Tag Archives: Health 2.0

An Apple a Day Might Keep the Doctor Away – if Steve Jobs was in healthcare…

I just got to Rochester, Minnesota for the Mayo Clinic Social Media Summit. I anxiously await the next 2 days for an exciting lineup on using social media in healthcare.

There’s a great Veterans Administration contingent here. Tonight I’m here with @chipharman, @RachelECondy, @erinhynes, @DawnellRDorio, @Hi2molly (Molly Manion), @Tweet16C (Diane Bedecarre). We’re enjoying wine and refreshments, spirited discussion and group energy.

We were talking about how organizations need to take advantage of employees’ creativity and passion (hello!!)…and I mentioned how inspiring it was to hear the 1996 interview NPR’s Terry Gross did with Steve Jobs (re-played the day after his death). Many great things have been written about him the past few weeks, but I find his words the most glorious. In this interview, Jobs talked about 2 ingredients he found essential to success: (1) “watering” clever employees to drive innovation, and (2) bringing ART to the science of technology.

GROSS: I wonder if there are any lessons you learned about what worked and didn’t work in the corporate lifestyle at Apple that you’ve applied to your current companies, NeXT and Pixar.

JOBS: Apple was a very bottoms-up company when it came to a lot of its great ideas. And we hired, you know, truly great people and gave them the room to do great work. A lot of companies – I know it sounds crazy – but a lot of companies don’t do that. They hire people to tell them what to do. We hired people to tell us what to do. And that led to a very different corporate culture, and one that’s really much more collegial than hierarchical.

GROSS: What do you think the state of the computer would be if it weren’t for Apple? This is a chance, I guess, for a really self-serving answer. But, I mean, I’m really curious what you think.

JOBS: I think our major contribution was in bringing a liberal arts point of view to the use of computers. If you really look at the ease of use of the Macintosh, the driving motivation behind that was to bring not only ease of use to people – so that many, many more people could use computers for nontraditional things at that time – but it was to bring, you know, beautiful fonts and typography to people, it was to bring graphics to people, not for, you know, plotting laminar flow calculations, but so that they could see beautiful, you know, photographs, or pictures, or artwork, et cetera, to help them communicate what they were doing potentially.

Our goal was to bring a liberal arts perspective and a liberal arts audience to what had traditionally been, you know, a very geeky technology and a very geeky audience.


Now I keep thinking: What If Steve Jobs was in healthcare? He would have taken Health 2.0 ideas, blended them with the best innovators and added a high level of ART and user design. It would have conjured up something we probably haven’t seen – YET, like —

1. Easy ways for patients to enter stories into the health record (written, audio, video).
2. New built environments (UNwaiting rooms) that SHOW people patient-facing health technology.
3. Full sharing of the electronic record – on any device, anywhere.
4. Specialist visits on the T.V. (or device du jour) for self-care, triage and treatment.
5. Incentives (lower premiums) just for using health technology, including peer support.
6. Getting tailored information, like where to find care virtual/in-person and cheapest medications.
7. New community places…where health, work, education, energy & financial support ALL converge.

Double Sigh. I definitely think an Apple a Day would have kept the doctor at bay.

Dear ONC: Nothing about me without my input. Design with me.

The Office of the National Coordinator has asked for input as they develop strategies to “Empower Consumers to Better Manage Their Health through Health IT”. To kick it off, they are seeking public response to specific objectives, including:

Objective A. Engage consumers in federal health IT policy and programs
Objective B. Accelerate consumer access to electronic health information
Objective C. Foster innovation in consumer health IT
Objective D. Drive consumer-provider electronic communications

These are a great start. To get to truly meaningful, ONC should use its position to get to truly transformational. The aim of electronic records in every clinic is a must. As the focus now shifts to patients and caregivers, we need thinking that’s way out of the box. This opportunity is unprecedented. With Health 2.0 at our disposal, let’s not look at our electronic records as partly “facing consumers”, let’s figure out how to design our health records and exchanges in the context of patients’ lives. I’ll offer modified objectives.

A. Practice participatory design in federal health IT policy and programs.
Rather than a media campaign to “help consumers understand” HIT policies, stakeholders should gather more information about consumers, and practice participatory policy design. Patients and caregivers want policies that give access to all their information and allow them to contribute to their health record. We need to leverage untapped consumer power to drive policies that make sure we go beyond face-to-face encounters. Healthcare won’t be transformed until we get away from the tyranny of the visit. Here’s our sweet spot: both clinicians and patients want telephone and online care mainstreamed. Yet another example of how consumers are the #1 underutilized member of the team.

B. Ensure consumer access to all health information and ability to input information.
Patients can get access to notes, but rarely do. Electronic access will be ground-breaking (See Open Notes post). Yet we need more than unidirectional pushing information out. We need sea change, where patients and caregivers enter content directly, not have it transcribed by clinicians. Valuable patient-centered data, such as: a picture, a nickname, what clinicians should to know about them, their social support, self-reported use of medications and health risks, and whether they agree or disagree on problems and assessments. Yes, this will alter our notes, but what’s wrong with that? (see next objective) Patients and caregivers can work with HIT stakeholders about how notes should change and where greater accuracy will be gained if people input their own information.

