Last week, I attended the launch of the World Health Organization (WHO) “Safe Surgery Saves Lives” campaign. It’s an impressive international project that has tremendous potential for reducing surgical errors by the simple inclusion of a checklist into the process of surgical care.

As the initiative’s lead, Harvard surgeon and noted mainstream author Atul Gawande said, the idea is to borrow from the processes adopted by the much safer airline industry. Checklists went a long way in reducing flight errors so long ago that they are now fully ingrained in the process.

The Surgical Safety Checklist is brilliant in its simplicity and in the way it directly addresses many problems that arise with surgery, but I also think there’s a big missed opportunity on WHO’s “first edition” of the checklist. The third column–the “Sign Out” process–doesn’t specify any patient engagement. The closest it comes is, “Surgeon, anaesthesia professional and nurse review the key concerns for recovery and management of this patient.”

My understanding from people involved in the process was that the first stage of the campaign specifically decided to focus on the “intra-operative” aspects of safe surgery to the exclusion of patient participation and education. No doubt there are plenty of errors that can be solved by getting the surgical team all on the same page, but failure to engage patients is a major lost opportunity.

As WHO prepares for its “second edition,” I hope that at the very least, they add an additional box to check on the “Sign Out” column of the checklist that would read, “Patient’family provided an information prescription regarding instructions for post-operative management and what signs should trigger contact with providers or other actions.”

With Consumers Advancing Patient Safety President Susan Sheridan advising WHO, I know that they are getting excellent and passionate guidance about consumers’ information needs. I just hope that they listen to it as they go forward to maximize the potential impact of the Safe Surgery Saves Lives campaign.

This year, for the second time in my life, I had the opportunity to choose between several health insurance providers.  I opted for a provider that has a good reputation for embracing the latest information technology and also being patient-centered.  I chose my doctor online, scheduled an appointment online, and received communication - prior to my initial appointment - online.

Several days before my appointment, as instructed, I went to my assigned one-stop shopping center (a.k.a. medical center) to have my blood drawn.  Later that day, I received my cholesterol levels online (cool!).  The day before the appointment, I received the results of the remaining blood tests.  I don’t know much about white cells and red cells and what is supposed to be high or low, but my results were reported alongside desirable ranges.  At my appointment, my doctor walked me through the blood test results, reviewed my medical history, and asked about my medical concerns. 

The grand finale of my visit was receiving my first “after-visit summary.”  In addition to my vital signs (I could have lived without the inclusion of my alleged weight!), the summary included follow-up instructions for various issues we discussed.  For example, since I am a new patient, the summary tells me where to go in the one-stop shopping center to request the transfer of my previous medical records.

I feel like a kid again, like a child who has just learned a new and exciting skill.  I feel a sense of ownership over this experience because I was able to do things like choose a health plan and view my test results online…all without the “supervision” of an adult!  Obviously, I was happy to have an in-person interaction with a real doctor to explain my test results and address my medical concerns.  I feel like a big kid, though, because I feel I am being treated like a capable and welcome participant in my own health care.  Maybe it’s not really me “growing up,” but the health care system.  Either way, it’s a good thing.

Paul Wallace (now Medical Director for Health & Productivity Programs at Kaiser Permanente and Chair of the IxCenter Board of Directors) closed out the first day of last week’s 7th Annual Ix Conference with some insights on how we can modernize health care effectively.

He noted that he came of age as a physician during what he termed “Health 0.0.” Although much of health care is now being practiced in a “Health 1.0″ mindset as information flows more freely, there is still a long way to go until we’ve reached the Health 2.0 goals of on-demand, 24/7 access to information that can be democratically created.

Paul pointed out that we need to figure out how to hold onto the close in-person relationships from 0.0, and build the information flow from 1.0 as we create the social networks and real-time information access of 2.0. The goal they all have in common is building trust–one of the most important elements in an ideal health care delivery system.

Ideally, the new tools of Health 2.0 will actually help us do a better job of meeting the demands of 0.0 by creating more efficient ways to allow for personalized health care. How can new technologies enhance our ability to take care of people one patient at a time?

Sometimes when I talk about information therapy (Ix), I get a lot of head-nodding, but people still don’t fully understand what Ix really looks like in practice.

