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.

At the 7th Annual Ix Conference, “Next-Generation Patient-Centered Care,” we are having a track on the second day about The Role of Ix in Enabling the Patient-Centered Medical Home. We’ll have quite varied perspectives on the topic, ranging from the American College of Physicians to innovative implementers.

One of the big questions that will be addressed by Kaiser Permanente physician David Sobel (a guru for decades in health education and engaging consumers in managing their own care) is, “Who’s the PCP in the patient-centered medical home?” and “whose home is it anyway?” Here’s the abstract for his session:

Who’s the PCP in the Patient-Centered Medical Home?
David Sobel, MD, MPH

Whose home is it anyway? And is anyone home? A true patient-centered approach recognizes the patient as the true primary care provider and the true medical home needs to be designed and built with patient involvement. What are the basic structural requirements for a patient-centered medical home to serve patient’s need for information, care, and psychological support? How can emerging technologies allow for remodeling of the home? And how can subcontractors (i.e., health professionals) be managed and retrained to allow for co-habitation and true partnership? What skills do home-owners need? Finally, even if the financing and incentive issues could be solved (e.g. in a prepaid group practice), what walls still exist to co-ownership of the medical home and how can these walls be remodeled?

David always taks a thoughtful and provocative approach, and I think it will be a good way to frame the debate.

Other faculty for this track include:

• Rushika Fernandopulle, MD, MPP, Co-Founder, Renaissance Health (Track Chair)
• Michael Barr, MD, MBA, Vice President, Practice Advocacy & Improvement, American College of Physicians
• Ted Eytan, MD, MS, MPH, Medical Director, Health Informatics and Web Services, Group Health Cooperative
• Kerry Meyer, PhD, ARNP, RN, Care Manager, Valley Medical Center, who will be presenting with one Valley’s patients

If you’re interested in seeing what the real opportunities are for patient-centered medical homes, come to the conference next week (June 12-13) at the Newseum in Washington, DC.

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.

This month’s issue of Mayo Clinic Proceedings has two interesting studies and an insightful editorial (”Medication Literacy Is a 2-Way Street”) that highlight why information therapy (Ix) is so valuable at the end of a hospital stay.

Kripalani et al found that, for patients with limited literacy skills discharged for acute coronary syndrome, 22% had not filled their prescriptions and 21% had difficulty understanding the purpose of the drugs prescribed to them. Maniaci et al studied well-educated patients discharged from an internal medicine hospital ward with at least one new medication prescribed. This study found that, 1-2 weeks post-discharge, 14% were unaware of being given a new medicine. Much worse were the percentages of patients that could recall the name (64%), dosage (56%) or purpose (64%) of the drugs.

It’s clear that providers are not doing an adequate job of ensuring that patients are leaving the hospital with the information they need to manage their recovery effectively. But it’s largely not due clinician error; rather, it’s that little has been done to integrate that information transfer into the care delivery process–especially at critical moments in care such as the discharge process.

That’s why Ix is so critical to ensuring that discharged patients can recover to better health and reduce the chances of being readmitted. Innovative Ix leaders from around the country will be sharing best practices on how to change care delivery to meet patients’ information needs at the 7th Annual Conference. Please join us June 12-13 in Washington, DC to get engaged in this critical element of patient-centered care delivery redesign.

An Associated Press story published today highlights a new CMS (the federal government agency that administers Medicare and Medicaid) advertising campaign to improve quality and transparency for US hospitals. This marks the first year that CMS has publicly released HCAHPS data on hospital patients’ experience with care.

The HCAHPS (Hospital Consumer Assessment of Health Providers and Systems) survey may begin to build a business case for hospitals to focus more intently on delivering more patient-centered care and information therapy (Ix). NCQA’s (National Committee for Quality Assurance) HEDIS public reporting efforts have dramatically improved health plan performance on a range of quality indicators, and CMS is optimistic that its Hospital Compare tool can do the same for hospitals.

