Ok…well, not by itself.  But follow with me for just a couple of minutes…

I attended an excellent briefing on Capitol Hill yesterday sponsored by the Institute for Alternative Futures in Conjunction with the Congressional Hispanic Caucus. The briefing, “The Health Disparities Collaboratives: Enhancing Quality and Reducing Disparities,” is part of the IAF’s Disparity Reducing Advances project, in which I have been involved for a few years.

Two of the central messages from all the excellent presenters (David Stevens, MD, Director, Quality Center, National Association of Community Health Centers; Paloma Hernandez, CEO, Urban Health Plan; Roland Gardner, CEO, Beaufort, Jasper, Hampton Comprehensive Health Services) were (not surprisingly):

1. Targeted patient education that is tailored to the community’s needs and supported in a variety of ways and is designed to engage and empower people to manage their own health (basically information therapy or Ix) is critically important to successful health care interventions in underserved populations.
2. No matter what these excellent CHCs do to improve health care services, these populations will continue to experience disparities because of the underlying poverty of their communities.

That got me thinking…  If those interventions described (in #1 above) have been shown to have an enormous impact on the health of these populations, maybe Ix and related initiatives can be applied to a wide variety of challenges that underserved populations face — to help with education, employment, and ultimately, poverty itself.

Sometimes I need to be kept in check that Ix is not a panacea for health care (and I am well aware that it is part of a panoply of tactics needed to redesign health care delivery), but perhaps sometimes I also need to think bigger. Where are the opportunities to extend the principles, research and insights we have gained from years of Ix advancement to improve society more broadly?

I’m sure there are many examples out there, so please let me know where you see them.

It’s far too early to predict what will happen in the 2009 health care reform debate but as has been pointed on blogs ranging from The Health Care Blog to the Wall Street Journal (both its Health Blog and its Politics channel), there are some signs that the process and strategy will be somewhat different than what transpired 1993-4.

Just to name a few… It appears that the effort will be led by former Senate Majority Leader Tom Daschle. The president-elect has an email distribution list of more than 10 million activists. The country is even more aware of how it suffers from a costly delivery system (not to mention other problems). And a substantially greater portion of the employed population cannot get or cannot afford health insurance through their employers.

From the perspective of advancing the practice and science of information therapy (Ix), one of the major questions is what types of standards, oversight bodies, or other infrastructure will be built into proposed health care reform that could help drive an expectation of Ix delivery into the care delivery process?

Among the possibilities now being discussed is what Daschle, in his book “Critical: What We Can Do About the Health Care Crisis,” called a “Health Fed.”Modeled after the Federal Reserve that manages monetary policy and (at least theoretically) provides an infrastructure for stable financial services markets, Daschle hopes that a Health Fed can take some of the critical infrastructure development out of the politically charged environment in Congress.

Given the problems that a lack of Ix leads to (discussed on this blog numerous times–including everything from higher costs to greater mortality), there may be an opportunity to build Ix delivery into the expectations for how effective care is delivered in the future. Perhaps a Health Fed is a mechanism for embedding that expectation into care delivery.

In the near future, I’ll blog more about the range of issues it makes sense for a future Health Fed to tackle.

Our IxAction Alliance focused our monthly IxInsights webinar today on the synergies between Health 2.0 and information therapy (Ix). This marks the first of a series of activities for the IxCenter on the H20-Ix intersection as we gear up for next spring’s “Health 2.0 Meets Ix” conference in Boston (April 22-23, 2009).

In today’s webinar, Indu Subaiya, Matthew Holt, and I provided some context for the exploration of the intersection of these two movements. We focused on several key tensions and challenges including:

• Building Health 2.0 into the delivery system
• Trust, personalization & participatory medicine
• What is the future role of the doctor?
• Info-mediaries: Human & automated navigation
• Knowledge creation: expert vs. wiki
• User-generated health care

We heard from five different innovative companies that have created Ix-oriented Health 2.0 applications.

• Enhanced Medical Decisions
• Krames
• Healthwise
• Silverlink
• bWell Informed

As we move forward, we’re going to tackle a variety of questions, such as:

• What are the biggest needs in health care that Ix and Health 2.0 could solve?
• What are the “home runs” at the intersection of Ix and Health 2.0?
• What are the most important issues, tools and technologies that we should cover at our April conference?

This is a great time to help shape our agenda. What do you think?

A good study appeared in the October 30, 2008 New England Journal of Medicine related to the first public release of HCAHPS data. HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is a “standardized survey of the experiences of adult inpatients with hospital care and services.” This study is based on July 2006-June 2007 voluntary reporting, but Medicare (CMS) is requiring hospital reporting going forward.

Overall experience data are not surprising: Reasonably satisfied but plenty of room for improvement. Although 89% of patients rated their overall experience 7 or better (10 being the best), only 63% rated it a 9 or 10.

What was most informative was where the data suggested were the greatest areas for improvement:

• Provision of clear discharge instructions
• Communication about medications
• Nursing care
• Pain control

I could make an argument that good information therapy (Ix) that was integrated into systems of care would improve performance in all four of these areas. Clearly, though, the first two areas for improvement are obvious targets for Ix interventions.

Hospitals that want to score better in how they provide discharge instructions and communicate about medications should be working hard now to embed Ix strategies into their core care delivery practices. With public reporting of HCAHPS data just around the corner, this could become an important strategic initiative for hospitals in competitive markets.

Just a few days into the “administration” of President-Elect Barack Obama, the direction and plausibility of health care reform are already undergoing great debate. I’ve seen ads on TV, debates on the Web, op-ed pieces in major newspapers, and Sunday morning talking heads already debating the possibility of health reform.

What I’ve been saying since it became clear that an Obama presidency was a distinct possibility is that his administration could fundamentally change how legislation is debated in Congress. It’s not just that Obama is a unique leader. It’s also that he better understands the tools at his disposal in 21st-century America than most wonks in Washington.

There is a great line paraphrasing Howard Dean’s 2004 campaign strategist Joe Trippi in a page 2 article in today’s Washington Post that articulates some of my thinking, “Just as John F. Kennedy mastered television as a medium for taking his message to the public, Obama is poised to transform the art of political communication once again.”

Obama has 10 million email addresses of activist supporters, more than 3 million of whom made financial contributions to his presidential campaign. Before he even had his White House chief of staff in place, he had launched www.change.gov, in order to ensure that no momentum from the campaign is lost in the transition.

Cynics and long-time Washington insiders remain skeptical that health care reform is possible or that this year will be any different than the fights they have seen over it in 1993-94 (or earlier). There is no doubt that the sinking economy and exploding national debt only make the mountain to climb steeper and higher.

But bringing the 2.0 tools that Obama deployed to run one of the most strategic, disciplined and effective presidential campaigns in history to the act of governing gives his administration a legitimate chance…. Probably better odds than he was given just 12 months ago to become president.