That’s why one of the most illuminating sessions at the 7th Annual Ix Conference next week (June 12-13) at the Newseum in Washington, DC will be, “Ix Killer Apps: Patient-Centered HIT in the Real World.

Specific Ix applications to be discussed include after-visit summaries, pre-visit preparation, multimedia decision aids, medication reconciliation, Ix for lab results, and use of health risk assessments for delivering more tailored information prescriptions. Both electronic and paper solutions will be addressed.

We’ll hear from innovative leaders from different kinds of practice settings and opposite sides of the country.

• James Hereford, Executive Vice President, Strategic Services & Quality, Group Health Cooperative
• Bill Kormos, MD, Education Director, John D. Stoeckle Center for Primary Care Innovation, Massachusetts General Hospital

After I provide a five-minute Ix overview, these leading innovators will demonstrate how Ix has been implemented in their disparate delivery settings. They will discuss the strategic reasons for pursuing Ix initiatives, issues involved in implementation, and their impact on care and efficiency.

If practices can implement these tools efficiently, they really will have nailed some “killer apps” by providing tools that really make a difference in the lives of their patients. Join us next week to figure out how to make this happen.

The Office of the National Coordinator for HIT released the long-awaited Federal HIT Strategic Plan yesterday. It has two goals: Patient-focused health care; and population health. Furthermore, the plan explicitly states that the 43 strategies proposed are characterized by three things including, “Focus on the consumer of health care as a critical participant in achieving the two overarching goals of the Strategic Plan.

Chuck Friedman, the Deputy National Coordinator who played an instrumental role in writing the strategic plan, will be discussing its implications for Ix implementation–with a particular emphasis on health disparities–at our 7th Annual Ix Conference next week in the session, “Ix Initiatives to Overcome Health Disparities: Strategic Planning and Implementation in the Public & Private Sectors.”

A few strategies (copied below) are particularly noteworthy. If implemented, they could go a long way to advancing information therapy (Ix), improving health care delivery, and saving our health care system.

• Strategy 1.2.6: Encourage health care organizations to provide personal health information in usable standardized electronic form to consumers or their designees.
  • Consumers are being encouraged to take a more active role in managing their own health care. Interoperable health IT can catalyze patient-focused care by increasing consumers’ (or their designees’) ability to electronically access, accumulate, and manage their personal health information. Greater access to usable, electronic health information in standard formats can yield improvements in health literacy, patient-provider communication, care coordination, and overall quality of care. Strategy 1.2.6 seeks to encourage health care organizations to offer health information to consumers or their designees in standardized electronic form.
• Strategy 1.2.8: Through the identification and recognition of standards, empower individuals to use their health data to serve their needs beyond direct patient care delivery.
  • Medical records play a significant role in many areas of an individual’s life beyond direct patient care. Records are needed for everything from preventing illness, to establishing immunizations for school attendance, to determining the impact of a disabling condition in order to obtain services and benefits. Immediately critical in this arena is the need to enable persons with disabilities to authorize the electronic movement of their medical records to key public and private service providers. This strategy seeks to promote the development and recognition of standards necessary to support this type of interoperability, and to encourage providers to take advantage of the benefits it brings.
• Strategy 1.3.6: Identify key PHR functions and features that will allow individuals to link their health information to a wide variety of market-driven personal health tools that they and their designees find valuable in managing their heath and care.
  • PHRs have low rates of adoption to date for many reasons. While secure websites that enable patients to access their electronic health records are widely used where available, there is considerable confusion about what constitutes a free-standing PHR that is wholly controlled by the patient or consumer. This strategy seeks to define the key elements of a free standing PHR that will support secure maintenance of an individual’s personal health information so that it can link to the myriad of applications being developed in the marketplace to support that individual’s ability to manage his or her own health.
• Strategy 1.3.7: Design methods to promote the use of PHRs and other consumer health IT tools by consumers and their designees.
  • Communicating with consumers about the benefits of PHRs and self management of one’s own health may require new approaches to be effective. This strategy will expand and increase our understanding of how best to use these new technologies to the benefit of individuals interested in better management of their own health and care.
• Strategy 1.3.9: Remove technical, financial, workflow, and other barriers to diagnosing, treating, and communicating with patients outside the boundaries of traditional health care settings.
  • Our provider focused health care system is predicated on patients accessing care in the clinical setting. However, actual care is primarily dependent on decisions made in the home, office, or school setting by the patient – often without the guidance of their clinicians. Adoption and use has been very slow of new technologies that can provide data and enable communication between individuals and their clinicians at the time when it is needed. This strategy will promote adoption by helping the industry to understand the sources of the barriers to adoption and by identifying solutions that promote more widespread use of these technologies.
• Strategy 1.4.2: Empower consumers through representation in multi-stakeholder governance entities at the national, state, and local level.
  • For care delivery to truly be patient-focused, consumers’ interests must be reflected in policies and governance for the exchange of health information nationwide. Consumer participation in national, state, and local governance entities is necessary to enable health IT initiatives that reflect consumer priorities, ensure public trust, and maximize consumer welfare. Strategy 1.4.2 emphasizes the importance of consumer involvement in developing organizational policies and procedures around the exchange of health information, identifying effective methods for engaging consumers, and working to promote consumer involvement in activities nationwide.

