#sgshealth Twitter Archive

Salzburg Global Seminar on Informed Medical Decision Making, Dec. 12-17 2010

Text Username Created
@ePatientDave I was thinking #sgshealth. Sound good? mollytoba Sun 12 Dec 2010 15:00:56
We have a winner! RT @mollytoba @ePatientDave I was thinking #sgshealth. Sound good? ePatientDave Sun 12 Dec 2010 15:03:27
At Salzburg Global Seminar:greatest untapped resource in healthcare?Informing+involving patients in decisions about their
care #sgshealth LaylaMcCay Sun 12 Dec 2010 15:24:29
Fascinating collection of people from 19 nations at Salzburg Global Seminar on informing/involving patients. #sgshealth is
proper hashtag garyschwitzer Sun 12 Dec 2010 15:36:03
RT @garyschwitzer: Fascinating collection of people from 19 nations at Salzburg Global Seminar on informing/involving
patients. #sgshealth is proper hashtag kgapo Sun 12 Dec 2010 15:45:09
patients. #sgshealth is proper hashtag mollytoba Sun 12 Dec 2010 15:46:04
patients. #sgshealth is proper hashtag FIMDM Sun 12 Dec 2010 15:52:13
Hey @rawarrior one of the participants @ #sgshealth is a #RA patient since age 3. Currently using meditation &
ayurvedic. ePatientDave Sun 12 Dec 2010 15:57:59
Listening to the real Jack Wennberg describe founding @FIMDM #sgshealth ePatientDave Sun 12 Dec 2010 16:02:04
http://yfrog.com/gzedrkj Presentations begin at #sgshealth: paternalism or partnership? Angela Coulter speaking. ePatientDave Sun 12 Dec 2010 16:20:06
#sgshealth organizer @fimdm was formed in 1989 out of Dartmouth's work on variations in care ePatientDave Sun 12 Dec 2010 16:20:08
#sgshealth "make care evidence based by tackling avoidable ignorance" - love that term! ePatientDave Sun 12 Dec 2010 16:21:58
Also *increase* *warranted* variation: make care patient centered by personalizing treatment decisions. #sgshealth ePatientDave Sun 12 Dec 2010 16:23:36
http://yfrog.com/gz4qrzj Key components of shared decision making #sgshealth ePatientDave Sun 12 Dec 2010 16:27:10
@SusannahFox small typo: @epatientdave is at #sgshealth not sqs. I'm following too. :) jsperber Sun 12 Dec 2010 16:30:34
@ElinSilveous Reminder that's #sGshealth not sqs ePatientDave Sun 12 Dec 2010 16:35:31

Thank you Dave! Mind your Gs and qs folks. :) RT @ePatientDave: @ElinSilveous Reminder that's #sGshealth not sqs ElinSilveous Sun 12 Dec 2010 16:44:12
(That period of silence was brought to you by break time at #sgshealth. *Marvelous* elbows to rub.) ePatientDave Sun 12 Dec 2010 16:51:06
Jack was hated by md's. Glad progressed. RT @ePatientDave: #sgshealth organizer @fimdm 1989 Dartmouth work on
variations in care health20Paris Sun 12 Dec 2010 16:55:04
@health20Paris Was Wennberg hated by docs because he questioned their judgment? #sgshealth ePatientDave Sun 12 Dec 2010 16:55:43
@ePatientDave Was hated because he demonstrated unjustified variation in quality. 1st crack in opacity. #sgshealth health20Paris Sun 12 Dec 2010 16:56:28
@ePatientDave should decision aids b free openaccess+validated in trials e.g. http://kercards.e-bm.info or proprietary
payperview?#sgshealth vmontori Sun 12 Dec 2010 16:58:55
@epatientdave dartmouth atlas: 1st to show probability surgery depends on where US patient lives #sgshealth health20Paris Sun 12 Dec 2010 16:58:57
@vmontori My opinion of course is that decision aids will never get used if they're pay per view #sgshealth ePatientDave Sun 12 Dec 2010 16:59:47
@health20Paris Yes see my post about this event http://bit.ly/gTwnUE #sgshealth ePatientDave Sun 12 Dec 2010 17:00:45
@SusannahFox tweets fm salzburg also frm #sgs477 (shorter than #sgshealth).. kgapo Sun 12 Dec 2010 17:02:22
Now speaking #sgshealth: @FIMDM co-founder Al Mulley and president Mike Barry ePatientDave Sun 12 Dec 2010 17:02:45
Mike Barry on why practice variation is such a surprise to MDs: they operate in silos but assume that others are doing the
same #sgshealth FIMDM Sun 12 Dec 2010 17:05:16
@ePatientDave #sgshealth http://bit.ly/gRwHt8 my short video ending by Dr Fletcher "patient = 1st member medical
team" health20Paris Sun 12 Dec 2010 17:06:18
Just learned about intl alliance of patient advocacy organizations http://bit.ly/hWB7Et - president is @ #sgshealth ePatientDave Sun 12 Dec 2010 17:06:25
On e-patients.net: Salzburg Global Seminar on shared medical decision makinghttp://bit.ly/h0bYYP. Help me represent you.
#sgshealth ePatientDave Sun 12 Dec 2010 17:07:00
Mulley: one unanticipated outcome of SDM (shared decision making) was: pts chose expensive treatmts less often
RT @ePatientDave: Mulley: one unanticipated outcome of SDM (shared decision making) was: pts chose expensive
treatmts less often #sgshealth Stelerix Sun 12 Dec 2010 17:08:52

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Barry: SDM is about *2* way communic: info on options *to* patient; expression of preferences *from* pt is harder.
treatmts less often #sgshealth chukwumaonyeije Sun 12 Dec 2010 17:10:47
@Colin_Hung Apologies URL for IAPO (pt alliance) is this http://bit.ly/dPJHRZ #sgshealth ePatientDave Sun 12 Dec 2010 17:11:08
"You've got a belief that docs r scientists who make the right decision w very little uncertainty all the time; just isn't
true" #sgshealth ePatientDave Sun 12 Dec 2010 17:15:53
There are now 96 randomized trials to test shared decision making #sgshealth ePatientDave Sun 12 Dec 2010 17:16:21

RT @ePatientDave: There are now 96 randomized trials to test shared decision making #sgshealth #hcsmeu #health20fr health20Paris Sun 12 Dec 2010 17:16:45
@health20Paris (That's 96 clinical trials *now* underway) #sgshealth ePatientDave Sun 12 Dec 2010 17:17:15
RT @ePatientDave: There are now 96 randomized trials to test shared decision making #sgshealth kgapo Sun 12 Dec 2010 17:17:15
Re SDM (shared decision making) we say takes 2 to tango; "more like a square dance" - others are involved
(payers family etc) #sgshealth ePatientDave Sun 12 Dec 2010 17:19:05
Establishment needs to prove value shared decisionmaking RT @ePatientDave: 96 clinical trials #sgshealth #health20fr
#hcsmeu health20Paris Sun 12 Dec 2010 17:19:36
Mulley: there's a diff between one-time decisions and chronic decisions. #sgshealth ePatientDave Sun 12 Dec 2010 17:20:09
Mulley: "healthcare is a team sport." Often includes factors like family that influence health (smoker bad
cooking...) #sgshealth ePatientDave Sun 12 Dec 2010 17:20:47
Great: Mulley talking about realistic constraints e.g. pt saying "Doc I don't have bandwidth [or support] to do all
that" #sgshealth ePatientDave Sun 12 Dec 2010 17:21:32
RT @ePatientDave: Mulley: "healthcare is a team sport." Often includes factors like family that influence health
(smoker bad cooking...) #sgshealth crgonzalez Sun 12 Dec 2010 17:25:05
treatmts less often #sgshealth crgonzalez Sun 12 Dec 2010 17:25:16
Barry: "If provider knows yr prefs & u don't WANT to decide the words can come out of provider's mouth"
<=very dicey imo #sgshealth ePatientDave Sun 12 Dec 2010 17:25:54
#sgshealth Could an MD possibly make a less good decision when including patient input? health20Paris Sun 12 Dec 2010 17:26:37
@health20Paris Gotta define "good" lady... #sgshealth ePatientDave Sun 12 Dec 2010 17:27:12
Mike Barry: dangerous to only focus on tools better to think more about improving the process for shared-decision making.
#sgshealth FIMDM Sun 12 Dec 2010 17:27:20
Great: Mulley talking abt realistic constraints eg pt saying "Doc I don't have bandwidth [or support] to do all that"
#sgshealth #sgs477 kgapo Sun 12 Dec 2010 17:27:58
uh-oh my battery's pooping out- may have to switch to Droid #sgshealth ePatientDave Sun 12 Dec 2010 17:28:47
Mulley: Some of Wennberg's earliest work was informing docs in Maine how they compared to norm. They changed w/no
lever on them #sgshealth ePatientDave Sun 12 Dec 2010 17:30:34
@sgs477 #opnHealth #hcsmeu Mike Barry: dangerous 2 only focus on tools better 2 think more abt improvng process for
SDM #sgshealth kgapo Sun 12 Dec 2010 17:33:10
From Salzburg seminar: imagine health care providers having to compete on the quality of the shared decision-making
employed. #sgshealth garyschwitzer Sun 12 Dec 2010 17:36:02
Robt Johnston pres of IAPO #sgshealth telling fabulous story of troubleshooting his own near-migraines. Total e-patient.
Next pt speaking of how ovarian cancer *patients* were the ones to figure out it WASN'T "silent killer" - they had
symptoms #sgshealth ePatientDave Sun 12 Dec 2010 17:38:34
If Bill can ask us to define "is" I can define "good" RT @ePatientDave: @health20Paris Gotta define
"good" lady... #sgshealth health20Paris Sun 12 Dec 2010 17:44:07
That's a wrap for #sgshealth - it's dinnertime in Salzburg. Post your thoughts on http://e-patkents.net! ePatientDave Sun 12 Dec 2010 17:46:19

