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Communication Technology and Health 2.0 for ACP Internal Medicine 2011
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Communication Technology and Health 2.0 for ACP Internal Medicine 2011






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  • WSO 205 - Engaging e-Patients: How e-Messaging, Social Media, and Patient Activation Can Transform Your Practice Explain medicolegal barriers to the use of social networking (such as Facebook or Twitter) in patient care and how we might overcome them. Discuss how care and collaboration can be enabled by using advanced technologies, such as video conferencing, Web-based collaboration, social networking, personal health records, and patient Web sites. Cite limitations of current communication technologies in health care. Describe how social networking can benefit patients without involving physicians.  
  • We can drill down and see that there are many transitions across the healthcare continuum. These take place among the home, the doctor’s office, the emergency room, the hospital, and then in rehabilitation and long-term care facilities. Discharge planning, which we discussed in Sophia’s care, is a subset of transition planning.
  • In healthcare IT, we often talk about the importance of data connections , or delivering the right information to the right person for the right patient at the right time, not much attention is paid to human connection , or connecting to the right person about the right patient at the right time. Both are critical in healthcare.
  • While connecting the healthcare ecosystem for information transfer is important, the connections of human communications are equally essential to healthcare. Healthcare is and will always be dependent upon people, and people need to communicate, both to exchange information (much of which is not encoded in computers) and for the affective (emotional and caring) components of healthcare delivery.
  • There are many tools available for communication in the “real world”: Telephone Digital Pager Mobile phone (although prohibited throughout many hospitals despite little evidence of harm in most settings) PDAs/SmartPhones E-mail Instant Messaging Video conferencing Web-based collaboration But most of healthcare is still restricted to telephones and pagers, technology that has been virtually unchanged for decades!
  • In large part these technologies are underutilized, making it difficult for clinicians to reach other clinicians. In 2006, Forrester Research surveyed hospital nurses across the country. They found, among other things, that 2/3 of nurses spent more than 20 minutes per shift trying to reach staff (including 26% who spent an hour or more). On average, this was over 7% of the shift wasted. A similar percentage stated that they searched more than one channel trying to reach staff (for example, phone and pager) 84% felt that this time spent negatively impacted patient care, because it took them away from patients. If they could reach the correct physician more easily, they felt that almost all of that wasted time would be recovered.
  • This can be used to share images, such as radiology images, or to collaboratively develop a document, such as a discharge plan.
  • Although the status quo has the advantage of communication simplicity, as we have discussed it is not effective. Simply adding communication tools may actually increase complexity in the environment, even as it may increase effectiveness due to the large variety of tools. Unifying the disparate communication channels into one seamless workflow has the benefits of increasing simplicity and effectiveness at the same time.
  • As collaboration expands, the number of tools we use to collaborate is also expanding. As you see here, until recently the tools have been primarily text- or document-centric: email, IM, and portals or workspaces. These tools work best for one-to-one or one-to-few interactions. Transition: Increasingly, however, healthcare providers are adopting a much broader toolset to collaborate with more people, including physicians and nurses, patients, other healthcare networks, and even government agencies . Here are some of these tools. Wikis, blogs and discussion forums in the text centric world. And in the voice and video worlds, vmail, conferencing, telepresence, video on demand, unified communications and contact centers. This mix of rich media provides the context, the nuance, and the intimacy that healthcare providers need to operate successfully in a world with distributed team – where travel may be restricted. Transition: So what can collaboration do to improve patient outcomes and experiences, improve workflow, or even the bottom line? Let’s look at some key business processes and see how collaboration is making an impact today.
  • This will illustrate many of the functions of PatientSite.
  • Mail: PatientSite is a secure server that has a secure messaging function. Whenever possible, messages are automatically routed to support staff who can best take care of a particular issue. Staff can take responsibility for tasks so that the patient and the rest of the team can know who is responsible for it. Services: PatientSite allows patients to request prescription refills, appointments, ad managed care referrals online. In addition, they can view their bills. Records: Patients can securely view their records online, including medications, allergies, problems, an all test results. In addition, they can maintain a personal health record where they can store their own information and track symptoms and physical findings. Education: Providers can prescribe Web-based educational information to their patients; these links are then incorporated into the patients’ home pages on PatientSite. Patients can also maintain their health home pages on PatientSite, adding their own links or collections of links that we provide for them.
