Two days into my vacation, my 4 1/2-year-old wakes up with some wheezing. As I wrote in April, his first asthma event was a shock to us but because it came during one of the worst pollen seasons in recent memory this spring and he had no symptoms since that initial course of treatment, it had settled deep in the back of our minds.

We were a few hundred miles from home (where Ryan’s nebulizer was) and couldn’t figure out what to do, so we called our pediatrician on-call that Sunday morning. She advised us to seek care before beginning the second leg of our vacation journey (another 6-hour drive).

I spent a couple of hours reading books to Ryan at the nearest urgent-care clinic. The facility and clinicians were fine, but did not provide clear explanations and–although I did leave the office with a written after-visit summary–it was completely disconnected from my previous care experience.

I desperately wanted access to a personal health record (PHR)–some tool that would allow me to connect Ryan’s past asthma encounter with the current event. I knew that the medications were different, but was unclear as to the rationale.

• Why is he getting just one inhaled medication (the albuterol for short-term relief) instead of two (no Pulmicort or other inhaled corticosteroid for long-term control)?
• Why did they prescribe an oral steroid this time instead?
• How necessary is the prescribed antibiotic since he only seemed to have a cold (in fact, we decided not to fill that prescription and it turned out he clearly didn’t need it)?
• Perhaps most importantly, how do we monitor his progress and know how often to give him the inhaled meds?

Ryan seems to be doing fine now, but we clearly need to set up more of an asthma care plan to be prepared if/when something else triggers another respiratory reaction. I hope I can find the right tools to help me and his mom manage this condition in the long term.

I was on a panel today at the Chronic Care & Prevention Congress put on by the World Congress. The session’s title was “Innovative Technologies Showcasing Results in the Management of Chronic Care Shaping Future Policy to Drive Innovations in Healthcare.”

The lead presenter for our panel was the always insightful Joe Coughlin, PhD, of the MIT Age Lab. Joe has a lot of thoughtful and out-of-the-box things to say, but I think they boil down to the basic message that people designing health care behavior change interventions need to “meet people where they are” (my words) and they need to be “fun” (Joe’s words).

I particularly liked Joe’s closing slide on the disconnect between chronic care management today and consumers’ values (particularly the values of baby boomer women–who Joe says make on the order of 90% of the health care decisions in the US…that seems a little bit high to me, but his point is well taken). I think I’ve gotten most of this right–if I’ve mistaken anything, I hope Joe can correct me. The today is first and the consumer values are second in each dichotomy below.

• Data intensive vs. Useful knowledge
• Empower physicians vs. Empower consumers
• Trust authority vs. Trust experience
• Populations based vs. Personalized services
• Physician-patient-centric vs. Social networks
• Hospital & home focus vs. Ubiquitous
• Deliberate speed vs. Internet time
• Disease & illness care vs. Proactive vitality (wellness)

I fundamentally agree with Joe on his insights, although–as with many things–the current state of the chronic care management world has probably begun to move away from the left side a little bit already. What will be interesting to see is how many progressive provider organizations and other health care institutions proactively move toward the right side of these dichotomies. If not, consumers likely will eventually get fed up with providers and turn elsewhere (e.g., the Internet, Wal-Mart, Health 2.0 companies, etc.) to get what they need.