The American College of Cardiology’s Cardiosource Video Network has posted a new four-minute video segment on “Next-Generation Patient Care.” The segment provides an excellent summary of the issues addressed at last week’s 7th Annual Ix Conference.
Today’s iHealthBeat “Features” story offers an external outsider’s perspective on last week’s 7th Annual Information Therapy (Ix) Conference. George Lauer, iHealthBeat Features Editor, reviews several of the conference’s speakers, summarizes new reports released, and discusses the relevance of ideas presented to other health care industry developments.
In response to Susannah Fox’s request/comment on this blog yesterday, I have summarized my opening presentation from last week’s 7th Annual Ix Conference. The slides will be available on our Web site this week. I welcome any comments. Here it is…
Although you may not all have gotten a good view of the front of the building, be sure to check it out at some point…What you would see on the left side of the Newseum is a 74-foot-high marble engraving of the First Amendment.
In part, it reads, “Congress shall make no law … abridging the freedom of speech, or of the press.”
We are here at the Newseum today—because like the founders of this great country—we believe in free access to information for everyone.
The goal of these opening remarks is to draw the connection between information therapy (Ix) and what the 1st amendment represents. There are important implications of the unique nature of the American media for the evolution of
The Internet ushered in a new era of information democratization. Suddenly, information available only to experts in a field became widely accessible to anyone with a way to access the World Wide Web.
Now, the challenge is how to harness that potential. By figuring out how to harness the power of free access to information, we can:
1. Translate information democratization into effective communication
2. Maximize potential of new media to make health care more efficient, more convenient, and more responsive to everybody’s needs
3. Improve decision making and health behaviors.
Many in the audience are familiar with Paul Starr’s Pulitzer Prize-winning book, The Social Transformation of American Medicine, written in 1984. In 2006, Starr created an equally well-researched book, The Creation of the Media: Political Origins of Modern Communications.
Although I’ve studied a fair amount of American history, this book brought into focus for me the unique nature of the First Amendment and the evolution of American media. I’m going to share with you a number of insights about free access to information in this country that Starr reports, and I’m also going to connect Starr’s insights to broader themes about what’s going on in the
Postal Service: Yes, the Pony Express were not only trailblazers of the Wild West. They were trailblazers in what other countries might have viewed as so democratic as to be nearly subversive. Indeed,
Can you guess what technology and what decade these quotes refer to?
Although we despair at the challenges we face in overcoming barriers to connect health care actors electronically, all of the technologies that have been implemented have had to overcome interoperability problems. There was no standard for motion pictures a century ago, but we were able to overcome them because of the great value they ultimately provided.
Why did movies take off in the
Think about the
The US Census provides some important lessons too. Information democratization in the
Like linking health information to the best available evidence, we might call our approach to the Census a little of EBG—Evidence-Based Government.
When we step back and look at all the innovations and revolutions in information and communication, it really is remarkable.
We also see in the way that European and American newspapers looked 1 or 2 centuries ago. When European newspapers were focused on literary essays, their American counterparts much more actively were reporting the news. Not only did Europeans do less information gathering, it was actually a novel concept when American journalists invented the interview—yes, let’s actually go ask people what they think.
So, what parallels can we draw between the creation of the American media and US health care?
First, think about how information democratization highlights that “knowledge is power.” Look at how that parallels the history of medicine. That fear of knowledge equaling power has caused ruling elites to keep knowledge secret and limit discussion. At a previous Ix conference, IxCenter Board Chair Paul Wallace summarized 1000 years of history of medical education. A millennium ago, the professor just stood up at the front of the room and lectured didactically at medical students. After five centuries, Gutenberg invented the printing press and suddenly the students had access to the medical textbook too. This was a revolutionary democratization and shift of power that medical students could actually find the answers themselves. Of course, it took another half a millennium for consumers to have access to the information.
Second, consumer empowerment. Starr writes, “Old ideas about who should know what no longer made sense,” and “Popular sovereignty implied a change in the cognitive relationship between the state and the people.”
The third parallel to health care was that 3: American newspapers were something of a “Press 2.0.” In the American Revolution, colonial newspapers were not only reporting protests and not only editorializing and championing the cause of the revolution. Colonial newspapers also provided a forum for discussion. In one sense, they turned disorder into a more coherent opposition movement. It was perhaps the first communication medium that demonstrated the power of social networks.
Finally, some are waiting for widespread adoption of technologies by the powers that be in health care. What we know from the history of American media: Everybody will eventually adopt a new medium if powerful. As Starr wrote, “…in the antagonistic expansion of a medium, even reluctant side has no choice but to adapt more powerful means of expression.”
So what does this mean for us today? The democratization of information is a great American opportunity for health care system redesign. …But there are also potential dangers. We need to figure out how to harness the power.
Harnessing the power of information democratization requires us to identify the challenges and finding an appropriate solution…
If we can figure out how to do these three things, we have a great opportunity to create real improvement in health care delivery…
So when you leave the Newseum tonight, take a look up and ponder what the First Amendment means for American health care.
Over the next several days, I’ll share insights generated from our 7th Annual Information Therapy (Ix) Conference, “WIxRED: Next-Generation Patient-Centered Care.” You can also check back on our site later in the week to see all the PowerPoint presentations. In the interim, you might want to check out what others are saying about it.
