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Salzburg	  Global	  Seminar	  on	  Informed	  Medical	  Decision	  Making,	  Dec.	  12-­‐17	  2010Text                    ...
Salzburg	  Global	  Seminar	  on	  Informed	  Medical	  Decision	  Making,	  Dec.	  12-­‐17	  2010Text                    ...
Salzburg	  Global	  Seminar	  on	  Informed	  Medical	  Decision	  Making,	  Dec.	  12-­‐17	  2010Text                    ...
Salzburg	  Global	  Seminar	  on	  Informed	  Medical	  Decision	  Making,	  Dec.	  12-­‐17	  2010Text                    ...
Salzburg	  Global	  Seminar	  on	  Informed	  Medical	  Decision	  Making,	  Dec.	  12-­‐17	  2010Text                    ...
Salzburg	  Global	  Seminar	  on	  Informed	  Medical	  Decision	  Making,	  Dec.	  12-­‐17	  2010Text                    ...
#sgshealth Twitter Archive
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#sgshealth Twitter Archive

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All tweets from the Salzburg Global Seminar on Informed Medical Decision Making, held Dec. 12-17 2010, through 1/14/11 with the hashtag #sgshealth.

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  1. 1. Salzburg  Global  Seminar  on  Informed  Medical  Decision  Making,  Dec.  12-­‐17  2010Text Username Created@ePatientDave I was thinking #sgshealth. Sound good? mollytoba Sun 12 Dec 2010 15:00:56We have a winner! RT @mollytoba @ePatientDave I was thinking #sgshealth. Sound good? ePatientDave Sun 12 Dec 2010 15:03:27At Salzburg Global Seminar:greatest untapped resource in healthcare?Informing+involving patients in decisions about their care #sgshealth LaylaMcCay Sun 12 Dec 2010 15:24:29Fascinating collection of people from 19 nations at Salzburg Global Seminar on informing/involving patients. #sgshealth is proper hashtag garyschwitzer Sun 12 Dec 2010 15:36:03RT @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 15:45:09RT @garyschwitzer: Fascinating collection of people from 19 nations at Salzburg Global Seminar on informing/involving patients. #sgshealth is proper hashtag mollytoba Sun 12 Dec 2010 15:46:04RT @garyschwitzer: Fascinating collection of people from 19 nations at Salzburg Global Seminar on informing/involving patients. #sgshealth is proper hashtag FIMDM Sun 12 Dec 2010 15:52:13Hey @rawarrior one of the participants @ #sgshealth is a #RA patient since age 3. Currently using meditation & ayurvedic. ePatientDave Sun 12 Dec 2010 15:57:59Listening to the real Jack Wennberg describe founding @FIMDM #sgshealth ePatientDave Sun 12 Dec 2010 16:02:04http://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 Dartmouths 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 16:21:58Also *increase* *warranted* variation: make care patient centered by personalizing treatment decisions. #sgshealth ePatientDave Sun 12 Dec 2010 16:23:36http://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. Im following too. :) jsperber Sun 12 Dec 2010 16:30:34@ElinSilveous Reminder thats #sGshealth not sqs ePatientDave Sun 12 Dec 2010 16:35:31Thank you Dave! Mind your Gs and qs folks. :) RT @ePatientDave: @ElinSilveous Reminder thats #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 16:51:06Jack was hated by mds. 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 theyre 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 17:02:22Now speaking #sgshealth: @FIMDM co-founder Al Mulley and president Mike Barry ePatientDave Sun 12 Dec 2010 17:02:45Mike 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 17:06:18Just learned about intl alliance of patient advocacy organizations http://bit.ly/hWB7Et - president is @ #sgshealth ePatientDave Sun 12 Dec 2010 17:06:25On e-patients.net: Salzburg Global Seminar on shared medical decision makinghttp://bit.ly/h0bYYP. Help me represent you. #sgshealth ePatientDave Sun 12 Dec 2010 17:07:00Mulley: one unanticipated outcome of SDM (shared decision making) was: pts chose expensive treatmts less often #sgshealth ePatientDave Sun 12 Dec 2010 17:07:57RT @ePatientDave: Mulley: one unanticipated outcome of SDM (shared decision making) was: pts chose expensive treatmts less often #sgshealth Stelerix Sun 12 Dec 2010 17:08:52Barry: SDM is about *2* way communic: info on options *to* patient; expression of preferences *from* pt is harder. #sgshealth ePatientDave Sun 12 Dec 2010 17:09:02RT @ePatientDave: Mulley: one unanticipated outcome