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@garyschwitzer Multidisciplinary teams (shared decision) are common in academic medicine #sgshealth medcareerist Sun 12 Dec 2010 17:50:20
@health20Paris Could an MD make a worse decision when including patient input? -> yes they could prescribe antibiotics
for colds #sgshealth Dr_Bob Sun 12 Dec 2010 17:56:18
RT @ePatientDave: @vmontori My opinion of course is that decision aids will never get used if they're pay per view
#sgshealth vmontori Sun 12 Dec 2010 17:57:37
@ePatientDave: OK. Long comment with no spell check. Hope it's what you're looking for. #sgshealth #e-patient Annie_Stith Sun 12 Dec 2010 18:09:30
RT @ePatientDave: There are now 96 randomized trials to test shared decision making #sgshealth cmeadvocate Sun 12 Dec 2010 18:33:02
RT @ePatientDave "healthcare is a team sport." Often includes factors like family that influence health (smoker
bad cooking...) #sgshealth CaringWise Sun 12 Dec 2010 19:13:00
@dr_bob an informed patient's input #sgshealth health20Paris Sun 12 Dec 2010 20:25:03
Michael Barry: What we are really dealing with is an agency problem - who decides and who suffers the consequences.
#sgshealth FIMDM Sun 12 Dec 2010 21:00:19

Beginning day 2 of #sgshealth Salzburg Global Seminar on informed medical decision making. Post: http://bit.ly/gTwnUE ePatientDave Mon 13 Dec 2010 08:11:55
Jack Wennberg lecturing: arrival of Medicare in LBJ administration raised concerns about system capacity. #sgshealth ePatientDave Mon 13 Dec 2010 08:13:41

Millions joined the system (1960s); goal of original data gathering was to detect and eliminate underserving. #sgshealth ePatientDave Mon 13 Dec 2010 08:15:09
RT @garyschwitzer: Salzburg seminar: imagine health care providers competing on quality of shared decision-making
#sgshealth doctorblogs Mon 13 Dec 2010 08:15:48
Wennberg: "What we found instead was chaotic patterns of service." [Note: w/o data u have no idea what to fix]
#sgshealth ePatientDave Mon 13 Dec 2010 08:16:17
RT @ePatientDave Al Mulley: Wennberg's earliest work compared docs in Maine to norm. They changed w/no lever on
them #sgshealth doctorblogs Mon 13 Dec 2010 08:17:11
Note: his data is *population* based (residence not where svc was done) #sgshealth ePatientDave Mon 13 Dec 2010 08:17:35
RT @ePatientDave: Jack Wennberg lecturing: arrival of Medicare in LBJ administration raised concerns about system
capacity. #sgshealth Infocept Mon 13 Dec 2010 08:19:10
Jack Wennberg reviewing early health care variations research with intn'l audience at global seminar in scenic snowy
Salzburg. #sgshealth garyschwitzer Mon 13 Dec 2010 08:19:11
RT @ePatientDave: Beginning day 2 of #sgshealth Salzburg Global Seminar on informed medical decision making. Post:
http://bit.ly/gTwnUE Infocept Mon 13 Dec 2010 08:19:18
A snowy Salzburg morning kicks off with John Wennberg on practice variation #sgshealth LaylaMcCay Mon 13 Dec 2010 08:19:45
Agree. It's abt *process* RT @FIMDM: Mike Barry: dangerous to only focus on tools...think more re shared-decision making
process #sgshealth doctorblogs Mon 13 Dec 2010 08:20:20

Example of practice variation: In Wennbergs' kids' childhood 1/4 had tonsils out; next town over 3/4 would have. #sgshealth ePatientDave Mon 13 Dec 2010 08:21:59
Tweetstream for #sgshealth Salzburg Global Seminar on health: http://wthashtag.com/Sgshealth ePatientDave Mon 13 Dec 2010 08:25:10
RT @ePatientDave: Tweetstream for #sgshealth Salzburg Global Seminar on health: http://wthashtag.com/Sgshealth eczemasupport Mon 13 Dec 2010 08:26:53
Tonsillectomy rates near Wennberg's home in Vermont before & after data was published #sgshealth
http://yfrog.com/h0buvqj ePatientDave Mon 13 Dec 2010 08:27:41
Wennberg:demographics of places with huge variation were almost identical-unwarranted variation and risk of iatrogenic
harm #sgshealth LaylaMcCay Mon 13 Dec 2010 08:27:55
http://yfrog.com/h3hb3tj Data showed overtreatmt led to as much risk of hosp-induced harm as risk of UNDERtreatmt
RT @ePatientDave: http://yfrog.com/h3hb3tj Data showed overtreatmt led to as much risk of hosp-induced harm as risk of
UNDERtreatmt #sgshealth eczemasupport Mon 13 Dec 2010 08:32:19
Analysis of prostate surgery (TUR) outcomes showed it *didn't* improve survival did improve quality of life #sgshealth ePatientDave Mon 13 Dec 2010 08:33:29

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All that was from analyzing Vermont Medicare data. In 90s when HC reform was in process did the same nationally
Prostate surgery is preference based issue-trade off:do you prefer good urination or good sex?How could doctors decide!
#sgshealth LaylaMcCay Mon 13 Dec 2010 08:35:51
Robert Wood Johnson Foundation gave grant to do it. They created 306 hospital referral regions. #sgshealth ePatientDave Mon 13 Dec 2010 08:36:56
Then Clinton bill didn't pass; all the data became The Dartmouth Atlas. #sgshealth ePatientDave Mon 13 Dec 2010 08:37:16
Variation that can't be explained by illness medical evidence or patient preferences is definition of unwarranted variation

Definition challenged: medical evidence doesn't change by region; definition modified to remove that aspect #sgshealth LaylaMcCay Mon 13 Dec 2010 08:39:33
Wennberg's work is about *unwarranted* variation in HC delivery both over AND under standard of care. #sgshealth ePatientDave Mon 13 Dec 2010 08:39:36
3 categories: Effective care preference-sensitive care ("matter of opinion") supply-sensitive. #sgshealth ePatientDave Mon 13 Dec 2010 08:40:32
3 types of unwarranted variation: effective care preference-sensitive care and supply sensitive care #sgshealth LaylaMcCay Mon 13 Dec 2010 08:41:02

"Effective care" = no medical debate that the treatmt is justified e.g. beta blockers after heart attack. #sgshealth ePatientDave Mon 13 Dec 2010 08:41:39
Note: the standard can change (e.g. whether hernia surgery is needed); this is about current std. #sgshealth ePatientDave Mon 13 Dec 2010 08:42:41
RT @LaylaMcCay: 3 types of unwarranted variation: effective care preference-sensitive care & supply-sensitive care