Susannah Fox from the Pew Internet & American Life Project put together a nice summary of her favorite moments at e-patients.net. Matthew Holt and Jen McCabe Gorman had a number of reports on June 12 and 13 at The Health Care Blog.
At the conference on June 12, Rachel Block, Executive Director of the New York eHealth Collaborative, provided an overview of findings from the Patient-Centered HIT Initiative. The day before, the California HealthCare Foundation, released their report on PCHIT that I authored with Ted Eytan titled, “Helping Patients Plug In: Lessons in the Adoption of Online Consumer Tools.”
There’s more to our decision to hold the 7th Annual Ix Conference (”WIxRED: Next-Generation Patient-Centered Care”) at the Newseum than its striking architecture, fabulous exhibits, and the media buzz (for example, in the New York Times and Washington Post) surrounding its recent opening.
The Newseum, an interactive museum of news celebrating the First Amendment, is dedicated to free access to information–a central theme to the information therapy (Ix) movement.
The unique nature of America’s commitment to the democratization of information became clear to me from reading Paul Starr’s excellent book, The Creation of the Media: Political Origins of Modern Communications. Starr’s thorough history of the evolution of the media in the United States and Europe demonstrates that it is no accident that the revolutionary idea of a constitutional right to a free press emanated in the U.S.
When I open the Ix conference next month, I’ll briefly describe some of the insights gained from Starr’s research, not only to connect Ix to the venue of our event. There are important implications of these findings for how we reform U.S. health care delivery. There also are several relevant parallels between the evolution of the American media and the trajectory of our future health care system.
The democratization of information offers the U.S. health care system a great American opportunity, but there are also potential perils if we do not maximize its potential. I hope you’ll join me and many innovative health care leaders for a rich agenda that will explore how we chart a reformed health care delivery system.
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:
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.
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
Although the New York Times took a pass on my letter in response to a Jane Brody column January 30 (http://www.nytimes.com/2007/01/30/health/30brody.html?ex=1170910800&en=c1237335b6037a06&ei=5070), I thought others might be interested…
To complement the expert suggestions in “The Importance of Knowing What the Doctor Is Talking About” (January 30, 2007), keep in mind that most people are “patients” in the traditional clinical environment far less than 1% of any year’s 8,760 hours.
Therefore, we should maximize the value of that in-person clinical encounter with information targeted to the individual’s moment in care and tailored to their individual needs.
More specifically, a “visit prep” information prescription preceding every encounter will better prepare both patient and clinician for their 15 minutes (give or take) together. Also, research that tells us that patients forget 50% to 80% of everything a doctor says by the time they get home, so an after-visit summary reinforces key issues they discussed.
Implementing these two strategies brings us closer to the Institute of Medicine’s first recommendation from its landmark “Crossing the Quality Chasm” report for care based on “continuous healing relationships.”
–Josh
With Revolution Health launching its new consumer portal, a newspaper reporter called me earlier this week to ask what I thought about new efforts such as this….
It’s clear to me that—even though they generally don’t express it this way—consumers are clamoring for information therapy (Ix). And just to be clear, Ix is not simply a shorthand for health information. Ix involves delivering information targeted to a person’s specific moment in care and tailored to the individual’s particular needs.
A wide variety of consumer research makes it clear that consumers are hungry for health information. For example, Susannah Fox from the Pew Internet & American Life Project (www.pewinternet.org) has previously described a “Dr. Google phenomenon” in that, in a typical day, more people go online to get health information than visit doctors to get answers to their health questions.
I fully support the democratization of information ushered in by the Internet and other forces, but I also realize that it’s not fulfilling the needs of many consumers. Most consumers aren’t interested in generic health information. They want answers to specific questions at a particular moment in care that relate to people in their specific circumstances.
To date, the Internet hasn’t delivered that. It’s akin to having a garden with plants, flowers and vegetables that need varying amounts of water and the weather gods delivering a monsoon.
Part of the reason that the term “information therapy” has value is because of the corollaries between it and medication therapy. Information overload can result in an “overdose.” Consumers reading the wrong information can experience negative “side effects.” The right kind and amount of information depends on the specific individual, which means that we often need to “titrate the dosage,” much the same way doctors might adjust the dose of warfarin (Coumadin) for patients with atrial fibrillation (an irregular heartbeat).
Going online for health information generally involves (at least) four challenges. First, can you find the information you need? Again, it’s not hard to find information, but it’s another thing to find it highly specific to your need at a particular time. Once you find it, do you understand it? Has it been provided to you in a way that you can make sense of it? Third, there’s the issue of whether you can remember it.
Finally, even if you can find, understand and remember the information you need, you still may need help in contextualizing it for your own situation. That’s why there often is value in having your personal health library as part of bidirectional communication system with your clinician (of multidirectional to the extent that it involves multiple care professionals). With all that in place, then you’re ready to act on the information to improve your health, decision making and healthy behaviors.
The answer I had to give to the reporter is “I don’t know.” It’s far too early to tell whether Revolution or Google Health will create the kind of navigational support that will guide consumers to the Ix they need. At the very least, however, the fact that people with the resources of Steve Case and Google are pouring money into finding answers tells us that there’s a lot of interest in figuring this out.
There’s no doubt that much research remains to better understand what the optimal dose, frequency, and duration of information prescribing is for people in different circumstances. We are beginning to pursue this as part of our Ix research agenda and, when we figure it out, we’ll be sure to let you know.
–Josh
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