of SDM (shared decision making) was: pts chose expensive 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"Youve got a belief that docs r scientists who make the right decision w very little uncertainty all the time; just isnt true" #sgshealth ePatientDave Sun 12 Dec 2010 17:15:53There are now 96 randomized trials to test shared decision making #sgshealth ePatientDave Sun 12 Dec 2010 17:16:21RT @ePatientDave: There are now 96 randomized trials to test shared decision making #sgshealth #hcsmeu #health20fr health20Paris Sun 12 Dec 2010 17:16:45@health20Paris (Thats 96 clinical trials *now* underway) #sgshealth ePatientDave Sun 12 Dec 2010 17:17:15RT @ePatientDave: There are now 96 randomized trials to test shared decision making #sgshealth kgapo Sun 12 Dec 2010 17:17:15Re 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 17:19:05Establishment needs to prove value shared decisionmaking RT @ePatientDave: 96 clinical trials #sgshealth #health20fr #hcsmeu health20Paris Sun 12 Dec 2010 17:19:36Mulley: theres a diff between one-time decisions and chronic decisions. #sgshealth ePatientDave Sun 12 Dec 2010 17:20:09Mulley: "healthcare is a team sport." Often includes factors like family that influence health (smoker bad cooking...) #sgshealth ePatientDave Sun 12 Dec 2010 17:20:47Great: Mulley talking about realistic constraints e.g. pt saying "Doc I dont have bandwidth [or support] to do all that" #sgshealth ePatientDave Sun 12 Dec 2010 17:21:32RT @ePatientDave: Mulley: "healthcare is a team sport." Often includes factors like family that influence health (smoker bad cooking...) #sgshealth crgonzalez Sun 12 Dec 2010 17:25:05RT @ePatientDave: Mulley: one unanticipated outcome of SDM (shared decision making) was: pts chose expensive treatmts less often #sgshealth crgonzalez Sun 12 Dec 2010 17:25:16Barry: "If provider knows yr prefs & u dont WANT to decide the words can come out of providers 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 17:27:12Mike 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 17:27:20Great: Mulley talking abt realistic constraints eg pt saying "Doc I dont have bandwidth [or support] to do all that" #sgshealth #sgs477 kgapo Sun 12 Dec 2010 17:27:58uh-oh my batterys pooping out- may have to switch to Droid #sgshealth ePatientDave Sun 12 Dec 2010 17:28:47Mulley: Some of Wennbergs 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 17:33:10From Salzburg seminar: imagine health care providers having to compete on the quality of the shared decision-making employed. #sgshealth garyschwitzer Sun 12 Dec 2010 17:36:02Robt Johnston pres of IAPO #sgshealth telling fabulous story of troubleshooting his own near-migraines. Total e-patient. #sgshealth ePatientDave Sun 12 Dec 2010 17:36:25Next pt speaking of how ovarian cancer *patients* were the ones to figure out it WASNT "silent killer" - they had symptoms #sgshealth ePatientDave Sun 12 Dec 2010 17:38:34If Bill can ask us to define "is" I can define "good" RT @ePatientDave: @health20Paris Gotta define "good" lady... #sgshealth health20Paris Sun 12 Dec 2010 17:44:07Thats a wrap for #sgshealth - its dinnertime in Salzburg. Post your thoughts on http://e-patkents.net! ePatientDave Sun 12 Dec 2010 17:46:19@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 17:56:18RT @ePatientDave: @vmontori My opinion of course is that decision aids will never get used if theyre pay per view #sgshealth vmontori Sun 12 Dec 2010 17:57:37 Page  1
  2. 2. Salzburg  Global  Seminar  on  Informed  Medical  Decision  Making,  Dec.  12-­‐17  2010Text Username Created@ePatientDave: OK. Long comment with no spell check. Hope its what youre looking for. #sgshealth #e-patient Annie_Stith Sun 12 Dec 2010 18:09:30RT @ePatientDave: There are now 96 randomized trials to test shared decision making #sgshealth cmeadvocate Sun 12 Dec 2010 18:33:02RT @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 patients input #sgshealth health20Paris Sun 12 Dec 2010 20:25:03Michael Barry: What we are really dealing with is an agency problem - who decides and who suffers the consequences. #sgshealth FIMDM Sun 12 Dec 2010 21:00:19Beginning day 2 of #sgshealth Salzburg Global Seminar on informed medical decision making. Post: http://bit.ly/gTwnUE ePatientDave Mon 13 Dec 2010 08:11:55Jack Wennberg lecturing: arrival of Medicare in LBJ administration raised concerns about system capacity. #sgshealth