Despite the personalized attention I get in our pediatrician’s office and their general responsiveness to calls — both to their own nurse call line and during on-call hours — I find certain aspects of this 20th-century practice frustrating. The most important ongoing issue relates (not surprisingly) to the one chronic condition we have to manage: The intermittent asthma of my youngest son, 5-year-old Ryan.

Back in April, at the height of Washington’s spring allergy season, I wrote about my frustration in feeling unprepared to help Ryan in crisis. After another asthma flare-up two weeks ago when Ryan had a mild fever, I decided that I needed to take a more active caregiver role. It was time to become an “im-patient consumer.”

The first need to address was the idea I had back in April — empowering Ryan and his family to feel confident in using an inhaler and spacer when he needs albuterol (rescue medication) immediately.

Step 1: I ordered a Flip Video cam via Amazon.

Step 2: I told Ryan that we were going to the pediatric allergist’s office and I’d videotape the doctor showing Ryan how to use the inhaler. To which Ryan responded with high face lighting up, “Cool!”

Step 3: At the outset of the visit, I explained the issue to our doctor and I instructed him that I would videotape him demonstrating use of the inhaler and spacer to Ryan.

Step 4: I filmed two approximately 30-second video segments — first, facing the doctor and second, facing Ryan.

Step 5: When I got home, using FlipShare, I quickly emailed the videos to my wife and Ryan’s grandparents with copy to me (the people most likely to be present when Ryan needed help with his asthma).

Step 6: I sat down with Ryan to watch the videos. I don’t know about your 5-year-olds, but with mine, just about the only thing cooler than playing on Daddy’s computer is watching video of himself on Daddy’s computer.

Step 7: We’ll continue to watch and practice until he (and his parents) feel comfortable that he can use the inhaler well enough to get the medicine he needs to help him breathe more comfortably when he’s wheezing and coughing. Ryan may not yet be able to define “self-efficacy” but we’ll all know it when we see it.

Result: I have an empowered 5-year-old at home now.

At the request of Neil Calman, I had the opportunity to speak in Albany last week at the New York State AHEC (Area Health Education Center) System Advisory Board meeting on “Health Care Reform & the Health Information Technology Workforce.” The trip was well worthwhile for many reasons, certainly not the least of which being the chance to soak up more wisdom from Neil Calman, MD, CEO of IxAction Alliance member, the Institute for Family Health (IFH).

Neil — a member of the Health Information Technology (HIT) Policy Committee advising HHS on the implementation of HIT provisions in the American Recovery & Reinvestment Act — set up the discussion about the all-important definition of “meaningful use” of electronic health records (which will determine whether physicians are rewarded with incentives for HIT adoption). As others have stated, Neil made clear that “It’s not about the technology.” Rather, he said, “It’s about the handshake between HIT and health care reform.”

Neil then proceeded to give a great example from his own delivery system of the difference between HIT implementation and meaningful use of HIT. When IFH implemented its EHR in 2002, it experienced no improvement in the rate at which its older patients got a pneumonia vaccination. However, IFH added an electronic reminder system to its EHR in November 2003, which produced an immediate and sustained spike in vaccination rates that continues to hover around 80%.

Neil discussed other examples of meaningful use and highlighted that what it’s really about is changing the way clinicians practice. Although many clinicians bemoan the transition from handwritten, paper progress notes to electronic notes available for the patient to review, Neil emphasized that this modern form of documentation can produce important improvements in care delivery. This transparency (an important goal by itself) does much more than just create an environment of participatory medicine for its own sake.

Neil pointed out, “When you change what you write in progress notes,” to make them appropriate for your patients’ consumption, “you drill down further to the real reason” for sub-optimal care. In the past when a patient wasn’t taking a new medicine, an IFH clinician may have just written in the progress notes, “Patient non-compliant.” But such a statement obviously begs the question: Why? So the doctor now will ask, and the answer often provides important direction for improved care delivery: “Patient took first 2 pills and they made him sick.” Now, the clinician and patient know what they need to discuss in order to improve adherence to a medication regimen.

That’s what meaningful use is all about. Taking apart HIT, we’re not just changing the T (technology), but actually fundamentally changing the I (information) in order to improve H (health).