Several HCAHPS questions have the potential to drive Ix and patient-centered HIT initiatives in the inpatient setting. Most notably:

• How often did nurses explain things in a way you could understand? (Q3)
• How often did doctors explain things in a way you could understand? (Q7)
• Before giving you medicine, how often did hospital staff tell you what the medicine was for? (Q16)
• Before giving you medicine, how often did hospital staff describe possible side effects in a way you could understand? (Q17)
• Did you get information in writing about what symptoms or health problems to look out for after you left the hospital? (Q20)

There are other important market drivers of inpatient Ix. JCAHO has existing standards that reinforce the need for Ix, and hospitals have reported to the IxCenter that JCAHO reviewers have been more strongly emphasizing the need to document Ix delivery. Specifically, the Comprehensive Accreditation Manual for Hospitals (CAMH) includes 12 references to atient education as services that JCAHO expects hospitals to instruct patients on during their hospital stay. Among the most relevant patient education items in JCAHO are:

• LD.3.15 – patients admitted to a temporary location must have rights and access to services
• LD.3.120 – leaders plan and support patient education
• PC.6.10 – patient receives education and training specific to patient’s needs
• PC.6.30 – patient receives education and training specific to patient’s abilities

The issue of “aligning incentives” and creating market rewards for Ix is one of the topics that we will be addressing June 12-13 at the 7th Annual Ix Conference, “WIxRED: Next-Generation Patient-Centered Care” at the Newseum in Washington, DC.

We have added a new session to the Ix & Health Disparities Track at the 7th Annual Ix Conference, “WIxRED: Next-Generation Patient-Centered Care.

In collaboration with the U.S. Department of Health & Human Services (HHS), we will hold a session titled, “Ix Initiatives to Overcome Health Disparities: Strategic Planning and Implementation in the Public & Private Sectors.” Three HHS leaders–Chuck Friedman, PhD, Deputy National Coordinator for HIT, Linda Harris, PhD, from the Office of Disease Prevention & Health Promotion, and Ahmed Calvo, MD, MPH, Chief Medical Officer for the Health Disparities Collaborative at HRSA (Health Resources & Services Administration)–are combining with a private sector perspective, Elisa Stomski, MPH, Clinical Research Manager at WellPoint/Anthem Blue Cross.

HHS and stakeholders around the country are building an ambitious agenda for the country to use health communication and HIT to overcome health disparities and improve health and health care delivery for everyone. This session will highlight the process by which HHS is incorporating health communication and HIT into Healthy People 2020. HHS will also report on implementation of related “expanded care model” strategies being deployed at community health centers across the country. For a private sector perspective, WellPoint will share its experience in health improvement outreach to a diverse range of Latino populations.

This will be at the of one of two tracks on the second day that will lead us into some working lunches to develop new learning collaboratives and/or special interest groups for moving Ix initiatives forward.

I will be doing a considerable amount of my blogging about information therapy (Ix) at the now-live Patient Centered Health Information Technology (PCHIT) blog. The Center for Information Therapy’s (IxCenter’s) new PCHIT Initiative will have an active learning community of clinicians hosted by me and Ted Eytan, MD, the IxCenter’s Senior Visiting Fellow, who is currently on sabbatical from Group Health Cooperative in Seattle, where he serves as Medical Director for Health Informatics & Web Services.

–Josh

A colleague out in Seattle posted a great story, Information Therapy on the Go, about his experience in despensing information therapy (Ix) in taxis. The end of his post raised some questions: What is an information therapist? Who can be an information therapist? How can we train people to be information therapists in order to meet the great need that’s out there for them?

I, too, get asked to prescribe Ix to family, friends and randome people with considerable frequency (and I’m more than happy to help if I can). Even though I’m not a physician like Ted, as my at-the-time, 3-year-old Ben said, I am a “question doctor,” perhaps a colloquial version of information therapist.

The colleague I mention above is Ted Eytan, MD (Medical Director, Health Informatics & Web Services, Group Health Cooperative), who is on his way to Washington next week for a sabbatical. He’ll be spending quite a bit of his time serving as a Visiting Senior Fellow here at the Center for Information Therapy (IxCenter), and we’re thrilled to have him working with us more closely. Since he’s been one of the greatest Ix champions in the country, we’ve been working with him ad hoc since the birth of the IxCenter six years ago, but having a greater mindshare is going to be a fantastic opportunity for the IxCenter.