ePatientDave Mon 13 Dec 2010 08:13:41Millions joined the system (1960s); goal of original data gathering was to detect and eliminate underserving. #sgshealth ePatientDave Mon 13 Dec 2010 08:15:09RT @garyschwitzer: Salzburg seminar: imagine health care providers competing on quality of shared decision-making #sgshealth doctorblogs Mon 13 Dec 2010 08:15:48Wennberg: "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 08:16:17RT @ePatientDave Al Mulley: Wennbergs earliest work compared docs in Maine to norm. They changed w/no lever on them #sgshealth doctorblogs Mon 13 Dec 2010 08:17:11Note: his data is *population* based (residence not where svc was done) #sgshealth ePatientDave Mon 13 Dec 2010 08:17:35RT @ePatientDave: Jack Wennberg lecturing: arrival of Medicare in LBJ administration raised concerns about system capacity. #sgshealth Infocept Mon 13 Dec 2010 08:19:10Jack Wennberg reviewing early health care variations research with intnl audience at global seminar in scenic snowy Salzburg. #sgshealth garyschwitzer Mon 13 Dec 2010 08:19:11RT @ePatientDave: Beginning day 2 of #sgshealth Salzburg Global Seminar on informed medical decision making. Post: http://bit.ly/gTwnUE Infocept Mon 13 Dec 2010 08:19:18A snowy Salzburg morning kicks off with John Wennberg on practice variation #sgshealth LaylaMcCay Mon 13 Dec 2010 08:19:45Agree. Its 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 08:20:20Example 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 08:21:59Tweetstream for #sgshealth Salzburg Global Seminar on health: http://wthashtag.com/Sgshealth ePatientDave Mon 13 Dec 2010 08:25:10RT @ePatientDave: Tweetstream for #sgshealth Salzburg Global Seminar on health: http://wthashtag.com/Sgshealth eczemasupport Mon 13 Dec 2010 08:26:53Tonsillectomy rates near Wennbergs home in Vermont before & after data was published #sgshealth http://yfrog.com/h0buvqj ePatientDave Mon 13 Dec 2010 08:27:41Wennberg:demographics of places with huge variation were almost identical-unwarranted variation and risk of iatrogenic harm #sgshealth LaylaMcCay Mon 13 Dec 2010 08:27:55http://yfrog.com/h3hb3tj Data showed overtreatmt led to as much risk of hosp-induced harm as risk of UNDERtreatmt #sgshealth ePatientDave Mon 13 Dec 2010 08:30:34RT @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 08:32:19Analysis of prostate surgery (TUR) outcomes showed it *didnt* improve survival did improve quality of life #sgshealth ePatientDave Mon 13 Dec 2010 08:33:29All that was from analyzing Vermont Medicare data. In 90s when HC reform was in process did the same nationally #sgshealth ePatientDave Mon 13 Dec 2010 08:35:41Prostate 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 08:35:51Robert Wood Johnson Foundation gave grant to do it. They created 306 hospital referral regions. #sgshealth ePatientDave Mon 13 Dec 2010 08:36:56Then Clinton bill didnt pass; all the data became The Dartmouth Atlas. #sgshealth ePatientDave Mon 13 Dec 2010 08:37:16Variation that cant be explained by illness medical evidence or patient preferences is definition of unwarranted variation #sgshealth LaylaMcCay Mon 13 Dec 2010 08:37:23Definition challenged: medical evidence doesnt change by region; definition modified to remove that aspect #sgshealth LaylaMcCay Mon 13 Dec 2010 08:39:33Wennbergs work is about *unwarranted* variation in HC delivery both over AND under standard of care. #sgshealth ePatientDave Mon 13 Dec 2010 08:39:363 categories: Effective care preference-sensitive care ("matter of opinion") supply-sensitive. #sgshealth ePatientDave Mon 13 Dec 2010 08:40:323 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 08:41:39Note: the standard can change (e.g. whether hernia surgery is needed); this is about current std. #sgshealth ePatientDave Mon 13 Dec 2010 08:42:41RT @LaylaMcCay: 3 types of unwarranted variation: effective care preference-sensitive care & supply-sensitive care #sgshealth doctorblogs Mon 13 Dec 2010 08:43:34Preference-sensitive = tradeoffs exist: multiple options w diff. outcomes; shd be based on pts preferences. #sgshealth ePatientDave Mon 13 Dec 2010 08:43:37RT @ePatientDave: "Effective care" = no medical debate that the treatmt is justified e.g. beta blockers after heart attack. #sgshealth calliopeconsult Mon 13 Dec 2010 08:44:03No-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 08:45:14RT @ePatientDave "Effective care"=no