Happy New Year!

So much excitement is on the horizon in the new year. Here are five IxCenter priorities for 2009:

• The intersection of information therapy (Ix) and Health 2.0
  • There has never been a conference like the upcoming first-ever “Health 2.0 Meets Ix” Conference in Boston April 22-23!
• More intensive efforts in Ix implementation in safety-net populations
  • New IxAction safety-net providers as well as a few potential new Ix grant projects with underserved populations have great potential to show the reach of Ix initiatives.
• Building the Ix infrastructure in the context of health care reform
  • How do we build on 2008’s Ix private sector infrastructure successes by developing Ix-oriented performance measures and integrating these efforts into the national health care reform debate?
• More detailed exploration of Ix strategies for Rx management
  • What is the role of Ix in improving medication management, reducing medication errors, and streamlining medication selection decisions?
• Deep dives on key Ix applications
  • These may include pre-visit prep, after-visit summaries, prevention reminders, decision aids, and others.

What matters most to you as we work to advance the practice and science of information therapy in 2009?

As most readers of this blog probably have heard, President-Elect Obama’s health care transition team has encouraged people around the country to hold “Health Care Community Discussions” to get health system input and stories from across the nation.

I co-hosted one such event last week for about 10 DC health policy & HIT veterans. I also attended one hosted by the American Occupational Therapy Association (our office space is in their building) that drew a larger (about 25) and more diverse audience.

These two events apparently are among literally thousands of community discussions taking place around the country in the last two weeks of 2008. In addition, at least one organization (Partners’ Center for Connected Health) is hosting an online version of these discussions.

There were many similarities between the two events I attended, with considerable attention paid to misalignment of the system, such as our focus on treating disease rather than maximizing health. Both discussions also included a heavy dose of moral alarm not only at the number of uninsured, but the rationing this country does on the basis of economic status.

Perhaps the most obvious difference between the two was the way that was discussed. Most of the participants in the first event had the means to visit doctors who have (completely or mostly) opted out of the insurance system. It struck us that this was a “reform” (not a particularly positive one) that had already taken place in the marketplace.

In contrast, at the second event, there were multiple stories about people having to get second jobs to pay for their children’s mental health care or families facing the possibility of home foreclosure as health care treatment bills mounted up.

It’s evident that the economic burden of health care costs has already created dramatic differences, not only in health care but ultimately in individuals’ life experiences. I suppose that the only good news is that it may increase the urgency that we apply to rationally reforming the health care delivery system.

I’ve written before (for example, here and here) about the importance and challenges of engaging consumers in learning about their health. Indeed, we often need to come up with creative ways to “meet people where they are.”

This morning, I met Ikenna Okezie, MD, MBA, the founder and president of HealthTank, LLC, a new company whose tag line is “improving outcomes through education.”

Ikenna’s product innovation is that he has developed a strategy for communicating health information through a normal game activity that all kinds of people already play. HealthTank has created playing cards with health education facts to spur better self-care and conversations with clinicians.

They produce The Heart Deck (English & Spanish), the Campus Health Deck, and the Baby Deck, each of which includes 52 discrete health education messages. In the Heart Deck I can now use to play “Go Fish” with my kids, some cards are meant to be purely educational (e.g., “…women who smoke die 14.5 yeas earlier than women who don’t.”) while others (e.g., about “taking an aspirin…”) are trying to stimulate action steps (”…Ask your doctor if aspirin is right for you.”).

Although the health decks may be somewhat limited in how tailored and activation-oriented they can be (although I suppose more tailoring is theoretically possible for those playing online solitaire, poker, etc.), there are some great opportunities. Ikenna identified heart attacks and firefighters as one, and certainly their Campus Health Deck is another excellent example. I can also envision health messaging for teens and pre-teens, for which playing cards (or video games) may be the only way to get their attention on health issues.

We need more innovative approaches to get pertinent health information in front of people in entertaining or engaging ways that fits into their normal daily lives. What other suggestions do people have?