C. Use consumers and other HIT users to transform how we document and deliver care.
Let’s think Blue Sky and use this opportunity to change how we use HIT to interact with patients, how we document interactions and share information. Let me offer an example. I work with internal medicine residents. After a clinical encounter, they “present the case”. I’ve heard the same thing for over 20 years: a 53 year old woman with diabetes and hypertension.…a 79 year old man with heart failure and depression who frequently no-shows and is non-compliant. I often ask “context” and perception questions — Does he live alone? Is there a support network? Does he use the Internet? What does he think he has? Often these questions haven’t been asked. While the resident sees value in these questions, it seems there’s little time to ask so many. Meticulous notes are written, which focus on diagnosis and treatment. Who is the patient? Mostly, our notes ensure proper documentation for coding and billing. We need patient-entered information that increases our knowledge and builds trust that’s so critical to outcomes. We need to re-structure our notes to gain meaning for everyone – clinician and patient. (who reads the social history, anyway?)

D. Get all the right people on the bus to tackle consumer engagement.
We have lots of work to do here, and focus on people and behavior. It’s easy to think about cool tools and widgets to “get patients more engaged”. We need to work with non-IT folk, like anthropologists and behavioral and social scientists, to crack this nut. There’s great science on how to engage people (see post on bringing behavioral scientists into HIT development and adoption). Make it fit into people’s beliefs. Provide things people want. Meet people where they are. Make sure shared decision-making really means people participate. Importantly, don’t believe people “will get engaged” if they just take advantage of HIT. Finally, let’s go outside medicine and healthcare. We have parallel consumer-engagement-and-information grid development happening in energy and sustainability. I posted about this recently. These worlds should collide and conquer together. I’m sure there’s other parallel intelligences happening.

E. Drive the provision of services with greatest consumer value, while mitigating disparities in care.
ONC Objective D. identifies secure email and telemonitoring as serving to engage consumers in their care. Slam dunk. These tools have been shown to improve satisfaction and health outcomes. While systems should support clinician participation, we should think more about how we can drive consumer demand which in turn can drive the use of services. Above all, our policies need first to support (see A) offering these services. Our educational programs must ensure clinical staff understand appropriate use of these tools. Our marketing programs must learn about value to the consumer then increase awareness. Our built environments must be modified so all patients and caregivers can learn about consumer HIT and use it to their advantage. Our researchers must prove we’re not creating more disparities as some but not all patients access these services. And we must put great innovators in our communities so that these likely disparities are minimized because point-of-care provides services of comparable quality.

Thanks, ONC, for asking. Let’s make sure the consumers are co-piloting the ship as well as helping pick the destination.

Imagine John Lennon as a Health 2.0 User

Just back from the biggest and best Health 2.0 conference in San Francisco. My brain’s on overdrive from all the demos and presentations. I’d like to wave a magic wand, and *POOF* everything would be mainstream in healthcare. Sigh.

I’m ready for the future now, although am nostalgic today. It’s John Lennon’s birthday. He would be 70. A child of the 60’s, I like to imagine the world with more music about peace, and well, more peace.

You say you want a Health 2.0 revolution? What would Lennon think if he watched the emergence of Health 2.0?

Come together (the title of this artwork), he would say. Get people and experts and all the health information connected. He’d also say: find Health 2.0’s soul. Make it personal, make it emotional, make it about peoples’ lives and what they care about.

Find Health 2.0’s soul, Lennon would say. Experts and information that’s personal and emotional, about what people care about..

Of all I heard in San Francisco, these were the messages that struck a chord for me. As one speaker said, “when we crack the consumer engagement piece, we’ll get somewhere”. Here are some bright spots that made emotional connections with me – and are likely to help drive engagement…

The winner of the engagement contest didn’t compete in the Health 2.0 Developer Challenge. Regina Holliday, a fabulous artist and advocate for record access, proves the importance of emotional connections. She was in the back of the room for 2 days, painting. Her prior painting tells the stirring story of her husband’s illness and challenges of getting their health information. I’d like to get her in front of every person who works at the VA and share that story.

The session Behavior Change, Health 2.0 & The Unmentionables was excellent, striking that emotional chord. Alexandra Drane of Eliza talked about how it’s not about technology or information, it’s about issues important to people’s lives. Speaking of key issues, Qpid.me wants confidential sharing of test results – STD and HIV – at really key, real-time moments.

I loved hearing about Jeff Livingston, an OB/Gyn using social networking to PULL teens and young women in for sensitive conversations about their health and care. There is a lovely paradox I’ve written about before, where electronic communication can be more personal and sensitive for the patient. I expect to great stuff coming from MIT’s New Media Medicine lab. Their CollaboRhythm project has dynamic and appealing interfaces for connecting patients and providers.

Come together. Make an emotional connection, related to my life. Mainstream. Imagine.