med Dbate that treatmt justified e.g. Œ≤ blockers after heart attack. #sgshealth #sgs477 #opnHealth kgapo Mon 13 Dec 2010 08:45:36Failure to base preference sensitive care options on patient preference is patient safety issueie operating on the wrong patient #sgshealth LaylaMcCay Mon 13 Dec 2010 08:45:52RT @ePatientDave: Preference-sensitive = tradeoffs exist: multiple options w diff. outcomes; shd be based on pts preferences. #sgshealth edrneelesh Mon 13 Dec 2010 08:47:01RT @doctorblogs: RT @LaylaMcCay: 3 types of unwarranted variation: effective care preference-sensitive care & supply-sensitive care #sgshealth edrneelesh Mon 13 Dec 2010 08:47:06btw Wennbergs work on population healthcare data is summarized in new book Tracking Medicine #sgshealth ePatientDave Mon 13 Dec 2010 08:48:00Is 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 08:48:24RT @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 08:51:47Salzberg shared-decision making conference this week: Follow #sgshealth & @ePatientDave @FIMDM @LaylaMcCay @garyschwitzer [cc @cebmblog] doctorblogs Mon 13 Dec 2010 08:55:15RT @LaylaMcCay: A snowy Salzburg morning kicks off with John Wennberg on practice variation #sgshealth mollytoba Mon 13 Dec 2010 08:57:25You 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 its *patient* choice. Do your patients go through a shared-decision making process? #sgshealth cc @FIMDM doctorblogs Mon 13 Dec 2010 08:58:50RT @LaylaMcCay: Number of knee replacements directly relates to number of available orthopaedic surgeons #sgshealth kgapo Mon 13 Dec 2010 08:59:16Greek orthopedic surgeons: do ur patients go thru a shared decision making process? #sgsHealth #opnHealth kgapo Mon 13 Dec 2010 09:00:19RT @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 09:01:18Greek 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 09:02:05RT @ePatientDave: Beginning day 2 of #sgshealth Salzburg Global Seminar on informed medical decision making. Post: http://bit.ly/gTwnUE FIMDM Mon 13 Dec 2010 09:03:25Hawker et al 2011 15% of people eligible for hip and knee replacement actually wanted surgery when preferences tested #sgshealth LaylaMcCay Mon 13 Dec 2010 09:03:46RT @LaylaMcCay: A snowy Salzburg morning kicks off with John Wennberg on practice variation #sgshealth FIMDM Mon 13 Dec 2010 09:04:21Determining need 4 hip/knee arthroplasty: the role of clinical serverity & pts preferencs (Hawker) discussed by Prf. J Wennberg #sgsHealth kgapo Mon 13 Dec 2010 09:05:32RT @kgapo ‚Äúthe patient is the first member of the medical team‚Äù http://bit.ly/h9Uiu7 via @health20Paris #sgs477 #sgshealth doctorblogs Mon 13 Dec 2010 09:06:50 Page  2
  3. 3. Salzburg  Global  Seminar  on  Informed  Medical  Decision  Making,  Dec.  12-­‐17  2010Text Username CreatedDo patient preferences vary by age? Probably: differing risk/benefit and side effect profile #sgshealth LaylaMcCay Mon 13 Dec 2010 09:11:54Only 15% patients choose surgery RT @LaylaMcCay 15% people eligible for hip/knee replcmnt wanted op when prefs tested.Hawker2011 #sgshealth doctorblogs Mon 13 Dec 2010 09:12:05Patient 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 09:14:56Mike Barry of @FIMDM says theyve just published first large scale epidemiological study of decision quality #sgshealth (need link!) ePatientDave Mon 13 Dec 2010 09:15:32Informed consent current practice is flawed - asking people after process finds theyre not really very informed #sgshealth LaylaMcCay Mon 13 Dec 2010 09:15:38Wennberg: End of life variations - in some regions 30-40% of deaths happen in ICUs. (Ugh!) #sgshealth ePatientDave Mon 13 Dec 2010 09:17:56Jack 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 09:19:03We 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 09:19:24integrate 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 09:23:36Excerpt from Wennbergs new book "Tracking Medicine": http://www.trackingmedicine.com/excerpt.php #sgshealth ePatientDave Mon 13 Dec 2010 09:23:50RT @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 hadnt seen it. Thanks! #sgshealth ePatientDave Mon 13 Dec 2010 09:24:58http://j.mp/gCPe1X ‚ôª @ePatientDave Note: his data is *population* based (residence not where svc was done) #sgshealth healthgist Mon 13 Dec 2010 09:25:18TY @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 09:25:18Clinical appropriateness s/b based on evidence; medical necessity s/b based