Preference-sensitive = tradeoffs exist: multiple options w diff. outcomes; shd be based on pt's preferences. #sgshealth ePatientDave Mon 13 Dec 2010 08:43:37
RT @ePatientDave: "Effective care" = no medical debate that the treatmt is justified e.g. beta blockers after
heart attack. #sgshealth calliopeconsult Mon 13 Dec 2010 08:44:03
No-brainer? Gentlemen:which wld you choose good sex or good peeing? RT @LaylaMcCay Prostate surgery is preference-
based trade off #sgshealth doctorblogs Mon 13 Dec 2010 08:45:14
RT @ePatientDave "Effective care"=no med Dbate that treatmt justified e.g. Œ≤ blockers after heart attack.
#sgshealth #sgs477 #opnHealth kgapo Mon 13 Dec 2010 08:45:36
Failure to base preference sensitive care options on patient preference is patient safety issueie operating on the wrong
patient #sgshealth LaylaMcCay Mon 13 Dec 2010 08:45:52
RT @ePatientDave: Preference-sensitive = tradeoffs exist: multiple options w diff. outcomes; shd be based on pt's
preferences. #sgshealth edrneelesh Mon 13 Dec 2010 08:47:01
RT @doctorblogs: RT @LaylaMcCay: 3 types of unwarranted variation: effective care preference-sensitive care &
supply-sensitive care #sgshealth edrneelesh Mon 13 Dec 2010 08:47:06
btw Wennberg's work on population healthcare data is summarized in new book Tracking Medicine #sgshealth ePatientDave Mon 13 Dec 2010 08:48:00
Is this Jack Wennberg talking? RT @LaylaMcCay Failure to base pref-sensitive care options on patient pref is patient safety
issue #sgshealth doctorblogs Mon 13 Dec 2010 08:48:24
RT @LaylaMcCay Failure 2 base prefrence senstve care options on pt prefrence is pt safty issueie opratng on the wrong pt
#sgshealth #sgs477 kgapo Mon 13 Dec 2010 08:49:19
@doctorblogs @LaylaMcCay yes Wennberg. Follow #sgshealth ePatientDave Mon 13 Dec 2010 08:50:15
#sgs477 tweeting from Salzburg on Informing & Involving Pts in Decsions about their medical care moves to
#sgshealth #opnHealth #hcsmeu kgapo Mon 13 Dec 2010 08:51:47
Salzberg shared-decision making conference this week: Follow #sgshealth & @ePatientDave @FIMDM @LaylaMcCay
@garyschwitzer [cc @cebmblog] doctorblogs Mon 13 Dec 2010 08:55:15
RT @LaylaMcCay: A snowy Salzburg morning kicks off with John Wennberg on practice variation #sgshealth mollytoba Mon 13 Dec 2010 08:57:25
You cannot predict the rate of one procedure by knowing rates for different procedures. #sgshealth LaylaMcCay Mon 13 Dec 2010 08:57:35
@UK_Urologist great! As long as it's *patient* choice. Do your patients go through a shared-decision making process?
#sgshealth cc @FIMDM doctorblogs Mon 13 Dec 2010 08:58:50

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RT @LaylaMcCay: Number of knee replacements directly relates to number of available orthopaedic surgeons #sgshealth kgapo Mon 13 Dec 2010 08:59:16
Greek orthopedic surgeons: do ur patients go thru a shared decision making process? #sgsHealth #opnHealth kgapo Mon 13 Dec 2010 09:00:19

RT @LaylaMcCay: You cannot predict the rate of one procedure by knowing rates for different procedures. #sgshealth doctorblogs Mon 13 Dec 2010 09:00:33
@lancet1 Salzberg shared-decision making conference this wk: Follow #sgshealth & @ePatientDave @FIMDM
@LaylaMcCay @garyschwitzer doctorblogs Mon 13 Dec 2010 09:01:18
Greek orthopedic surgeons: do ur patients go thru a shared decision making process bfr knee/hip replacement? #sgsHealth
#opnHealth kgapo Mon 13 Dec 2010 09:02:04
@BMJ_latest Salzberg shared-decision making conference this wk: Follow #sgshealth & @ePatientDave @FIMDM
@LaylaMcCay @garyschwitzer doctorblogs Mon 13 Dec 2010 09:02:05
RT @ePatientDave: Beginning day 2 of #sgshealth Salzburg Global Seminar on informed medical decision making. Post:
http://bit.ly/gTwnUE FIMDM Mon 13 Dec 2010 09:03:25
Hawker et al 2011 15% of people eligible for hip and knee replacement actually wanted surgery when preferences tested
RT @LaylaMcCay: A snowy Salzburg morning kicks off with John Wennberg on practice variation #sgshealth FIMDM Mon 13 Dec 2010 09:04:21
Determining need 4 hip/knee arthroplasty: the role of clinical serverity & pts preferencs (Hawker) discussed by Prf. J
Wennberg #sgsHealth kgapo Mon 13 Dec 2010 09:05:32
RT @kgapo ‚Äúthe patient is the first member of the medical team‚Äù http://bit.ly/h9Uiu7 via @health20Paris #sgs477
Do patient preferences vary by age? Probably: differing risk/benefit and side effect profile #sgshealth LaylaMcCay Mon 13 Dec 2010 09:11:54
Only 15% patients choose surgery RT @LaylaMcCay 15% people eligible for hip/knee replcmnt wanted op when pref's
tested.Hawker2011 #sgshealth doctorblogs Mon 13 Dec 2010 09:12:05
Patient preferences vary depending on age #sgshealth #opnHealth #hcsmeu kgapo Mon 13 Dec 2010 09:13:11
@engagementstrat Salzberg shared-decision making conference: Follow #sgshealth & @ePatientDave @FIMDM
@LaylaMcCay @garyschwitzer @glynelwyn doctorblogs Mon 13 Dec 2010 09:14:56
Mike Barry of @FIMDM says they've just published first large scale epidemiological study of decision quality #sgshealth
(need link!) ePatientDave Mon 13 Dec 2010 09:15:32

Informed consent current practice is flawed - asking people after process finds they're not really very informed #sgshealth LaylaMcCay Mon 13 Dec 2010 09:15:38
Wennberg: End of life variations - in some regions 30-40% of deaths happen in ICUs. (Ugh!) #sgshealth ePatientDave Mon 13 Dec 2010 09:17:56
Jack Wennberg: variations in end of life care easiest for consumers to understand and relate to bc of their own experiences.
#sgshealth mollytoba Mon 13 Dec 2010 09:19:03
We should be cautious in assuming doctors understand the evidence;might this be a barrier to delivering shared decision
making? #sgshealth LaylaMcCay Mon 13 Dec 2010 09:19:24
integrate patient preferences in EBM guidelines M Barry #sgshealth #opnHealth #hcsmeu kgapo Mon 13 Dec 2010 09:21:11
@ePatientDave http://bit.ly/f53gMF link to @fimdm Decisions Study #sgshealth mollytoba Mon 13 Dec 2010 09:23:36
Excerpt from Wennberg's new book "Tracking Medicine": http://www.trackingmedicine.com/excerpt.php
RT @ePatientDave:1st large scale epidemiological study of decision quality #sgshealth (need link) here 'tis:
http://bit.ly/f6hwEm #sgshealth garyschwitzer Mon 13 Dec 2010 09:23:54
@LaylaMcCay #sgshealth correct not all docs undrstand or I wld say know the evidence: barrier not only 2 SDM but 2 hlth
outcomes #opnHealth kgapo Mon 13 Dec 2010 09:24:48
@garyschwitzer @mollytoba Oh THAT famous study! Heard of it hadn't seen it. Thanks! #sgshealth ePatientDave Mon 13 Dec 2010 09:24:58

http://j.mp/gCPe1X ‚ôª @ePatientDave Note: his data is *population* based (residence not where svc was done) #sgshealth healthgist Mon 13 Dec 2010 09:25:18