At a Center for American Progress forum today, historian Robert Dallek offered some generic guidance on key ingredients for major legislative reforms and health policy veteran Chris Jennings shared the nine reasons why health care reform is more possible in ‘09 than in 93-94.

Dallek argued that any fundamental legislative change requires national consensus, which presidents can facilitate by creating a “national sense of shared purpose.” He also had a cautionary message, “War kills reform.” Every reform movement in this country from populism through the Progessive Era to the New Deal has been stopped in its tracks when a major war broke out.

Jennings came to the event with nine specific reasons in ‘09 why “health care reform is possible, if not likely,” in many cases, contrasting the current situation with what happened in 1993-94.

1. All economists advising Obama appear to agree that health care reform is critical to economic recovery.
2. Businesses are aggressively pushing health care reform today (and are more engaged than ever before.
3. There is a new debate on quality and value, which is fundamentally different than the typical debate over cost containment.
4. There is an increasing understanding that un- and under-insured need to be addressed for health care system efficiency reasons (not just as a moral imperative) due to issues such as cost shifting, prevention, cherry picking, etc.
5. Bipartisan support for health care reform is growing, especially in the critical Senate Finance Committee, where the Chairman (Max Baucus) is leading the way, in great contrast to the reluctance of then-Chairman Moynihan.
6. The experience of 1993-94 has positively affected the policy ingredients (stripping out from most proposals the items that were so controversial).
7. Economic crisis opens the door to health care reform because, in this country, we only do reform in response to a crisis.
8. There is an increasing understanding and realization that comprehensive health care reform may be more viable than incremental reform because so many people have issues that need addressing — if everyone can get something…
9. Special interests are much more willing/ready to engage constructively because there is such widespread recognition that the current health care system is unsustainable.

I thought it was an excellent list and one that does provide additional optimism that something comprehensive could get done in 2009. If there had been time, I would have asked (as I described in more detail last month) if he thought the Web 2.0 strategies that Obama deployed in the campaign and is bringing to the White House would be another critical factor in applying pressure to Congress for comprehensive reform.

Near the end of the hour, Dallek suggested that, to be successful in capturing the nation’s imagination and developing that shared sense of purpose, health care reform advocates needed a great catch phrase (e.g., corollary to “The New Deal” or “The Great Society”).

I agree. What do you think the catch phrase should be?

Just before Thanksgiving, Senators Kent Conrad (D-ND) and Sheldon Whitehouse (D-RI) asked the Government Accountability Office (GAO) “to study best practices used by states, hospitals, and other countries to reduce health care costs and improve quality.”

The focus on best practices also is a clear priority for HHS Secretary-designate Tom Daschle. In a phone call with hundreds of health care experts today, he repeatedly emphasized the importance of learning from best practices in order to improve quality and contain costs. He particularly emphasized that best practices for improving prevention, wellness, HIT implementation, and overall efficiency of health care delivery were critically important to the Obama administration’s health care reform goals.

As I have written before, health services researchers (myself included) need to be creative in developing rigorous methods for integrating prospective studies from the peer-reviewed literature with the organic experiments that form the backbone of best practices research. When we rely exclusively on the peer-reviewed literature to determine how to best deliver health care, we limit the possibilities for systemic change in health care delivery that our country so desperately needs.

That doesn’t mean that we don’t apply rigorous analysis to the process of understanding what can truly improve quality and contain cost. Rather, we need to systematically and objectively apply evidence from the array of innovation that exists.

With a seed grant from Group Health Cooperative in Seattle (fitting since GHC has been one of the great drivers of best practices in the US for decades) the Center for Information Therapy (IxCenter) is launching the development of a Methodical Library of Ix Research with these objectives in mind. GHC’s IxCenter Pioneer Sponsorship will help us lay the foundation for a database that will help us answer questions about the key attributes of successful Ix best practices.