  • Dave then Danny discuss agenda setting
  • I told Dave to search for information. This is the type of information that he found, and the source was the National Cancer Institute by way of WebMD….
  • I told Dave to search for information. This is the type of information that he found, and the source was the National Cancer Institute by way of WebMD….
  • But I also told him to go to ACOR…
  • Dave, then Danny talking about Dave’s comment to me.
  • To start, I wish to define clinical computing as [read slide] As opposed to financial or administrative computing, Clinical Computing involves building information systems which help clinicians care for their patients. (This seems very simple but is really quite profound--how many of you are directly assisted by computers in your patient care activities?)
  • Many physicians feel comfortable with knowledge asymmetry in the doctor-patient relationship. In other words, the doctor know everything and the patient knows nothing. When the patient needs to know something she must ask the physician. I would submit that this is a terrible burden for the physician, and is inappropriate for many patients today. Today, patients have access to the same medical information their physicians read. Fully 1/3 of medical literature searches are performed by lay people. In fact, because the patient has but one disease and the physician takes care of many patients’ diseases, the patient has more of an incentive to know everything they can about their disease. Rather than feeling threatened by this, physicians should embrace this. No longer do they have to feel that they need to know everything about everything—after all, one can’t know everything in the rapidly changing medical sciences. We can use the patient as an ally, freeing us to spend more time with the more human aspects of medical healing.
  • According to data from the Pew Internet and American Life Project, 62% of online adults have looked to the Internet for health information. This may be a conservative estimate, since Harris Interactive and other have suggested that up to 80% have done so. According to Pew, every day in the US 6 million Americans search for health information online. 3 million people participate in online support communities. In comparison, only 5 million see a physician in some setting. Interestingly, almost half of those who found information online acted on the information, for example, by deciding to see or not to see a health care provider, or deciding to take or not take a prescription.
  • Patty Brennan at the University of Wisconsin calls care away from healthcare professionals “The care between the care.”
  • Thank you.

Communication Technology and Health 2.0 for ACP Internal Medicine 2011 Communication Technology and Health 2.0 for ACP Internal Medicine 2011 Presentation Transcript

  • Engaging e-Patients: How e-Messaging, Social Media, and Patient Activation Can Transform Your Practice
    • Daniel Z. Sands, MD, MPH, FACP, FACMI
    • Cisco Internet Business Solutions Group,
    • Beth Israel Deaconess Medical Center, and
    • Harvard Medical School
    • President, Society for Participatory Medicine
    • Boston, MA
  • Daniel Z. Sands, MD, MPH, FACP Has disclosed relationships with entities producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Disclosure of Financial Relationships Cisco Systems, Inc.: Employee and Shareholder
  • How Crucial is Communication in Healthcare? “… communication extends all the way from the intimate interaction between a clinician and a patient, to the most public dissemination of information.” Harvey Fineberg, MD, PhD President, Institute of Medicine
  • Many Reasons for Collaboration
    • Sharing and co-creating knowledge
    • Learning
    • Negotiating
    • Building consensus
  • Many Transitions Across Care Continuum … Home / Self-care Inpatient Care Emergency Care Ambulatory Care Post-acute Care
  • Collaborative Planning Improves Transitions in Care Each step requires collaboration Discharge or Transfer Planning Admission Admission Planning
  • Two Types of Connections Deliver the right information to the right person for the right patient at the right time Connect to the right person about the right patient at the right time
  • Human Connections are as Important as Data Connections in Healthcare Connected Life Sciences and Research Connected Hospital Connected Clinician Connected Health Information Exchanges Connected Health Authorities Connected Patient Connected Public Health Connected Funder or Payer
  • Many Tools for Communication…
  • … And Reaching People is Difficult Source: Forrester Research, February 2006 “ Every minute engaged in tracking and locating others reduces a nurse’s availability for the patient .” 66%  Search more than one channel to reach staff 84%  Time spent trying to reach staff impacts patient care 65%  20-60+ min / shift just trying to reach staff
  • Other Research
    • > 50% pages received by first-year medical residents were considered non-urgent and frequently interrupted the care interns were delivering to a patient at the time (Katz M.H., Schroeder S.A., NEJM 1988. 319:4)
    • Hospital clinicians made successful connection 74% of the time, and ¼ of the calls associated with determining who needed to be contacted for a specific situation (Coiera E., Tombs V., BMJ February 28, 1998)
    • The value of high quality communication systems and processes measured in Buckles and Herrin 2007, and Kuruzovich et al. 2010.