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.

There’s been a really passionate and constructive dialog transpiring on The Health Care Blog triggered by Pew Internet health expert Susannah Fox’s post there on “E-patients can and will revolutionize health care.” I have weighed in with a couple of observations connecting what Susannah and many advocates describe as “e-patients” with the goals of information therapy (Ix).

The first post focused on how Ix can facilitate e-patients’ connections with their clinicians:

Peter’s point is important because a reluctance of clinicians (and/or systems to support them) to embrace patients’ use of new technologies often leads to “parallel play” in health care–where people end up pursuing two parallel tracks for tackling their personal health. In fact, Susannah’s Pew research demonstrated that–when told by their physicians to stop going online–most consumers either said they’d either switch doctors or “go underground.” In other words, consumers end up using the Web to address their health care needs but don’t talk about it with their clinicians–a recipe for (at best) inefficient care.

That’s why developing strategies to integrate targeted health information and personal electronic tools into the care delivery process (a.k.a. information therapy or Ix) is so important and has so much potential. That integration of patient-centered care and HIT is the focus of the 7th Annual Ix Conference, “WIxRED: Next-Generation Patient-Centered Care,” (June 12-13 in Washington, DC) where Susannah and other advocates for e-patients will be presenting.

The second post was really to help clarify that Ix is not meant to impede the efforts of e-patients–in fact, it’s just the opposite: Ix tries to help provide a better infrastructure for e-patients to gain support from other resources…

I completely agree with Cheryl that it was imperative for her to take control of her own care. And thank goodness she did! I have heard Cheryl’s personal story before, and she provides a powerful demonstration of the potential for e-patients to change the course of their own lives.

Regarding John’s questions, for some people, online searching works fine. However, many others report that they feel lost in the maze of information spun by the World Wide Web–reporting problems with some combination of: finding the most relevant information for their specific needs; understanding it; remembering it; and/or contextualizing it.

That’s why consumer surveys consistently report that, when asked from where they would most like to get information, consumers’ first choice is their own physicians.

That’s not at all to say that consumers shouldn’t access information on their own; I certainly do it all the time and I think everybody should do so as much as they want. In fact, one of the reasons why we’re holding this year’s Ix conference at the Newseum is because of how fervently we believe in consumers’ free access to information–thus the link to the celebration of the First Amendment.

But most consumers would prefer that their clinicians could support them in that process through: pointing them in the right direction; sifting through questions that arise together; putting into context for their particular situations; etc.

The US Department of Health & Human Services (HHS) is hard at work developing new objectives for Healthy People 2020. This fourth version of objectives (the 1990 objectives were first published in 1979) is being designed like its predecessors to motivate action and improvements in the public’s health.

Healthy People has been holding stakeholder meetings across the country and held one this morning at the National Institutes of Health, where I had hoped to offer oral public comment. Not surprisingly, many others had the same plan and being number 48 on the list rendered it unlikely that I would get a chance to speak, so I have submitted a brief written statement instead. Here it is:

Healthy People 2020’s objectives should recognize that facilitating patient-centered communication through health information technology (HIT) is absolutely essential to health improvement.

