(Continuing to follow up with commentaries on insights from the 7th Annual Ix Conference…and the slides are not only available now, but they also are right-side-up!)

The day before the Ix conference, the California HealthCare Foundation released the report (“Helping Patients Plug In: Lessons in the Adoption of Online Consumer Tools”) that Ted Eytan and I authored summarizing the Patient-Centered HIT Initiative (funded by CHCF, the United Hospital Fund, Kaiser Permanente, and the Group Health Community Foundation). At the conference, Rachel Block–formerly with UHF and now the Executive Director of the New York eHealth Collaborative–provided an excellent overview of the project with a particular emphasis on our experiences with safety-net populations.

Susannah Fox–Associate Director of the Pew Internet Project and also a member of the PCHIT Advisory Group–responded with a presentation highlighting the digital thermometers she has created with Pew data. They provide a great snapshot of consumer use of Internet/email, cell phones and broadband, broken down by a wide range of demographic characteristics. Susannah has explained that access to electronic technologies is not a matter of a “digital divide” because access is not an “on-off switch” but more of a “dimmer switch.”

A few of her comments beyond the thermometers are worthy of considerable thought as we figure out how to maximize the potential of Ix and patient-centered HIT.

• Susannah notes that 80% of Internet health information seekers turned to a professional in a time of crisis–far greater than any other industry that Pew studies.
• It’s clear that low access does not equate with low interest–a finding that matches exactly what the PCHIT Initiative found.
• To better understand the Internet’s potential for health care, it’s critically important that we talk to those people who are not online as well.
• The world is changing rapidly, so it’s important to (as Susannah paraphrased Diana Forsythe) “design for what could be.”

What do all these findings from Pew and the PCHIT Initiative report mean for next-generation patient-centered care?

(Continuing to post on some of the session from our 7th Annual Ix Conference from June 12-13. Note that the PowerPoint presentations are now available. We had a minor glitch in our transfer to PDFs, so you need to rotate them sideways. We’ll get that fixed tomorrow.)

One of the most innovative Ix leaders in the safety-net provider community is Neil Calman, MD, the CEO of the Institute for Family Health (IFH), a network of federally qualified community health centers in New York. He presented in our Ix & Health Disparities Track in a session on “Engaging Safety-Net Providers in HIT” with Kyu Rhee, MD, MPP, Director of Innovation & Program Coordination, NIH Center for Minority Health & Health Disparities. IFH was one of the sites we visited during our Patient-Centered HIT Initiative.

Neil has a direct way of putting things and his presentation probably set a PowerPoint font size record. He started off by telling the audience that, “For the past 6 years we have done everything we could to help bring information to our patients to help them improve their health.”

He then frames this in terms of what it means for the clinicians at IFH: “We have worked really hard to be a model for how electronic health records could be used to help us become…Information Therapists!!”

Neil explained what they learned from their patients when they studied what the health care experience was like for people with chronic conditions in the southwest Bronx. What they found out was that–for many of them–going to the doctor’s office was often “traumatic.” They found two really important things. First, there was great distrust of, and disrespect by, health care providers serving racial an d ethnic minorities. Second, there was bad communication resulting in major misunderstandings.

So when IFH decided to invest $2 million in its EHR deployment, they did it with these two lessons from their patients in mind. Neil said, “We deployed our EHR in a way that would build trust wit our patients. And give them the tools to help them find their way through the health care system.”

That’s why they designed their exam rooms so there were flat-panel monitors that clinicians and patients could look at together and put printers in there so clinicians could print out Ix for their patients and hand it right to them.

It’s amazing what clinicians can do for their patients in EHR implementation if they start by asking them what they need and then bake that into their implementation plans. It’s too bad that’s not a requirement for every EHR deployment in the country.

African American men have the highest incidence and death rates for prostate cancer than any other racial/ethnic group in the US.  How can information therapy (Ix) promote increased health equity in prostate cancer outcomes?  One of the functions of Ix is to deliver relevant health information to consumers where they are – in this case, the barber shop.

Research suggests that community-based education efforts by barbers could increase prostate cancer screenings among African American men.  Barbers were trained on an educational intervention based on the principles of Paulo Freire’s critical pedagogy.  In this ongoing pilot study, barbers ask male clients over the age of 40 if they have been screened for prostate cancer.  Clients who have not been screened are educated about prostate cancer and informed that they are a candidate for screening.

The training resulted in a statistically significant increase in barbers’ knowledge of prostate cancer.  Screening rates are not yet available, but preliminary results from qualitative interviews indicate increased knowledge about prostate cancer in clients.

If you are interested in promoting health equity, join us at the 7^th Annual Ix Conference in Washington, DC on June 11 and 12.  The Ix and Health Disparities track on June 12 will address promising new interventions that have been developed to narrow health disparities.

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.

The Center for Children and Families at the Georgetown Health Policy Institute has just released a series of issue briefs on “Strengthening Medicaid.” I authored one of these papers, “Health Information Technology: Innovative Applications for Medicaid,” which discusses strategies that states can use to improve the quality and efficiency of Medicaid programs. The paper addresses how HIT relates to health disparities, health literacy, and the digital divide.

To see more about these issues, see the robust Ix discussion on the patient-centered health information technology (PCHIT) blog.

Lots of interesting Ix-related stories have been in the media recently, but none more dramatic than the study from the Archives of Internal Medicine that demonstrated a significant relationship between inadequate health literacy and all-cause mortality in seniors. In fact, Baker et al (7/23/07; abstract at http://archinte.ama-assn.org/cgi/content/short/167/14/1503) found that literacy is a more powerful predictor of death than education.

The authors also highlight past research that links inadequate health literacy to less knowledge and worse self-management skills for people with chronic disease.

This research should reinforce the call to action to deliver information to people that is tailored to their individual needs. Although using plain language is one useful strategy, effective tailoring requires multiple tactics–such as understanding individual needs and preferences better, addressing different learning styles, and delivering information through different media (print, electronic, video, audio, phone, etc.).

With the support of the California HealthCare Foundation, the United Hospital Fund, Kaiser Permanente, and the Group Health Community Foundation, IxCenter will launch a Patient-Centered Health Information Technology Initiative later this year. We will be assisting a diverse range of organizations in implementing HIT applications that focus on engaging consumers in care delivery. Although it will surely come up with all sites, particularly in our work with safety-net populations, we anticipate learning a lot about how to overcome health literacy barriers with innovative solutions.

In the interim, I’d love to hear your ideas for delivering tailored information in such situations.

–Josh