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 1^st amendment represents. There are important implications of the unique nature of the American media for the evolution of US health care delivery.

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 US health care industry.

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, America’s first information democratization was making sure that communication among the privileged and disadvantaged alike was facilitated by our delivery of personal communications.

Can you guess what technology and what decade these quotes refer to?

• “…inaugurated a new phase in the history of communications, the rise of modern technological networks…”
• “The new networks promised faster communications of people and places, of markets, armies and governments…”

• It could be the Internet…
• It could be the telephone…
• It was actually the electric telegraph in the 1840s

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 US and what does it tell us about the opportunities for health communications with underserved populations?

• Rise of motion pictures transpired during a massive wave of immigration to the US.
• Silent movies overcame barriers of English literacy.

Think about the US Constitution. It was only 5000 words, written mostly in plain English (the debate over the 2^nd Amendment notwithstanding), and accessible to all. It was a model of transparency, much the same as the US approach other aspects of government, such as public legislative sessions and concisely written and widely published state constitutions.

The US Census provides some important lessons too. Information democratization in the US was coupled with a mandated use of statistics

• Collection of data
• Publishing of statistical findings
• Use of that data to organize government

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.

• Free speech as constitutional principle
• Constitution written so ordinary citizens could read it
• Government subsidized newspapers rather than taxing them
• Comprehensive postal network & assured postal privacy
• Periodic census with published data (& anonymity)
• Extension of public primary schooling

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. Europe had a much smaller and more homogeneous audience. In 1840, the US weekly newspaper circulation actually equaled that of all of Europe despite the fact that Europe’s populations was 14 times greater (233 million vs. 17 million).

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…

• “Availability” does not necessarily equate with “access.” We need to translate widespread availability of information into true, ubiquitous access.
• “Data” is not the same as “information,” which is different from “knowledge,” which is not equal to “behavior.” In order to go up the chain from data all the way to the behavior change we need for positive health outcomes, we need to connect accessible data with science—such as evidence-based medicine, decision sciences, predictive modeling, and behavior change science.
• For some people, the free access to information has led to a diagnosis of “information overdose” and a high signal-to-noise ratio. We need to think creatively about how we target, tailor and contextualize health information for consumers.

If we can figure out how to do these three things, we have a great opportunity to create real improvement in health care delivery…

1. Translate information democratization into effective communication.
2. Maximize the 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.

So when you leave the Newseum tonight, take a look up and ponder what the First Amendment means for American health care.