Research has clearly demonstrated that effective care management, particularly for people with chronic conditions, requires engaging them effectively as active partners through proactive delivery of targeted information and other health communication strategies. Most notably, the body of research on the Chronic Care Model (CCM) led by Ed Wagner and the subsequent efforts that have built on the CCM framework have made clear how important the integration of HIT and patient-centered health communication is to improving the health of Americans.

Effective empowerment and engagement of lay people in their health care requires that we develop HIT tools focused on the needs of consumers. Specifically, we need to ensure that personal electronic health tools link individuals’ own health data to accurate, comprehensive content that puts that data into context in an understandable and meaningful way.

The evolution of personal HIT tools is evolving so quickly that we probably cannot even envision what the standard tools of 2020 will look like. If we look back 10 years to 1998, how many people could have foreseen how powerful applications such as online social networks and interactive multimedia health education have become?

What we can do is set objectives for the country that guide HIT developers to ensure that new applications meet consumers’ needs for information that is tailored to their particular needs. That is essential to overcome health disparities and improve health and health care for all Americans.

More to come in the near future on the IxCenter engagement around Healthy People 2020, including discussion of it at the 7th Annual Ix Conference by HHS’s Office of the National Coordinator for HIT and Office of Disease Prevention & Health Promotion. In the interim, if you’re interested in offering your insights, go to the Healthy People 2020 Web site and submit your own public comments.

Last week, the California HealthCare Foundation released a new “Snapshot” report titled, “Just Looking: Consumer Use of the Internet to Manage Care.” It’s a great title–not only clever but descriptive of what seems to be going on in California right now.

Although a majority of Californians are using the Internet to search for answers to their health questions, only between 1 in 10 and 1 in 8 are using it to fill a prescription, communicate with a clinician, or make an appointment. Between one quarter and one third of Californians are using the Web to find a physician, assess clinicians, or review benefits or claims information.

These data are hardly a surprise and are very much in keeping with what is going on around the country. Why is the Internet still mostly being used this way?

Certainly, much of it is due to the inadequate connection between consumers’ lives of on the Web and their lives in their doctors’ offices. We know from the Pew Internet Project that–when clinicians ignore consumers’ queries generated by Internet searching–frustrated consumers don’t stop searching, they just keep what they’re doing from their doctors.

The moment in care when a consumer is searching for information is the perfect time to connect him or her to some other health care management resource–whether human or electronic. We need to figure out how to weave those connections into the care delivery process. We also need to figure out that we can make sure that the content they find is understandable, meaningful and actionable to consumers.

That’s part of what makes an information therapy (Ix) “killer app”–which is one of the highlights of the 7th Annual Ix Conference, “WIxRED: Next-Generation Patient-Centered Care.” In the Killer Apps session, James Hereford (EVP of Strategic Services & Quality at Group Health Cooperative in Seattle) and Susan Edgman-Levitan (who runs Mass General’s Stoeckle Center for Primary Care Innovation in Boston) will share both their visions and their experiences with implementing such Ix initiatives in very different real-world settings.

To promote our 7th Annual Ix Conference, “WIxRED: Next-Generation Patient-Centered Care,” we sent out an email to our contacts yesterday with the subject line, “Register for the Ix Conference and Make Your Cat Jealous.”

The first lines in the body of the email were, “Does your cat receive health reminder postcards from your vet? Do you receive more timely health information from your veterinarian than your physician? Join us at the 7th Annual Ix Conference to learn about the latest advances in (human) health care delivery innovation. Your cat will be jealous!”

There may be some debate about whether this statement makes you laugh or makes you cry. For those of us for whom this statement is true (such as myself–as described in a my post “Canine-Centered Care” earlier this year), we better laugh or else we will cry.

The other question that this brings up is the issue of using humor for stimulating consumer engagement. We had presentations about this at the 2007 Ix Conference, when (among other things) we had a Hollywood screenwriter talk about how you connect with average consumers through humor.

The broader issue for those developing Ix interventions: How do we connect with people at an intrinsic level to engage them about their own health care? Is humor the best way to lure people in? If you do, will humor continue to keep them engaged? What are the alternatives to promote “stickiness”?

What gets you and keeps you engaged in your own health care management?