  • Connecting with Patients: e-Communication
    • e-Communication includes encrypted e-mail or, more commonly, secure web messaging
    • e-Communication can provide an efficient means of communication because it is asynchronous
    • This is cost-effective and benefits both patients and physicians
    Sources: Kane B, Sands DZ, JAMIA 1998. Delbanco T, Sands DZ, NEJM 2004.
  • Communication Using Video
    • Adds video to telephone calls
    • Three different video technologies:
      • IP telephone or soft phone w/ webcam (e.g., Skype, iChat, WebEx, etc.)
      • Dedicated video phone
      • Dedicated video conferencing unit or TelePresence
    • Enhances verbal communication with visual queues
  • Web-based Collaboration
    • Adds desktop/application sharing to IP video telephony
    • Permits:
      • Sharing and annotation of documents, images, or videos
      • Presentations
      • Collaborative document development
  • Cisco TelePresence— Transforming Communications, Transforming Business
    • A breakthrough technology for remote collaboration that allows local and remote participants feel as if they are “in person”
    • An immersive meeting experience created through a powerful combination of innovative technology and design
    • Integrates advanced audio, ultra-HD video, interactive collaboration tools and the underlying network as a platform
    • Cisco TelePresence can transform businesses
  • Increasing Effectiveness While Decreasing Complexity  Simplicity  Effectiveness  Simplicity ? Effectiveness  Simplicity  Effectiveness Unified Communications
  • Changing the Way We Work “ We are looking to technology to reduce administrative costs as well as direct care delivery costs… Collaboration plays an important role in both strategies.” — Terry Bayer, Chief Operating Officer, Molina Healthcare Text Voice, Video Number of Stakeholders Medium Documents Few Many Email IM TelePresence Unified Communications Vmail Discussion Forums Video on Demand Wikis Blogs Contact Center Conferencing Social Networking
  • Telemedicine as Collaboration with Patients
    • Many to many connection—routed based on network intelligence
    • Can recreate “up close and personal” experience
    • Telemetric data transmission
  • Attributes of Technology Channels Technology Synchronous? Information Density Telephone   E-messaging   Text messaging/IM  /   Remote monitoring   Telemedicine  (usually)  Advanced Telemedicine   Office visit  
  • Optimizing Personnel
    • Different personnel can provide care
    • Each has attributes
    • Each should practice at “top of their license”
    • Can add others to this list, even perhaps, Watson…
    Patient Self-care Counselor/ Educator Clinical Nurse NP/PA Physician Telephone E-messaging Text messaging/IM Remote monitoring Telemedicine Advanced Telemedicine Face-to-face visit
  • Optimizing Channel and Staff Patient Self-care Counselor/ Educator Clinical Nurse NP/PA Physician Telephone E-messaging Text messaging/IM Remote monitoring Telemedicine Advanced Telemedicine Face-to-face visit
  • “ [Health 2.0 is] the use of social software and light-weight tools to promote collaboration between patients, their caregivers, medical professionals, and other stakeholders in health.”
    • Jane Sarasohn-Kahn "Wisdom of Patients: Health Care Meets Online Social Media" California HealthCare Foundation 2008
    © 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Internet Business Solutions Group
  • Health 2.0 Technologies
    • E-messaging
    • Instant messaging
    • Text messaging
    • Patient portals
      • Communication
      • Information and records
      • Services
    • Other communities (e.g., ACOR, PatientsLikeMe)
    • Blogs
    • Twitter
    • Wikis
    • Social networking sites (e.g., Facebook, LinkedIn)
    • Others…
  • Physician Concerns Re: Health 2.0
  • http://www.patientsite.org
    • Mail :
    • Secure
    • Automated routing
    • Task assignment
    • Services :
    • Prescription refills
    • Appointment requests
    • Referrals
    • View bill
    • Records :
    • Secure
    • All CG records
    • Upcoming appointments
    • Meds/Problems/Results…
    • Personal records
    • Education :
    • Info prescriptions
    • Patient selected links
    • Predefined collections
    • Videos
  • 54M Consultant with HTN, Hyperlipidemia
    • This is too cool. It's almost SILLY that things can be this easy. I am having a very good patient/customer experience so far.
  • 61M Minister with DM and Chronic Pain
    • I have a lot of medical issues. This email system has left me feeling comfortable and in good hands! Otherwise, I would feel as cold, depleted, and alone, as the lifeless tree in my front yard in the deepest of winter!