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TY @kgapo 4 #sgshealth Salzburg Global Seminar 'Informing/Involving Pts in Decisions abt Their Med Care '
http://bit.ly/hfailv #hcsmeu #hcsm andrewspong Mon 13 Dec 2010 09:25:18
Clinical appropriateness s/b based on evidence; medical necessity s/b based on informed pt choice #sgshealth ePatientDave Mon 13 Dec 2010 09:26:25
The frequency of use is governed by the assumption that resources should be fully utilised #sgshealth LaylaMcCay Mon 13 Dec 2010 09:26:41
@Tabloidmed it's about understanding the pros & cons of treatment options & the patient's view... *not* abt
discouraging Tx #sgshealth doctorblogs Mon 13 Dec 2010 09:26:57
RT @kgapo: integrate patient preferences in EBM guidelines M Barry #sgshealth #opnHealth #hcsmeu <-- What plans for
this @cochranecollab? andrewspong Mon 13 Dec 2010 09:27:02
Jack Wennberg: evidenced-based medicine alone does not define medical necessity should be based on informed patient
choice. #sgshealth FIMDM Mon 13 Dec 2010 09:27:32
Now the juicy stuff: supply-sensitive care: Frequency of use is governed by assumption resources s/b fully utilized
RT @ePatientDave: Now the juicy stuff: supply-sensitive care: Frequency of use is governed by assumption resources s/b
fully utilized #sgshealth andrewspong Mon 13 Dec 2010 09:28:39
@Tabloidmed wow! That's not my understanding. Surely patients' views & inputs to their medical decisions is a good
thing? #sgshealth doctorblogs Mon 13 Dec 2010 09:30:22
RT @FIMDM: Jack Wennberg: evidenced-based medicine alone does not define medical necessity should be based on
informed patient choice. #sgshealth andrewspong Mon 13 Dec 2010 09:30:45
Specific medical theories & evidence play little role in governing use. #sgshealth ePatientDave Mon 13 Dec 2010 09:30:50
RT @garyschwitzer @ePatientDave 1st large scale epdemiological study of decsion quality #sgshealth http://bit.ly/‚Ä¶
http://twishort.com/ab5gh kgapo Mon 13 Dec 2010 09:30:54
RT @FIMDM: Jack Wennberg: evidenced-based medicine alone does not define medical necessity should be based on
informed patient choice. #sgshealth kgapo Mon 13 Dec 2010 09:31:30
@andrewspong Salzberg shared-decision making conference: Follow #sgshealth & @ePatientDave @FIMDM
@LaylaMcCay @garyschwitzer @glynelwyn doctorblogs Mon 13 Dec 2010 09:31:43
Jack Wennberg: in the absence of evidence and assuming that more is better available supply governs frequency of use.
#sgshealth mollytoba Mon 13 Dec 2010 09:31:45
Showed a graph of hip fracture vs bed census (no correlation) & chronic dx (very strong correlation) #sgshealth ePatientDave Mon 13 Dec 2010 09:32:00
@FIMDM Yes! patient-oriented evidence & outcomes not surrogate markers. #sgshealth andrewspong Mon 13 Dec 2010 09:32:54
RT @FIMDM Jack Wennberg: #EBM alone does not define medical necessity shld be based on informed patient choice
Chronic care in last 2 years of life is helpful for comparing variation as can't argue 'my patients are deader than yours'
contrasting practice patterns in managing chronic illness during the last 2 yrs of life Prof. J. Wennberg #sgsHealth
#opnHealth #hcsmeu kgapo Mon 13 Dec 2010 09:33:55
Physicians per 1000 deaths & % of deaths in ICU/by region: U of Wisconsin 17.3/16% UCLA Med Ctr 36.5/38%. Wow.
RT @doctorblogs: @andrewspong Salzberg shared-decision making conference: Follow #sgshealth & @ePatientDave
@FIMDM @LaylaMcCay @garyschwitzer @glynelwyn andrewspong Mon 13 Dec 2010 09:34:43
@LaylaMcCay #sgshealth layla I like your phlegmatic humour!! kgapo Mon 13 Dec 2010 09:34:54
RT @LaylaMcCay: Chronic care in last 2 years of life is helpful for comparing variation as can't argue 'my patients are
deader than yours' #sgshealth kgapo Mon 13 Dec 2010 09:35:09
Mayo Clinic 20.3/21.8%. #sgshealth ePatientDave Mon 13 Dec 2010 09:35:38
Jack Wennberg: #EBM alone does not define medical necessity shld be based on informed patient choice #sgshealth -via
@doctorblogs @FIMDM bacigalupe Mon 13 Dec 2010 09:35:56
The likelihood of dying in ICU is related to the number of ICU beds available in your area: supply-sensitive variation.

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Wennberg: there's pretty good evidence that more ICU beds in a region correlates w/ ignoring advance directives!
@andrewspong #sgshealth #opnHealth #hcsmeu no more the medical type eg AHRQ kgapo Mon 13 Dec 2010 09:36:34
Wennberg: costs of care at end of life at NYU twice that of U of Wisc driven by FTEs of MDs involved and %ICU
admits.#sgshealth FIMDM Mon 13 Dec 2010 09:36:49
Patients...The Greatest Untapped Resource in Healthcare? SharedDecisionMaking conf 12-17Dec http://bit.ly/eXV9qc
Likelihood of dying in ICU related to # of ICU beds available in your area: supply-sensitive variation #sgshealth -via
@LaylaMcCay bacigalupe Mon 13 Dec 2010 09:37:57
RT @doctorblogs: Patients...The Greatest Untapped Resource in Healthcare? SharedDecisionMaking conf 12-17Dec
http://bit.ly/eXV9qc #sgshealth shakingtree Mon 13 Dec 2010 09:38:03
Wennberg: even if there are advanced directives they are often ignored. #sgshealth FIMDM Mon 13 Dec 2010 09:38:15
RT @FIMDM: Wennberg: costs of care at end of life at NYU twice that of U of Wisc driven by FTEs of MDs involved and
%ICU admits.#sgshealth kgapo Mon 13 Dec 2010 09:38:15
@kgapo @epatientdave @LaylaMcCay hadn't even heard of this event. TY for bringing us into the room at #sgshealth :)
#hcsmeu #hcsm andrewspong Mon 13 Dec 2010 09:38:22
Wennberg: variations in end of life care easiest for consumers to understand/relate to bc of own experiences #sgshealth -
RT @mollytoba bacigalupe Mon 13 Dec 2010 09:38:50
@ePatientDave #sgshealth Dave advance directives do not exist in many countries #opnHealth #hcsmeu kgapo Mon 13 Dec 2010 09:39:26
Copayment (family's out of pocket expense) at end of life varies directly with those ICU numbers. Not just insurance issue.
RT @bacigalupe Wennberg #EBM not define medical necessity shd be based on informd patient choice #sgshealth via
@doctorblogs @FIMDM health20Paris Mon 13 Dec 2010 09:40:02
@kgapo OK but I'm hoping to hear more about clinical integration of patient reported *information* (PRI not the same as
PRO) #sgshealth andrewspong Mon 13 Dec 2010 09:40:14
http://bit.ly/eXV9qc #sgshealth Scottishpolicy Mon 13 Dec 2010 09:41:00
@bacigalupe Salzberg shared-decision making conf:follow #sgshealth @ePatientDave @FIMDM @LaylaMcCay
@garyschwitzer @glynelwyn @rmoynihan too doctorblogs Mon 13 Dec 2010 09:42:43
@andrewspong #sgshealth #hcsm haha! I caught U! U dont read me carfully had alrdy told #hcsmeu I was going &
asked abt other participants! kgapo Mon 13 Dec 2010 09:43:03
@@LaylaMcCay #sgshealth Layla was sitting just next to me tweeting fm blackberry and hd not realised it till now that we
spoke abt twitting! kgapo Mon 13 Dec 2010 09:46:03
@dianthusmed Patients...The Greatest Untapped Resource in Healthcare? SharedDecisionMaking conf 12-17Dec
http://bit.ly/eXV9qc #sgshealth doctorblogs Mon 13 Dec 2010 09:46:33
@dianthusmed Salzberg shared-decision making conf:follow #sgshealth @ePatientDave @FIMDM @LaylaMcCay
@garyschwitzer @glynelwyn @rmoynihan doctorblogs Mon 13 Dec 2010 09:47:48
@mjrobbins Patients...The Greatest Untapped Resource in Healthcare? SharedDecisionMaking conf12-17Dec
http://bit.ly/eXV9qc #sgshealth manteln Mon 13 Dec 2010 09:48:53
New 2 me via @doctorblogs Patients..Greatest Untapped Resource in Healthcare? Conf 12-17 Dec http://bit.ly/eXV9qc
#sgshealth #hcsmeu #hcsm lenstarnes Mon 13 Dec 2010 09:54:21
@lenstarnes Salzberg shared-decision making conf:follow #sgshealth @ePatientDave @FIMDM @LaylaMcCay
@manteln Salzberg shared-decision making conf:follow #sgshealth @ePatientDave @FIMDM @LaylaMcCay

