Sands - Health 2.0 and Patient Engagement - from ACP Medicine 2012
Upcoming SlideShare
Loading in...5
×
 

Like this? Share it with your network

Share

Sands - Health 2.0 and Patient Engagement - from ACP Medicine 2012

on

  • 2,154 views

 

Statistics

Views

Total Views
2,154
Views on SlideShare
2,144
Embed Views
10

Actions

Likes
1
Downloads
22
Comments
1

3 Embeds 10

https://twitter.com 6
https://si0.twimg.com 3
http://www.linkedin.com 1

Accessibility

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Sands - Health 2.0 and Patient Engagement - from ACP Medicine 2012 Presentation Transcript

  • 1. Engaging e-Patients: How e-Messaging, Social Media, and Patient Activation Can Transform Your Practice Daniel Z. Sands, MD, MPH, FACP, FACMI Cisco Healthcare Business Transformation, Beth Israel Deaconess Medical Center, and Harvard Medical School President, Society for Participatory Medicine Boston, MACisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 1
  • 2. Disclosure of Financial Relationships 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.Cisco Systems, Inc.: Employee and Shareholder
  • 3. 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 MedicineCisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 3
  • 4. Why Collaborate?  Share and co-create knowledge  Learn  Negotiate  Build consensusCisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 4
  • 5. Collaborative Planning Improves Transitions in Care Discharge or Admission Transfer Planning Planning Admission Each step requires collaborationCisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 6
  • 6. Two Types of Connections Deliver the right information to the Connect to the right right person for the person about the right right patient at patient at the right time the right timeCisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 7
  • 7. Human Connections are as Important as Data Connections in Healthcare Connected Connected Health Hospital Information ExchangesConnected Connected Life Health Sciences andAuthorities Research Connected Connected Patient Clinician Connected Connected Funder Public Health or Payer Cisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 8
  • 8. Many Tools for Communication…Cisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business
  • 9. …And Reaching People is Difficult 65%  20-60+ min / shift just trying to reach staff 66%  Search more than one channel to reach staff 84%  Time spent trying to reach staff impacts patient care “Every minute engaged in tracking and locating others reduces a nurse’s availability for the patient.” Source: Forrester Research, February 2006Cisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business
  • 10. 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.Cisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business
  • 11. 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 physiciansSources: Kane B, Sands DZ, JAMIA 1998. Delbanco T, Sands DZ, NEJM 2004.Cisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business
  • 12. 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 queuesCisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business
  • 13. Web-based Collaboration  Adds desktop/application sharing to IP video telephony  Permits: – Sharing and annotation of documents, images, or videos – Presentations – Collaborative document developmentCisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business
  • 14. Increasing Effectiveness While Decreasing Complexity Simplicity  Simplicity  Simplicity Effectiveness ? Effectiveness  Effectiveness Unified CommunicationsCisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business
  • 15. Changing the Way We Work Medium Many Text Voice, Video Number of Participants Social Networking Video on Demand Discussion Forums Unified Communications Wikis Blogs Contact Center Email Conferencing IM TelePresence Documents Few Vmail ―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 HealthcareCisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business
  • 16. Telemedicine as Collaboration with Patients  Many to many connection—routed based on network intelligence  Can recreate ―up close and personal‖ experience  Telemetric data transmissionCisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business
  • 17. Attributes of Technology Channels Technology Synchronous? Information Density Telephone   E-messaging   Text messaging/IM /   Remote monitoring   Telemedicine  (usually)  Advanced Telemedicine   Office visit  Cisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business
  • 18. Optimizing Personnel Patient Counselor/ Clinical NP/PA Physician Self-care Educator NurseTelephoneE-messagingText Differentmessaging/IM personnel can provide care  Each has attributesRemote  Each should practice at ―top of their license‖monitoringTelemedicine  Can add others to this list, even perhaps,Advanced Watson…TelemedicineFace-to-face visit Cisco BTx © 2012 Cisco and/or its affiliates. All rights Cisco Confidential Healthcare Business reserved.