  • Hi - there are several things I want to go over when we meet. I suspect several will require referrals, and given the time it takes to get a slot, I'm thinking of making those appointments now. (It's easy to cancel and create an opening for someone else.) I'm 56 and I generally don't have any complaints. Here are the symptoms I'm concerned about: […] What do you think? Copyright © 2008 D. Z. Sands and R. D. deBronkart. All rights reserved.
  • ACOR is great. I posted two messages tonight and got responses in 4 and 11 minutes. One responder also sent a private note mentioning Robin and Cathy. The other responder was Cathy. :) Through that list I've also found several other useful sites. Copyright © 2008 D. Z. Sands and R. D. deBronkart. All rights reserved.
  • Wikis: The Wisdom of the Crowd The wisdom of the crowd refers to the process of taking into account the collective opinion of a group of individuals rather than a single expert to answer a question. This process, while not new to the information age, has been pushed into the mainstream spotlight by social information sites such as Wikipedia and Yahoo! Answers, and other web resources that rely on human opinion.
  • http://medpedia.org
  • Twitter: “Microblogging”
  • Twitter’s Value to Me
    • Information/links/opinions from people I trust
    • News alerts
    • Concise
    • Can search, scan, drill down
    • Platform for me to share ideas
    • Build community of followers/build my brand
    • Determine zeitgeist of conferences I did not attend
    • Share key points of conferences (for others and for me)
  • “ We met online.”
  • What are Social Networks?
    • Illuminate our social and professional networks
    • Expand our communication options
    • Provide context and meaning to our communication
    • Validate who we are through our associations
  • Patient Network Plus:
    • SHARE
    • Patients’ sharing detailed health data is what makes our communities special. This information is the basis of the PatientsLikeMe network and validates each individual
    LEARN The shared information creates a new knowledge about the real world treatment , symptoms , and reality of living with illness. Patients learn about their disease and themselves in context of the community FIND Patients’ find other patients like them. They discover what options are available for treatment and if their experience with their disease is normal. They can reach out to others like them for advice and insight.
  • Medical Professional Social Networks
  • Social Network Analysis By Nicholas A. Christakis and James H. Fowler
  • “ Knowledge is power.” Sir Francis Bacon English author, courtier, & philosopher (1561 - 1626)
  • Information Needed for Knowledge
  • Shifting Paradigm?
    • Information asymmetry
      • Physician as oracle
      • Comfortable
      • A burden?
    • Information symmetry
      • Physician as partner
      • Threatening vs. liberating
      • Physician as healer
    ! ☺ ! !
  • The Power of “I Don’t Know”
  • E-patients
    • 85% of online adults
    • Rising over time
    • Each day, more people search for health information than see a physician!
    • More than half act on the information
    Source: www.pewinternet.org
  • Trusting Relationship
  • Professional Care $ ¢ Source: Ferguson, T. Consumer Health Informatics. Healthcare Forum Journal, 1995.
  • Professional Care ¢ $ Source: Ferguson, T. Consumer Health Informatics. Healthcare Forum Journal, 1995. Professionals as partners Professionals as authorities
  • http://participatorymedicine.org Participatory Medicine is a movement in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners.
  • Patient and Physicians Each Have Expertise
  • Patients Can (and Must) Help
  • “ It can be argued that the largest yet most neglected health care resource, worldwide, is the patient…” Slack WV. CyberMedicine: How Computing Empowers Doctors and Patients for better Health Care . Jossey-Bass 2001.
  • Because of the Web, Patients Can Connect to Information and Each Other (and to Doctors)
  • Changing Nature of Relationship Information Asymmetry Information Symmetry Passive Recipient Active Partner Patient-Physician Consumer-Provider Paternalism Participation
    • Human connections as important as data connections
      • Collaborations are key!
    • Many newer tools for connecting and collaborating
    • Collaborations can improve care of patients
      • Considering patients as collaborators yields benefits
    • Health 2.0 tools useful to both patients and providers
      • Helps shift balance of power
      • Lowers barriers to engagement
      • Empowering and enabling to patients and physicians
    • Physicians must learn how to better engage e-patients
  • Questions and e-mail address Questions? [email_address] Twitter: @DrDannySands http://www.facebook.com/DrDannySands http://www.linkedin.com/in/DannySands