovate, have fun, and learn a ton at the same time.

In the past, I have arranged convergences in a LEAN way that involved creative problem solving - no powerpoint slides. There are now unconferences, World Cafe (which I have never tried but looks interesting), BarCamp (same), and whole rooms of meeting attendees with laptops connected to the Internet that could be engaged beyond checking their e-mail. There are now options like a conference blog, wiki, and social networking site. The Health2.0 Conference did the latter in March, and I thought it was very effective.

Perhaps future CME accreditation requirements could mandate an alternate approach to meeting management. When I was in medical school, we called the easy way out the “parade of slide carousels” (I’m dating myself). I’m ready to try the more difficult way out, to inspire people to bring every ounce of creativity to the table when they are at the moment they are ready to learn. This includes social networking, walking (what a treat for an eager student to get coaching from an expert in their field), simulated (or real) rapid process improvement. This should also include the voice of the customer - in medicine, the patient.

What if the physician attendee at a conference was asked to walk with a patient for an hour, to learn about how they manage their health (I have always dreamed of a medical visit that involved a walk with a patient, maybe this the next best thing).

If we do this, we’ll then take the next step, which is harness peoples’ creativity every day, in everything they do, where they work. It will be the norm. No conference needed.

Those are my ideas off the bat. I welcome yours. And then let’s try them.

Colleague in patient empowerment Susannah Fox e-mailed me this question and so we thought we’d start one.

Jay Parkinson, MD, linked to a discussion happening on Digg in his blog. E-patients is also hosting an informed discussion on their blog.

Is it cliche to say that this is evolutionary, not revolutionary? I think it’s of benefit to patients and our profession that a dialogue has started around moving health care data in a standardized way to a place where people can aggregate and do things with it to improve their health. A year or two ago, it was hard to think about a standardized extract of a medical record that you could send from an EHR system except in very specialized situations. Now you can do with several partners, Google being the most recently announced option.

I didn’t even think about writing a special post about it, even though I thought, “Cool, this work will support the ideas I am exploring with the California Healthcare Foundation, that patients can be involved and active in their care, across health environments (health system, work, play).” So rather than writing about it, I just incorporated the possibility into the work we’re already doing, which is great.

I think of privacy as a state of being that allows a person to feel comfortable seeking health care regardless of the issue. This is a good place to be, and when that state of being doesn’t exist, people will seek it out, even if it means not seeking needed care, which could be devastating both to patient and health system. At the same time they seek comfort, they also want to build confidence in their ability to manage their health by having as much information their care as possible. In systems where patients have good access and trust, the care is better, and it feels great (and is great) to provide and receive care in that setting. Both things are important, we should not sacrifice one for the other; every patient deserves to achieve their life goals through optimal health.

See: The State of the Facebook Platform | 20bits. The number of active users has declined 27 % since January. Early adopters are leading the pack out.

I deactivated in December, 2007 (See: “I deactivated my Facebook Account, is LinkedIn Next?“), reactivated for a few days earlier this year, and then deactivated again. For good.

I did cancel my LinkedIn account, too. As I discussed in a post about it, if everyone has their own blog and RSS feed we can just communicate through those.

And I still think every patient should have a blog that their physician has access too through the electronic health record.

Over at one of my favorite blogs, e-patients.net, e-Patient Dave is starting a dicussion about what Health 2.0 “is;”: e-patients: Participate in defining “Health 2.0″

I started things off with a definition based on one created by The Economist, which I’ll repeat here:

Health 2.0 is the transition to personal, participatory health care. Everyone is invited to see what is happening in their own care and in the health care system in general, to add their ideas, and to make it better every day.

Feel free to suggest your improvements here, or there. I enjoy the idea that patients like Dave and readers of e-Patients will create improvements that can be incorporated.

If someone asked you, “What is Health 2.0?” Would you feel comfortable answering with the definition above? If not, how would you change it? Be sure if you would to tell a little bit about “why?” The story of how we get here is as important as the where we got to.

Businessweek: The Mac in the Gray Flannel Suit

This week’s cover of Businesweek appears to triumphantly announce Apple, Inc.’s comeback (sort of) into the enterprise, even if Apple isn’t actually marketing to that sector.

For Mac afficionados, this is a big change from Businesweek’s former pronunciation of near-death (see The Fall of An American Icon, from 1996, or the Apple Death Knell Counter from Mac Observer).

Okay, so Apple is back; however, the opportunity here for enterprise IT is not so much to bring on a new platform, it’s to explore more thoroughly the idea of “employee asset ownership.” I didn’t find much searching for this idea on Google (maybe there’s a more official name for this? If there is, please add it in your comments), except that a few companies like BP and Unisys are experimenting with it.


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