  • 19. Optimizing Channel and Staff Patient Counselor/ Clinical NP/PA Physician Self-care Educator NurseTelephoneE-messagingTextmessaging/IMRemotemonitoringTelemedicineAdvancedTelemedicineFace-to-face visit Cisco BTx © 2012 Cisco and/or its affiliates. All rights Cisco Confidential Healthcare Business reserved.
  • 20. “[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 2008Cisco IBSG © 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Internet Business Solutions Group 2222
  • 21. 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…Cisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 23
  • 22. Physician Concerns Re: Health 2.0  Privacy (HIPAA)  Helping patients but not me or my practice  Liability  Time  Don’t know how to get started  MoneyCisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 24
  • 23. http://www.patientsite.orgCisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 25
  • 24. Mail:Secure Services:Automated routing Prescription refillsTask assignment Appointment requests Referrals View billRecords:SecureAll CG recordsUpcoming appointmentsMeds/Problems/Results…Personal recordsEducation:Info prescriptionsPatient selected linksPredefined collectionsVideos
  • 25. 54M Consultant with HTN, Hyperlipidemia This is too cool. Its almost SILLY that things can be this easy. I am having a very good patient/customer experience so far.Cisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 27
  • 26. 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!Cisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 28
  • 27. ACOR is great. I posted two messagestonight and got responses in 4 and 11minutes. One responder also sent a privatenote mentioning Robin and Cathy. The otherresponder was Cathy. :)Through that list Ive also found severalother useful sites. Copyright © 2012 D. Z. Sands and R. D. deBronkart. All rights reserved.
  • 28. Copyright © 2012 D. Z. Sands.. All rights reserved. BTx- 35
  • 29. Copyright © 2012 D. Z. Sands.. All rights reserved. BTx- 36
  • 30. Copyright © 2012 D. Z. Sands.. All rights reserved. BTx- 37
  • 31. Copyright © 2012 D. Z. Sands.. All rights reserved. BTx- 38
  • 32. Wikis: The Wisdom of the CrowdThe 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 bysocial information sites such as Wikipedia and Yahoo! Answers, and other web resources that rely on human opinion.
  • 33. http://medpedia.org
  • 34. Twitter: “Microblogging”
  • 35. 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)Cisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 43
  • 36. “We met online.”
  • 37. 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 associationsCisco BTx © 2012 Cisco and/or its affiliates. All rights Cisco Confidential Healthcare Business reserved.
  • 38. Cisco Confidential Copyright © 2012 Cisco Systems, Inc. All rights reserved. Healthcare Business Transformation 47
  • 39. Cisco Confidential Copyright © 2012 Cisco Systems, Inc. All rights reserved. Healthcare Business Transformation 48
  • 40. Patient Network Plus: SHARE FIND LEARNPatients’ sharing detailed Patients’ find other patients like The shared information createshealth data is what makes them. They discover what a new knowledge about theour communities special. options are available for real world treatment,This information is the basis treatment and if their experience symptoms, and reality of livingof the PatientsLikeMe with their disease is normal. They with illness. Patients learn aboutnetwork and validates each can reach out to others like them their disease and themselves in for advice and insight. context of the communityindividual Cisco BTx © 2012 Cisco and/or its affiliates. All rights Cisco Confidential Healthcare Business reserved.
  • 41. Medical Professional Social NetworksCisco BTx © 2012 Cisco and/or its affiliates. All rights Cisco Confidential Healthcare Business reserved.
  • 42. Social Network Analysis By Nicholas A. Christakis and James H. FowlerCisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 52
  • 43. Cisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 53
  • 44. Ethics and Social Media  Cases  Principles  Guidelines  OtherCisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 54
  • 45. Ethics and SM Cases  Surgical resident taking picture of patients tattooed penis with phone during gallbladder surgery  Physician posting pictures of injured nursing home patient on Facebook  Physician making fun of patients on his blog  Posting video of end-of-year party performance in which patients were objects of derision  Participating in inappropriate Facebook groups  Posts promoting inappropriate behavior (sex, drugs, alcohol...)Cisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 55
  • 46. Ethics and SM Cases  Posting patient information  Providing medical advice online  Friending patientsCisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 56