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@dr_fiona Patients...The Greatest Untapped Resource in Healthcare? SharedDecisionMaking conf 12-17Dec
http://bit.ly/eXV9qc follow #sgshealth doctorblogs Mon 13 Dec 2010 10:03:27
RT @kgapo: #sgs477 tweeting from Salzburg on Informing & Involving Pts in Decsions about their medical care moves
to #sgshealth #opnHealth #hcsmeu ehealthgr Mon 13 Dec 2010 10:12:55
RT @kgapo: @sgs477 #opnHealth #hcsmeu Mike Barry: dangerous 2 only focus on tools better 2 think more abt improvng
process for SDM #sgshealth ehealthgr Mon 13 Dec 2010 10:13:25
Next: Angela Coulter author of "The Autonomous Patient: Ending Paternalism in Medical Care"
http://amzn.to/hGvUeF #sgshealth ePatientDave Mon 13 Dec 2010 10:17:54
RT @ePatientDave: Next: Angela Coulter author of "The Autonomous Patient: Ending Paternalism in Medical
Care" http://amzn.to/hGvUeF #sgshealth jkerrstevens Mon 13 Dec 2010 10:18:49
Coulter introduces Jennifer Dixon of UK's Nuffield Trust for Resch&Policy Studies http://bit.ly/9rCD69 by video
RT @ePatientDave: Coulter introduces Jennifer Dixon of UK's Nuffield Trust for Resch&Policy Studies
http://bit.ly/9rCD69 by video #sgshealth FIMDM Mon 13 Dec 2010 10:22:05
#sgshealth #opnHealth #hcsmeu Jennifer Dixon/Nuffield Trust Political economic and ethical consequences of practice
variations kgapo Mon 13 Dec 2010 10:22:14
Nuffield Trust set out to study how health systems across the globe are dealing w/economic downturn #sgshealth ePatientDave Mon 13 Dec 2010 10:23:47

(typo fix) Surprising similarity in all *countries*. One item: common need to get more value from HC pound/$. #sgshealth ePatientDave Mon 13 Dec 2010 10:25:23
Another common finding: the need to boost primary care in developed and poorer countries (e.g. UK and Uganda)
Angela Coulter The Autonomous Patient: Ending Paternalism in Medical Care http://amzn.to/hGv #sgsHealth #opnHealth
#hcsmeu kgapo Mon 13 Dec 2010 10:27:32
Jen Dixon howto involve individuals in SDM examples fm various countries #sgsHealth #opnHealth #hcsmeu kgapo Mon 13 Dec 2010 10:28:32
Singapore talked about variety of insur systems state pays for; they use health savings accts. #sgshealth ePatientDave Mon 13 Dec 2010 10:28:43
I believe this is the Nuffield Trust report Jen's talking about http://bit.ly/gyblna #sgshealth Sept 2010 ePatientDave Mon 13 Dec 2010 10:29:55
Finland in cutting deficit cut HC slowly. India cut cardiac care by streamlining hospital processes #sgshealth ePatientDave Mon 13 Dec 2010 10:31:40
Sweden: Community engagement in *design of new hospital* was crucial; result was *consumer* value for money.
Lesson fm Finland: if u wnt 2 keep social solidarity u dont cut on hc cost when defcit grows-kept hc during downturn in 90s-
now #sgshealth kgapo Mon 13 Dec 2010 10:33:08
Community engagement in designing local hospitals seems to improve efficiency (Sweden) #sgshealth LaylaMcCay Mon 13 Dec 2010 10:33:11
Good ideas should be adapted not just adopted (in different countries) #sgshealth LaylaMcCay Mon 13 Dec 2010 10:34:04
Variations in clinical practice: now more than ever must focus not just on cost but on *value* for the money #sgshealth ePatientDave Mon 13 Dec 2010 10:34:46
Design of the system can have significant effect on value - how we organize the care #sgshealth ePatientDave Mon 13 Dec 2010 10:35:12

Report last summer: emergency admissions in UK are growing 3-4%/yr - no justification for this #sgshealth. Most=0-1 day. ePatientDave Mon 13 Dec 2010 10:35:56

Emergency admissions rise by 3-4% each year in England; not related to increased illnessand most for <1 day #sgshealth LaylaMcCay Mon 13 Dec 2010 10:37:58
Dixon: a large amount of quality of care simply can't be measured. One reason for large variations in care. #sgshealth ePatientDave Mon 13 Dec 2010 10:39:10
discretion variotions due 2 lack of evidence based medicine - NICE in UK is doing vry work in ths field #sgshealth
#opnHealth #hcsmeu kgapo Mon 13 Dec 2010 10:39:14
Jennifer Dixon: in times of economic dowturn more imp to focus on drivers of healthcare costs and getting value for $.
#sgshealth FIMDM Mon 13 Dec 2010 10:39:22
Payment systems can enourage inflated use of care (supplier-induced demand) #sgshealth LaylaMcCay Mon 13 Dec 2010 10:39:37
in Europe gov R unlikely 2 tackle the medical profession 4 variations in profession #sgshealth #opnHealth #hcsmeu any
relation 2 Greece? kgapo Mon 13 Dec 2010 10:40:22

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Govt has been unlikely to attack variation by going at medical profession; more likely to use hospital payment as lever
RT @LaylaMcCay: Payment systems can enourage inflated use of care (supplier-induced demand) #sgshealth #opnHealth
#hcsmeu kgapo Mon 13 Dec 2010 10:41:23
Governments would rather change systems than address physician behaviour.What other professional groups incite such
reticence? #sgshealth LaylaMcCay Mon 13 Dec 2010 10:42:08
Dixon: govts in Europe reluctant to tackle clinical behavior/variation instead focus on payment reform and cost-sharing
#sgshealth FIMDM Mon 13 Dec 2010 10:42:18
RT @FIMDM Jen Dixon in times of economic dowturn more imp 2 focus on drivers of healthcare costs & getting value
4 $. #sgshealth #opnHealth kgapo Mon 13 Dec 2010 10:42:50
Coulter: plenty of data that variations exist; far less on what we can do about it. #sgshealth <=This is our task. ePatientDave Mon 13 Dec 2010 10:47:25
Need to adapt good practices from various countries and not just adopt them #sgshealth #opnHealth #hcsmeu kgapo Mon 13 Dec 2010 10:47:56

RT @LaylaMcCay: Community engagement in designing local hospitals seems to improve efficiency (Sweden) #sgshealth kgapo Mon 13 Dec 2010 10:48:41
Dixon: learned one reason for surging ED admissions: doc not confident about out of hospital care. #sgshealth ePatientDave Mon 13 Dec 2010 10:49:31
Jennifer Nixon UK Nuffield Trust: time when govts. can ignore huge variations in health care is long gone. #sgshealth garyschwitzer Mon 13 Dec 2010 10:49:34
The way we pay hospitals encourages reduction in length of stay and filling beds with more patients (plus risk averse
culture) #sgshealth LaylaMcCay Mon 13 Dec 2010 10:49:48
RT @FIMDM: Dixon: govts in Europe reluctant to tackle clinical behavior/variation instead focus on payment reform and
cost-sharing #sgshealth kgapo Mon 13 Dec 2010 10:50:11
Dixon: it appears (not confirmed) ER admission rates are related to whether beds are available. Lower where beds were cut.
RT @ePatientDave: Clinical appropriateness s/b based on evidence; medical necessity s/b based on informed pt choice
#sgshealth drtonyah Mon 13 Dec 2010 10:51:28
Dixon video finishes; Coulter leading discussion. #sgshealth ePatientDave Mon 13 Dec 2010 10:52:32

@KGApo: in Greece practice variation is NOT denied/debated - it's just taken as "this stuff happens" #sgshealth ePatientDave Mon 13 Dec 2010 10:52:52
@KGApo: Greece 1 of first nations to legislate patient rights (1992). Can select hospital & specialist they want
RT @kgapo: Lesson fm Finland: 2 keep social solidarity u dont cut on hc cost when defcit grows-kept hc during downturn in
90s-#sgshealth drtonyah Mon 13 Dec 2010 10:54:23
Jennifer Dixon (correct) UK Nuffield Trust: time when govts. can ignore huge variations in health care is long gone.
#sgshealth garyschwitzer Mon 13 Dec 2010 10:55:41