The following is a guest post from Arna Ionescu, who is Domain Director, Connected Health for a leading innovation design firm, IDEO, an IxAction Alliance member. This follows up on earlier guest post she wrote, explaining how this innovation test evolved. You can also find more background on the IxCenter’s increasing emphasis on Ix innovation design. 

In our July IxAction Alliance webinar, we interactively brainstormed ways we could leverage curiosity to prompt higher engagement with information therapy. Out of all the ideas generated, participants picked the “High Blood Pressure Club” to explore further. A few weeks ago, I wrote a blog entry about our efforts to better understand the parameters of this club through a “$10, 10 minute prototype.”

Since reducing blood pressure takes a long time, we used the analogous context of gas guzzling to run our experiment. Our three participants self-reported long commutes and minimal awareness of gas consumption. After a week of measuring their baseline gas usage, we inducted them into the “Gas Guzzler Club” and provided a week of information therapy. This involved a short video and daily tips through a channel of their choice (email, text or voice – all three chose email).

So did it work? In terms of the before and after gas consumption one participant did better, one worse and one stayed the same. While the numbers are inconclusive, our follow-up conversations with each participant revealed interesting and sometimes unexpected insights.

1. Our guilt trip was effective only to a degree. Participants juxtaposed words like “pejorative” and “pariah” with “motivational,” and they wanted to take action to get out of the club. However, the guilt only got them so far. One participant said he decided not to remove his roof rack because of the status he associated with that accessory. Name-calling did not outweigh his ego’s need to posture.
2. Feeling that the others are real, living, breathing people is critical. Our participants commented that being asked to participate by a person they knew was critical to keep them going. They commented that receiving the tips from a real person named “Emily” made them feel accountable. They commented that they wished they had more connection with others who do the same drive so they can learn from others’ successes. They commented that they wished they could see the group’s success – how much gas and money had their group of x people saved – since that would feel more significant than just their solitary success. It was clear that the secondary motivation prompted by continuous interaction with real people was as motivational, if not more so, than the primary motivation of reducing gas usage. The design of the club and communications should elevate that human connection and support.
3. The information therapy and the rewards must be personalized. People crave a genuine connection, and if their specific situation and preferences aren’t taken into account, then they’ll tune it all out. Participants commented that both tips and rewards must be personalized; tips must be relevant to their particular drives and rewards must correlate to what matters most to each individual.
4. Getting past the initial skepticism takes effort – so be prepared for it. Participants didn’t buy that small changes would make a difference. The design of this club should include a mechanism that provides constant feedback correlating the output data with a person’s actions. People forget what they did and have trouble relating cause and effect, so we need to help them with that.

This is a sample of the insights we culled from our $10, 10-minute experiment. This experiment wasn’t about statistical significance, but about developing a good sense of what matters to people and where our risk factors lay should we pilot an actual High Blood Pressure Club. Given our experience, we feel the idea holds merit, and we know more about where and how to focus our design efforts.

Who’s interested in taking this further?

Kaiser Permanente released two new ads as part of its ongoing “Thrive” campaign. Although both are quite entertaining, the one that struck me most is titled, “Connected.” Much has been made of Kaiser’s multi-billion dollar investment in health information technology (HIT), but perhaps what has received too little attention is how they structured it.

What the “Connected” ad does masterfully is to visually, technologically, and audibly demonstrate that all its technological investment has its member at the center and is focused on facilitating connections for that member. Connections to data, information, clinicians, and ultimately to everything that a member might need to manage their health and “thrive.”

This should not come as a surprise. When Kaiser launched their Epic implementation several years back, they decided to call it “HealthConnect.” Now, their vision is playing out among the more than 3 million Kaiser members taking advantage of that connectivity.

The connection theme deserves more attention in the national debate on reforming the health care delivery system. Connections among people and information can be incredibly powerful in enhancing clinician-patient relationships, creating truly patient-centered medical homes, and facilitating participatory medicine.

It’s important to note, however, that connection is about far more than simply creating electronic links between people and data. In order to maximize the connection potential, the data need to be translated into understandable, meaningful, useful information for each user. That information needs to be accessible in a convenient way for each person, and it must be proactively delivered to them in a just-in-time fashion in a way that engages them to initiate effective actions.

When we put all that together, those connections can create effective, efficient health care delivery.