Stay tuned for much more on this in the near future…

–Josh

Will the biggest disruption in health care be an Internet-based health care industry? We already know that more consumers get answers to their health care questions on a daily basis from the Internet than from their doctors. But do we think that online tools will evolve enough to allow consumers to organize and make sense of that information without trained professionals?

Will the trend toward “convenience care” (pharmacy- or mall-based walk-in clinics) have the greatest impact on how providers organize care delivery? Will they need to re-think the way they practice medicine to meet new consumer expectations?

Maybe CMS’s requirement that hospitals begin publicly reporting patient experience data in 2008 will forever change how hospital view patient-centered care. Will hospitals finally find that being truly patient-centered has a business ROI?

Will consumer control over their own health information via personal health records (PHRs) alter the historical information asymmetry and allow them to control their own health care lives? What needs to be done to make sure that PHRs actually fulfill their potential as a disruptive force given that personal health data availability by itself will have a marginal impact?

Will the evolution of electronic health records (EHRs) and a robust interoperable health information exchange dramatically change health care by increasing connectivity among systems, providers, and others? Or, will we just create a process for transferring 1’s and 0’s on top of poor models of health care delivery?

Will the boom in biomonitoring/wireless devices (the so-called “healthcare unbound” space) revolutionize health care by allowing consumers to access the health care they need anytime, anywhere, and any way they want it?

Maybe the answer lies in more ubiquitous technologies. Could expanded use of cell phones and the application of tailored automated telephony allow us to reach a broader audience more conveniently, thus increasing the likelihood that average consumers will be more activated about their health care needs?

Can we more effectively engage consumers in better managing their own health by learning from Hollywood or video games about how to draw people in through entertainment? By doing so, can we make health care “fun” or at least truly engaging?

Can we find new payment structures to eliminate the perverse incentives that plague our current health care delivery system? Or, will people find ways to game any new system we design…or will entrenched interests simply prevent new systems from coming into fruition?

Is there any hope at all for finding a way to cover the growing number of uninsured in the country given the politically changed environment in Washington?

What is the role of information therapy (Ix) in each of these potentially disruptive forces?

Which of these developments will have the biggest impact on health care? Beyond that, will any of them actually change a system that has so many challenges and problems?

Many of these questions will be tackled at our upcoming Ix conference October 8-10 in Park City (see http://guest.cvent.com/EVENTS/Info/Agenda.aspx?e=f586de48-3d6e-4064-8543-1c7037b58890 for the full conference agenda). I hope you’ll join us.

–Josh

There was an interesting piece in last Wednesday’s USA Today, “Communication now part of the cure“. They published a Letter to the Editor I wrote (Continue reading “Get an ‘Ix’ with a Rx” ») on July 27 (page 10A). Here’s the text:

Get an ‘Ix’ with a Rx

Joshua Seidman, president - Center for Information Therapy; Bethesda, Md.

USA TODAY’s article “Communication now part of the cure” about the importance of discussions between doctors and patients makes several good points (Life, Wednesday).

Since research shows that 40%-80% of everything a doctor tells a patient in the office is forgotten, taking along a patient advocate is a great strategy. Unfortunately, it is not always an option or sufficient. In order to ensure effective communication, every patient should leave the doctor’s office with an information prescription (Ix). This after-visit summary reinforces what transpired in the clinic and outlines the person’s next steps for self-management and interaction with the delivery system.

Providers that have implemented after-visit summaries — both in print form and available through a secure Web portal — have found that patients love them. The summaries provide something tangible to take home, guidance that is practical, and a bridge to the next visit or to a referral to another clinician.

Non-profit and government organizations such as the Center for Information Therapy, American College of Physicians and National Library of Medicine have been advocating information prescriptions for years.

Next time you go to the doctor, make sure to get an Ix with your Rx.