Greek patients gaming the system: 2-3 month delay to see oncologist(!) so pts go to ED w/fictional complaint #sgshealth ePatientDave Mon 13 Dec 2010 10:55:53
RT @kgapo: integrate patient preferences in EBM guidelines M Barry #sgshealth @FIMDM drtonyah Mon 13 Dec 2010 10:56:53

In Greece people use walk-in outpatient clinics to skip long waiting lists; government trying to instate gatekeeping #sgshealth LaylaMcCay Mon 13 Dec 2010 10:57:54
@KGApo No shared decision making in Greece - doc says "You're getting this surgery" no discussion allowed
RT @ePatientDave: Greek patients gaming the system: 2-3 month delay to see oncologist(!) so pts go to ED w/fictional
complaint #sgshealth Carolde Mon 13 Dec 2010 10:58:09
Is shared decision making too much of a luxury to implement in resource-poor countries? #sgshealth LaylaMcCay Mon 13 Dec 2010 10:59:33
RT @ePatientDave: @KGApo No shared decision making in Greece - doc says "You're getting this surgery" no
discussion allowed #sgshealth kgapo Mon 13 Dec 2010 10:59:42
complaint #sgshealth meducate Mon 13 Dec 2010 11:00:26

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How can this data follow the pt? RT @FIMDM: Wennberg: even if there are advanced directives they are often ignored.
#sgshealth drtonyah Mon 13 Dec 2010 11:00:32
RT @LaylaMcCay: In GR ppl use walk-in outpatient clinics 2 skip long waiting lists; gov trying 2 instate gatkeeping
#sgshealth #opnhealth kgapo Mon 13 Dec 2010 11:00:46
@kgapo doctors in Greece limited in # of test and treatments - neg effect of recent "austerity" measures or an
existing prob? #sgshealth mollytoba Mon 13 Dec 2010 11:00:53
@kgapo Wennberg's point was about cases where the hosp HAS the advanced directive and ignores it #sgshealth ePatientDave Mon 13 Dec 2010 11:01:31
RT @mollytoba @kgapo GRdocs limited in # of test/treatments/neg effect of Rcent austerty measures or an existng prob?
#sgshealth #opnHealth kgapo Mon 13 Dec 2010 11:03:02

China uses all different payment models. Big problem with shared decision making is widespread poor education #sgshealth ePatientDave Mon 13 Dec 2010 11:03:14
@ePatientDave #sgshealth txfor clarification kgapo Mon 13 Dec 2010 11:03:34
@ePatientDave #sgshealth it's not fictional rather complaints that cld be dealt w outside ED kgapo Mon 13 Dec 2010 11:05:05
China also has big issue with citizens not trusting docs thinking they're milking them for $ #sgshealth ePatientDave Mon 13 Dec 2010 11:05:25
@ePatientDave TU for the terrific tweets hope you make it to the Cafe Mozart Xmas market and Marionetten
#I<3Salzburg #sgshealth drtonyah Mon 13 Dec 2010 11:05:34
Can people with low health literacy meaningfully engage in shared decision making? Should we take a step back?
@drtonyah Got to Weinachtmarkt on Sunday before seminar started @ 3:30 #sgshealth ePatientDave Mon 13 Dec 2010 11:06:47
A. Coulter: cn pts w/ low educ level particpate in SDM?issue of health+digital literacy introducd #sgshealth #opnHealth
#hcsmeu #healthlit kgapo Mon 13 Dec 2010 11:08:49
South Africa uses shared decision making in HIV/AIDS:a readiness programme for starting ARVs to help decide when/if to
start. #sgshealth LaylaMcCay Mon 13 Dec 2010 11:10:13
In denial of death RT @ePatientDave: Wennberg: End of life variations - in some regions 30-40% of deaths happen in ICUs.
(Ugh!) #sgshealth drtonyah Mon 13 Dec 2010 11:12:22
It's fascinating to hear delegates from different countries discussing their systems. #sgshealth ePatientDave Mon 13 Dec 2010 11:12:46
RT @andrewspong: @kgapo @epatientdave @LaylaMcCay hadn't even heard event. TY for bringing us into the room at
#sgshealth :) #hcsmeu #hcsm MatthewBrowning Mon 13 Dec 2010 11:13:48
South africa: innov in HIV bc of resource constraints all pts on ARBs undergo a "readiness" program to educ on
disease and tx #sgshealth FIMDM Mon 13 Dec 2010 11:14:31
http://bit.ly/eXV9qc #sgshealth JulieLeask Mon 13 Dec 2010 11:14:54

#hcsmeu heads-up: great content coming out of #sgshealth c/o @kgapo @fimdm @epatientdave @laylamccay #hcsm andrewspong Mon 13 Dec 2010 11:15:12
RT @LaylaMcCay: South Africa uses shared decision making in HIV/AIDS:a readiness programme for starting ARVs to help
decide when/if to start. #sgshealth mollytoba Mon 13 Dec 2010 11:15:59
RT @meducate: RT @ePatientDave: Greek patients gaming the system: 2-3 month delay to see oncologist(!) so pts go to
ED w/fictional complaint #sgshealth KateEversole Mon 13 Dec 2010 11:16:03
@MatthewBrowning #sgshealth #hcsm solution: check #opnHealth #hcsmeu more closely hv twtd I was attending more than
3 times!! hv 2 find them kgapo Mon 13 Dec 2010 11:16:16
RT @andrewspong: #hcsmeu heads-up: great content coming out of #sgshealth c/o @kgapo @fimdm @epatientdave
@laylamccay #hcsm kgapo Mon 13 Dec 2010 11:16:31

@andrewspong: WTHashtag stream http://bit.ly/eY2Vsp; my intro post http://bit.ly/gTwnUE #sgshealth #hcsmeu #hcsm ePatientDave Mon 13 Dec 2010 11:16:45
RT @ePatientDave: @andrewspong: WTHashtag stream http://bit.ly/eY2Vsp; my intro post http://bit.ly/gTwnUE #sgshealth
#hcsmeu #hcsm andrewspong Mon 13 Dec 2010 11:18:11
In India too there is confrontation of traditional v. modern medicine #sgshealth #hcsmeu #opnHealth kgapo Mon 13 Dec 2010 11:18:14