  • 47. "The AMAs Code of Medical Ethics already contains an abundance of guidance for physicians regarding professional interaction with their patients that applies to communication in all settings, including online." Shore R, Halsey J, Shah K, Crigger B, Douglas SP. Report of the AMA Council on Ethical and Judicial Affairs: Professionalism in the Use of Social Media. J Clinical Ethics 2011. 22:2; 165-72.Cisco IBSG © 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Internet Business Solutions Group 57
  • 48. "Physicians must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their careers ..., and can undermine public trust in the medical profession." Shore R, Halsey J, Shah K, Crigger B, Douglas SP. Report of the AMA Council on Ethical and Judicial Affairs: Professionalism in the Use of Social Media. J Clinical Ethics 2011. 22:2; 165-72.Cisco IBSG © 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Internet Business Solutions Group 58
  • 49. Ethics and SM Principles  Professionalism  Maintaining trust in the profession and in treatment relationships  Boundaries: personal vs. professional social networking pages  Patient privacy and confidentialityCisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 59
  • 50. Ethics and SM Guidelines - Forbidden  Posting patient information  Posting private academic information of student or trainee  Claiming to be official representative of organization on a private social networking siteCisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 60
  • 51. Ethics and SM Guidelines - Discouraged  Using vulgar language  Using language or posting material that is disrespectful or offensive  Condoning irresponsible behaviors (sex, drugs, alcohol...)  Posting inflammatory material on someones site  Use of social networking that interferes with workCisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 61
  • 52. Ethics and SM Guidelines - Encouraged  Be aware that things you post may exist in perpetuity and can affect you  Point out inappropriate behavior to peers and, when necessary, to authorities  Monitor your online presence  Use privacy settingsCisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 62
  • 53. Ethics and SM GuidelinesCisco BTx © 2012 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Healthcare Business Transformation 63
  • 54. “Knowledge is power.”Sir Francis BaconEnglish author, courtier, & philosopher (1561 - 1626) Copyright © 2012 Cisco Systems, Inc. All rights reserved. BTx- 64
  • 55. Information Needed for Knowledge Wisdom Knowledge Information DataDZ Sands and RD DeBronkart © 2012 All rights reserved.
  • 56. Shifting Paradigm?  Information asymmetry ! –Physician as oracle –Comfortable –A burden? ! !  Information symmetry –Physician as partner ☺ –Threatening vs. liberating –Physician as healerDZ Sands and RD DeBronkart © 2012 All rights reserved.
  • 57. The Power of “I Don’t Know”DZ Sands and RD DeBronkart © 2012 All rights reserved.
  • 58. 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.orgDZ Sands and RD DeBronkart © 2012 All rights reserved.
  • 59. Honest AskingDisclosures Trusting Relationship Tacit Approval
  • 60. Encouraged $ Tertiary Professional Secondary Care Primary Self-Care Discouraged (Off the Map) ¢Source: Ferguson, T. Consumer Health Informatics. Healthcare Forum Journal, 1995.
  • 61. Encouraged ¢ Individual self-care Friends and families Self-health networks Professionals as facilitators Discouraged Professionals as Professional Care partners Professionals as $ authoritiesSource: Ferguson, T. Consumer Health Informatics. Healthcare Forum Journal, 1995.
  • 62. Participatory Medicine is a movement in which networked patientsshift from being mere passengers to responsible drivers of theirhealth, and in which providers encourage and value them as fullpartners. http://participatorymedicine.org Copyright © 2012 Cisco Systems, Inc. All rights reserved. BTx- 72
  • 63. Patient and Physicians Each Have ExpertiseDZ Sands and RD DeBronkart © 2012 All rights reserved.
  • 64. Patients Can (and Must) HelpDZ Sands and RD DeBronkart © 2012 All rights reserved.
  • 65. “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.DZ Sands and RD DeBronkart © 2010 All rights reserved.
  • 66. Because of the Web, Patients Can Connect to Information and Each Other (and to Doctors)DZ Sands and RD DeBronkart © 2012 All rights reserved.
  • 67. Changing Nature of RelationshipInformation Asymmetry Information Symmetry Passive Recipient Active Partner Paternalism Participation Patient-Physician Consumer-ProviderDZ Sands and RD DeBronkart © 2012 All rights reserved.
  • 68. Conclusions  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 – Beware of inappropriate sharing/discussions re: patients  Physicians must learn how to better engage e-patientsDZ Sands and RD DeBronkart © 2012 All rights reserved.
  • 69. Questions?dzsands@cisco.comTwitter: @DrDannySandshttp://www.facebook.com/DrDannySandshttp://www.linkedin.com/in/DannySands