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.

Certainly one of the best ways we have to assess patient-centered care is to ask consumers about their own experiences via scientific surveys. As I noted last week about Medicare publicly releasing HCAHPS data on patient experiences with hospital care, health care’s powers that be are emphasizing patient-reported data more than ever.

URAC has just released for public comment a new case management patient satisfaction tool, which is an important step forward in driving a patient-centered approach to delivering those services. Much of the tool is good.

Question #7 could be strengthened by drawing out more specific input from patients about the kind of information that helps people manage their care. It asks patients to rate agreement with the statement, “My Nurse/Case Manager provided verbal and/or written information that helped me reach my goals.”

We should have an expectation that case managers employ more than just live, oral communication to help people reach their goals. For that reason, the “or” is inadequate.

In some cases, however, “written” may not be sufficient either, given that it implies text. For some people, graphics, video, or audio may be more effective media. Perhaps most importantly, it should be information that the patient can save and refer to at his or her convenience.

Although the wording may still need work, better language to address patient-centered communication needs would be, “My Nurse/Case Manager provided information in a form that I could understand, access when I needed it, and helped me reach my goals.”

One thing that’s clear from a new study by Jack Fowler in this week’s JAMA is that hospital patients’ experience with care is unrelated to health care expenditures. Given how much we spend on health care in the US, we ought to figure out how to make it positively affect consumers’ experiences.

At our 7th Annual Ix Conference, “Next-Generation Patient-Centered Care,” we will address patient-centered communication and the incentives to encourage it from multiple angles. You can still register for this unique event in Washington, DC June 12-13.

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.

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.

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.

After a long build-up, Google finally launched its personal health record (PHR) for public consumption. There has been great anticipation that Google’s entry into the health care space could be the most disruptive innovation to a delivery system nearing a state of disarray. After all, before Google had invested even one dime in health care, each day more people were going to Google to answer their health questions than were going to a doctor.

The amazing economic and information transformation that Google has achieved in less than a decade coupled with the delays in launching Google Health led to perhaps unrealistic expectations. A quick review of what it has to offer leaves me with several questions…

• (The biggest question) Given that there is nothing in my Google Health profile right now and none of the links to Google’s partners provide any personal health data for me, what benefit is there for me to using Google versus a spreadsheet on my own laptop?
• Will consumers who have experienced auto-populated PHRs (e.g., via providers that have transferred EHR data to a secure patient portal) be interested in starting all over again (even if they can import that data–such as with Cleveland Clinic patients)?
• How big of a challenge will it be for Google to get consumers to trust the corporate behemoth with their personal data?
• Why does a search for “diabetes” in the Google Health search engine generate completely different content for me than looking under “diabetes” in Google’s “Health topics”?

This last question is particularly perplexing to me. Google Health tells me that one of the things it allows me to do is “Review trusted information on diseases and conditions and learn about possible medication interactions and other topics to talk your doctors about.” But I don’t know how they decide what is trusted information and why they direct me to different content depending on which way I decide to enter Google searching.

Part of the aforementioned unrealistic expectations is because health care is more complicated than many other information industries. There’s no doubt the health care delivery system is in dire need of dramatic change and that Google’s sheer power as an information broker has tremendous potential to shape any field that is so dependent on finding good information. I hope this is just the beginning.

At the 7th Annual Information Therapy (Ix) Conference, “WIxRED: Next-Generation Patient-Centered Care,” participants will hear from national leaders in implementing much of what Google Health is trying to do: Deliver the right information to the right person at the right time. Take a look at the agenda and register today.

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.

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.

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.

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?