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Greece China S.Africa India so far. RT @ePatientDave: fascinating to hear diff. countries' delegates discussing their
systems. #sgshealth garyschwitzer Mon 13 Dec 2010 11:18:21
@garyschwitzer Yeah it appears "global seminar" is truth in advertising! So glad to be here. #sgshealth ePatientDave Mon 13 Dec 2010 11:18:58
Interesting discussion of health decision making in different countries at #sgshealth. Thanks for the RT @vmontori cj_pope Mon 13 Dec 2010 11:19:03
huge disparities in health in India btwn rural and urban areas #sgshealth #opnHealth #hcsmeu kgapo Mon 13 Dec 2010 11:20:33
#hcsmeu #hcsm MatthewBrowning Mon 13 Dec 2010 11:22:09
India: rich patients tell doctors what they want but have sadly adopted the idea that "more is better" in terms of
medical tech #sgshealth mollytoba Mon 13 Dec 2010 11:22:37
in India docs vry much trusted treated as "gods"-little legislation on private hc-not monitoring of outcomes
#sgshealth #opnHealth #hcsmeu kgapo Mon 13 Dec 2010 11:23:14
RT @mollytoba: India: rich patients tell doctors what they want but have sadly adopted the idea that "more is
better" in terms of medical tech #sgshealth kgapo Mon 13 Dec 2010 11:23:24
My vote 4 "tweet of the day" #totd RT @andrewspong Yes!patient-oriented evidence&outcomesnot
surrogate markers #sgshealth doctorblogs Mon 13 Dec 2010 11:24:47
RT @garyschwitzer: Greece China S.Africa India so far. RT @ePatientDave: fascinating to hear diff. countries' delegates
discussing their systems. #sgshealth FIMDM Mon 13 Dec 2010 11:25:12
RT @doctorblogs: My vote 4 "tweet of the day" #totd RT @andrewspong Yes!patient-oriented
evidence&outcomesnot surrogate markers #sgshealth kgapo Mon 13 Dec 2010 11:25:32
Phillipines: Catholic church attempting to intervene to block reproductive health billl to limit choice #sgshealth mollytoba Mon 13 Dec 2010 11:29:05
very good presentation of hc system in Philippines #sgshealth #opnHealth #hcsmeu kgapo Mon 13 Dec 2010 11:30:35
This has been one of those sessions where there's so much to think about it's hard to live tweet. Lunch break now.
after lunch exercise in SDM to understand political background #sgshealth #opnHealth #hcsmeu kgapo Mon 13 Dec 2010 11:32:36
Is there room for shared decision making in child #vaccination? Could even encourg http://bit.ly/fAi9cB But needs more
discussion #sgshealth JulieLeask Mon 13 Dec 2010 11:43:07
RT @LaylaMcCay Good ideas should be adapted not just adopted (in different countries) #sgshealth #hcsmeu wissit Mon 13 Dec 2010 11:43:25
RT @andrewspong: #hcsmeu heads-up: great content coming out of #sgshealth c/o @kgapo @fimdm @epatientdave
@laylamccay #hcsm QiCProgramme Mon 13 Dec 2010 11:43:42
@kgapo hi thx for tweeting from #sgshealth ! wissit Mon 13 Dec 2010 11:43:56
Morning US! #sgshealth Salzburg Global Seminar @ lunch til 8am ET. Tweet stream & event info links:
http://bit.ly/eY2Vsp ePatientDave Mon 13 Dec 2010 11:44:34
Via @epatientdave - intro to #sgshealth http://bit.ly/gTwnUE ‚Äúthe most under-utilized resource in our info systems ‚Äì the
patient.‚Äù #hcsmeu QiCProgramme Mon 13 Dec 2010 11:45:39
RT @cj_pope: Interesting discussion of health decision making in different countries at #sgshealth. Thanks for the RT
@vmontori vmontori Mon 13 Dec 2010 11:47:48
Okay help me now. What's #sgshealth? Doctor_V Mon 13 Dec 2010 11:54:18
RT @Doctor_V: Okay help me now. What's #sgshealth? <-- See @epatientdave's tweet: http://bit.ly/fWHIfN #hcsm andrewspong Mon 13 Dec 2010 11:56:27
@Doctor_V: Guess? Telemedicine/ HealthIT Salzburg Global Seminar Tweet stream & event info links:
http://wthashtag.com/Sgshealth PracticalWisdom Mon 13 Dec 2010 11:56:40
@Doctor_V #sgshealth faculty abstract agenda: http://bit.ly/hfailv #hcsm andrewspong Mon 13 Dec 2010 11:58:11
RT @ePatientDave: Morning US! #sgshealth Salzburg Global Seminar @ lunch til 8am ET. Tweet stream & event info
links: http://bit.ly/eY2Vsp MatthewBrowning Mon 13 Dec 2010 12:15:01
RT @andrewspong: RT @Doctor_V: Okay help me now. What's #sgshealth? <-- See @epatientdave's tweet:
http://bit.ly/fWHIfN #hcsm MatthewBrowning Mon 13 Dec 2010 12:17:13
RT @garyschwitzer: Jennifer Dixon (correct) UK Nuffield Trust: time when govts. can ignore huge variations in health care is
long gone. #sgshealth rvaughnmd Mon 13 Dec 2010 12:21:07

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#hcsmeu #hcsm zenofbass Mon 13 Dec 2010 12:27:15

Repeat: #sgshealth Salzburg Global Seminar @ lunch til 8am ET. Tweet stream & event info links: http://bit.ly/eY2Vsp ePatientDave Mon 13 Dec 2010 12:31:41
RT @ePatientDave: Physicians per 1000 deaths & % of deaths in ICU/by region: U of Wisconsin 17.3/16% UCLA Med
Ctr 36.5/38%. Wow. #sgshealth swisshealth20 Mon 13 Dec 2010 12:40:21
RT @QiCProgramme: Via @epatientdave - intro to #sgshealth http://bit.ly/gTwnUE ‚Äúthe most under-utilized resource in
our info systems ‚Äì the patient.‚Äù #hcsmeu rainmakertom Mon 13 Dec 2010 12:40:31
RT @ePatientDave: Repeat: #sgshealth Salzburg Global Seminar @ lunch til 8am ET. Tweet stream & event info links:
http://bit.ly/eY2Vsp mkmackey Mon 13 Dec 2010 13:02:00
We're back. Woot - BMJ just invited 400 word blog posts from participants. Will I? Lemme think. :-) #sgshealth ePatientDave Mon 13 Dec 2010 13:08:23

Whoo: we're getting a group case study to work on - writing a memo to minister of health in an election year #sgshealth ePatientDave Mon 13 Dec 2010 13:09:38
By all means RT @ePatientDave: We're back. Woot - BMJ just invited 400 word blog posts from participants. Will I? Lemme
think :-) #sgshealth westr Mon 13 Dec 2010 13:10:11
RT @ePatientDave:We're back. Woot - BMJ just nvited 400 word blog posts frm participants. Will I? Lemme think. :-)
#sgshealth I suspect yes LeanThinker Mon 13 Dec 2010 13:12:03
RT @ePatientDave: Woot - BMJ just invited 400 word blog posts from participants. Will I? Lemme think. :-) #sgshealth <--
Nice idea BMJ #STM andrewspong Mon 13 Dec 2010 13:19:26

Is this on @doc2doc Dave? RT @ePatientDave: Woot - BMJ just invited 400 word blog posts from participants. #sgshealth Colleen_Young Mon 13 Dec 2010 13:21:40
RT @garyschwitzer: Greece China S.Africa India so far. RT @ePatientDave: fascinating to hear diff. countries' delegates
discussing their systems. #sgshealth chcradio Mon 13 Dec 2010 13:22:12
RT @ePatientDave Variations in clinical practice: now more than ever must focus not just on cost but on *value* for the
money #sgshealth susangiurleo Mon 13 Dec 2010 13:35:05
RT @ePatientDave: We're back. Woot - BMJ just invited 400 word blog posts from participants. Will I? Lemme think. :-)
#sgshealth MatthewBrowning Mon 13 Dec 2010 13:48:01
RT RT @ePatientDave: We're back. Woot - BMJ just invited 400 word blog posts from participants. Will I? Lemme think. :-)
#sgshealth Seanlogok Mon 13 Dec 2010 13:48:30
RT @cj_pope: Interesting discussion of health decision making in different countries at #sgshealth. Thanks for the RT
@vmontori #healthcare consultdoc Mon 13 Dec 2010 14:32:25
We're back from the case study (and tea) - I just got to present a simulated PSA for "You Deserve The Care You
Need"! #sgshealth ePatientDave Mon 13 Dec 2010 15:18:14
#sgshealth #opnHealth #hcsmeu 1st group @ePatientDave & Nadia Sawicki presenting kgapo Mon 13 Dec 2010 15:19:04
@Colleen_Young No clue. #sgshealth ePatientDave Mon 13 Dec 2010 15:19:25
@RAWarrior you really gotta e-meet 50 yr RA patient Richard Johnston of IAPO. You do skype? #sgshealth ePatientDave Mon 13 Dec 2010 15:20:27

@ePatientDave Dave you really sold your 30 sec spot! I think @fimdm needs to hire you to produce it! Priceless #sgshealth mollytoba Mon 13 Dec 2010 15:21:11
Wow Johnston's a smooth spokesman! He's simulating press conference for his case study group. #sgshealth ePatientDave Mon 13 Dec 2010 15:21:26
#sgshealth #opnHealth #hcsmeu 2nd group presenting Robert Johnstone and SAnjay Biwje addressing the
"Minister" kgapo Mon 13 Dec 2010 15:22:36
Johnston has chronic pain uses cane/wheelchair walks w/difficulty; gentle smile humor. Impressive. #sgshealth ePatientDave Mon 13 Dec 2010 15:22:41
Gr8 coverage by @ePatientDave of Salzburg Global Health: http://bit.ly/gTwnUE |Twitter stream http://bit.ly/eY2Vsp
#sgshealth #patiented janicemccallum Mon 13 Dec 2010 15:22:45
RT @kgapo: #sgshealth #opnHealth #hcsmeu SAnjay Biwje working with gov made a good point addressing the
"Minister" kgapo Mon 13 Dec 2010 15:24:03

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Now in day 2: #sgshealth Salzburg Global Seminar on informed medical decision making. Tweets & info links:
http://bit.ly/eY2Vsp ePatientDave Mon 13 Dec 2010 15:26:19
#sGshealth till now 323 twts by 54 contributors kgapo Mon 13 Dec 2010 15:29:05
complaint #sgshealth BioPharmaRob Mon 13 Dec 2010 15:30:19
#sgshealth How to persuade the minister to support shared decision making = sell short term gains involve patients get
media on side. glynelwyn Mon 13 Dec 2010 15:31:25
Thx @ePatientDave 4 #sgshealth Salzburg Global Seminar on informed medical decision making. Tweets & info links:
http://bit.ly/eY2Vsp LynetteMPH Mon 13 Dec 2010 15:31:35
Presenting result of our case study - "Minister of Health" @ table listens to advisor's pitch #sgshealth
http://yfrog.com/h3bkadj ePatientDave Mon 13 Dec 2010 15:36:36
#sgshealth #opnHealth #hcsmeu 3rd group presenting Richard Wexler addressing "Minister" kgapo Mon 13 Dec 2010 15:37:46
#sgshealth #opnHealth #hcsmeu out turn with Peggy Ford and Steven Laitner to address "Minister" kgapo Mon 13 Dec 2010 15:40:01
How can governments address supplier induced unwarranted variation?Groupwork scenario:involve all stakeholders and
educate? #sgshealth LaylaMcCay Mon 13 Dec 2010 15:40:53
#sgshealth Persuading the minister? Where's the patient orientated outcomes? Patients reify QOL over other outcomes
& r risk averse. glynelwyn Mon 13 Dec 2010 15:41:12
@LaylaMcCay #sgshealth I think this was unanimous agreement in all groups kgapo Mon 13 Dec 2010 15:41:56
@glynelwyn #sgshealth patients not sure when procedure is good for them this is how pt educ was suggested bfr any
decision making kgapo Mon 13 Dec 2010 15:44:09
Focus on providing holistic care:primarysecondary and tertiary;educate that tertiary care doesn't always equal best care
RT @LaylaMcCay: Focus on providing holistic care:primarysecondary and tertiary;educate that tertiary care doesn't always
equal best care #sgshealth kgapo Mon 13 Dec 2010 15:45:22
@LaylaMcCay #sgshealth and that when 3ry is refused this shld be EBM kgapo Mon 13 Dec 2010 15:46:24
PR is important tool in reducing unwarranted excess use of healthcare. Need to engage with media to educate public.
Major barrier in implementing shared decision making is perception that it's rationing by stealth #sgshealth LaylaMcCay Mon 13 Dec 2010 15:49:27
@LaylaMcCay #sgshealth not so sure mass media have been also used to manipulate or mislead public kgapo Mon 13 Dec 2010 15:52:09
#sgshealth Doing battle with anecdotes - be ready with the counter-anecdote. Model the good decision and give it to the
media. glynelwyn Mon 13 Dec 2010 15:52:10
Journalists need a narrative. A single person anecdote can sell shared decision making (or doom it!) #sgshealth LaylaMcCay Mon 13 Dec 2010 15:52:14
@LaylaMcCay #sgshealth not a single more individual stories kgapo Mon 13 Dec 2010 15:53:06

The single person anecdote is like a tactical human bomb. How do we make sure to use that power effectively? #sgshealth mollytoba Mon 13 Dec 2010 15:54:01
RT @ePatientDave: Analysis of prostate surgery (TUR) outcomes showed it *didn't* improve survival did improve quality of
life #sgshealth rkumar Mon 13 Dec 2010 17:03:43
@drdrew Patients...The Greatest Untapped Resource in Healthcare? SharedDecisionMaking conf 12-17Dec Salzberg
@Mtnmd Patients...The Greatest Untapped Resource in Healthcare? SharedDecisionMaking conf 12-17Dec Salzberg
Okay folks - #sgshealth is done for the day. (Forgot to tell y'all an hour ago!) Dinner. ePatientDave Mon 13 Dec 2010 17:49:28
@bamberjg @ehealthgr @patientopinion @Scottishpolicy @doctorblogs @Kiwfranc @edrneelesh thank your for RTs
#sgshealth #sgs477 kgapo Mon 13 Dec 2010 18:55:49
RT @kgapo: Angela Coulter The Autonomous Patient: Ending Paternalism in Medical Care http://amzn.to/hGv #sgsHealth
#opnHealth #hcsmeu ehealthgr Mon 13 Dec 2010 19:03:10

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@LaylaMcCay @wissit @QiCProgramme @MatthewBrowning @andrewspong @ePatientDave @mollytoba @drtonyah
@drtonyah #sgshealth #sgshealth kgapo Mon 13 Dec 2010 20:43:51
RT @ePatientDave: @KGApo: in Greece practice variation is NOT denied/debated - it's just taken as "this stuff
happens" #sgshealth kgapo Mon 13 Dec 2010 22:05:15
RT @ePatientDave: @KGApo: Greece 1 of first nations to legislate patient rights (1992). Can select hospital &
specialist they want #sgshealth kgapo Mon 13 Dec 2010 22:05:25
RT @mollytoba: @kgapo doctors in Greece limited in # of test and treatments - neg effect of recent "austerity"
measures or an existing prob? #sgshealth kgapo Mon 13 Dec 2010 22:06:21
RT @mollytoba: Phillipines: Catholic church attempting to intervene to block reproductive health billl to limit choice
#sgshealth jamespope Mon 13 Dec 2010 22:12:00
complaint #sgshealth fredtrotter Tue 14 Dec 2010 01:22:36
Day 3 of #sgshealth Salzburg Global Seminar on informed medical decision making. Tweetstream with links to info:
http://bit.ly/eY2Vsp ePatientDave Tue 14 Dec 2010 08:07:29
First session today: @GarySchwitzer of @HealthNewsRevu on impact of media & internet on consumer/patients
#sgshealth ePatientDave Tue 14 Dec 2010 08:10:41
Day 3 at the Salzburg Global Seminar kicks off with:influence of mass media&the internet on public perception of
medical care #sgshealth LaylaMcCay Tue 14 Dec 2010 08:10:52
@GarySchwitzer introducing Australian colleague Ray Moynihan who "invented" the Health News Review idea
Moynihan: why cover how media covers health? Media's a key info source not just for pts but media & HC
professionals #sgshealth ePatientDave Tue 14 Dec 2010 08:12:17
Media is key source of health info for patients health professionals and policymakers but are hugely flawed #sgshealth LaylaMcCay Tue 14 Dec 2010 08:12:31
Moynihan: there are fundamental flaws in the mechanisms of media info flow resulting in *false* inaccurate wrong stories
He realized in the 90s there were many forces feeding info to media - drug cos machine vendors etc #sgshealth ePatientDave Tue 14 Dec 2010 08:13:41
RT @LaylaMcCay: Media is key source of health info for patients health professionals and policymakers but are hugely
flawed #sgshealth FIMDM Tue 14 Dec 2010 08:14:36

#sgshealth roy moynihan - health reporting is driven by Press Release by promotion not by evidence - adverts not data glynelwyn Tue 14 Dec 2010 08:14:38
RT @ePatientDave: First session today: @GarySchwitzer of @HealthNewsRevu on impact of media & internet on
consumer/patients #sgshealth calliopeconsult Tue 14 Dec 2010 08:14:38
RT @LaylaMcCay: Day 3 at the Salzburg Global Seminar kicks off with:influence of mass media&the internet on public
perception of medical care #sgshealth mollytoba Tue 14 Dec 2010 08:15:09
Advertising and promotion often dressed up as news and journalism: big problem in health #sgshealth LaylaMcCay Tue 14 Dec 2010 08:15:11

Moynihan & a team @ Harvard created a methodical study of media coverage; 5 more since. Evidence. #sgshealth ePatientDave Tue 14 Dec 2010 08:15:21
#sgshealth #opnHealth #hcsmeu Roy Moynihan on unhealthy medical reporting kgapo Tue 14 Dec 2010 08:15:40
NEJM 2000 reported results. 200 news stories. How were benefits covered? Risks/harms? Conficts of interests covered?
#sgshealth moynihan NEJM 2000 = 200 media stories - comparing benefits and harms - were conflicts reported? benefits
exaggerated by 80% glynelwyn Tue 14 Dec 2010 08:16:17
80% of stories that quoted statistics exaggerated the benefits. Used relative risk not absolute figures. #sgshealth ePatientDave Tue 14 Dec 2010 08:16:24
80% of stories that quoted statistics exaggerated the benefits. Used relative risk not absolute figures. #sgshealth -via
@ePatientDave bacigalupe Tue 14 Dec 2010 08:16:53

RT @LaylaMcCay: Advertising and promotion often dressed up as news and journalism: big problem in health #sgshealth kgapo Tue 14 Dec 2010 08:16:57

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