on informed pt choice #sgshealth ePatientDave Mon 13 Dec 2010 09:26:25The frequency of use is governed by the assumption that resources should be fully utilised #sgshealth LaylaMcCay Mon 13 Dec 2010 09:26:41@Tabloidmed its about understanding the pros & cons of treatment options & the patients view... *not* abt discouraging Tx #sgshealth doctorblogs Mon 13 Dec 2010 09:26:57RT @kgapo: integrate patient preferences in EBM guidelines M Barry #sgshealth #opnHealth #hcsmeu <-- What plans for this @cochranecollab? andrewspong Mon 13 Dec 2010 09:27:02Jack Wennberg: evidenced-based medicine alone does not define medical necessity should be based on informed patient choice. #sgshealth FIMDM Mon 13 Dec 2010 09:27:32Now the juicy stuff: supply-sensitive care: Frequency of use is governed by assumption resources s/b fully utilized #sgshealth ePatientDave Mon 13 Dec 2010 09:27:41RT @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! Thats not my understanding. Surely patients views & inputs to their medical decisions is a good thing? #sgshealth doctorblogs Mon 13 Dec 2010 09:30:22RT @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 09:30:45Specific medical theories & evidence play little role in governing use. #sgshealth ePatientDave Mon 13 Dec 2010 09:30:50RT @garyschwitzer @ePatientDave 1st large scale epdemiological study of decsion quality #sgshealth http://bit.ly/‚Ķ http://twishort.com/ab5gh kgapo Mon 13 Dec 2010 09:30:54RT @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 09:31:43Jack Wennberg: in the absence of evidence and assuming that more is better available supply governs frequency of use. #sgshealth mollytoba Mon 13 Dec 2010 09:31:45Showed 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 09:32:54RT @FIMDM Jack Wennberg: #EBM alone does not define medical necessity shld be based on informed patient choice #sgshealth doctorblogs Mon 13 Dec 2010 09:33:01Chronic care in last 2 years of life is helpful for comparing variation as cant argue my patients are deader than yours #sgshealth LaylaMcCay Mon 13 Dec 2010 09:33:16contrasting practice patterns in managing chronic illness during the last 2 yrs of life Prof. J. Wennberg #sgsHealth #opnHealth #hcsmeu kgapo Mon 13 Dec 2010 09:33:55Physicians per 1000 deaths & % of deaths in ICU/by region: U of Wisconsin 17.3/16% UCLA Med Ctr 36.5/38%. Wow. #sgshealth ePatientDave Mon 13 Dec 2010 09:34:17RT @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 09:34:54RT @LaylaMcCay: Chronic care in last 2 years of life is helpful for comparing variation as cant argue my patients are deader than yours #sgshealth kgapo Mon 13 Dec 2010 09:35:09Mayo Clinic 20.3/21.8%. #sgshealth ePatientDave Mon 13 Dec 2010 09:35:38Jack Wennberg: #EBM alone does not define medical necessity shld be based on informed patient choice #sgshealth -via @doctorblogs @FIMDM bacigalupe Mon 13 Dec 2010 09:35:56The likelihood of dying in ICU is related to the number of ICU beds available in your area: supply-sensitive variation. #sgshealth LaylaMcCay Mon 13 Dec 2010 09:36:17Wennberg: theres pretty good evidence that more ICU beds in a region correlates w/ ignoring advance directives! #sgshealth ePatientDave Mon 13 Dec 2010 09:36:21@andrewspong #sgshealth #opnHealth #hcsmeu no more the medical type eg AHRQ kgapo Mon 13 Dec 2010 09:36:34Wennberg: 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 09:36:49Patients...The Greatest Untapped Resource in Healthcare? SharedDecisionMaking conf 12-17Dec http://bit.ly/eXV9qc #sgshealth doctorblogs Mon 13 Dec 2010 09:37:43Likelihood of dying in ICU related to # of ICU beds available in your area: supply-sensitive variation #sgshealth -via @LaylaMcCay bacigalupe Mon 13 Dec 2010 09:37:57RT @doctorblogs: Patients...The Greatest Untapped Resource in Healthcare? SharedDecisionMaking conf 12-17Dec http://bit.ly/eXV9qc #sgshealth shakingtree Mon 13 Dec 2010 09:38:03Wennberg: even if there are advanced directives they are often ignored. #sgshealth FIMDM Mon 13 Dec 2010 09:38:15RT @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 hadnt even heard of this event. TY for bringing us into the room at #sgshealth :) #hcsmeu #hcsm andrewspong Mon 13 Dec 2010 09:38:22Wennberg: 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 09:39:26Copayment (familys out of pocket expense) at end of life varies directly with those ICU numbers. Not just insurance issue. #sgshealth ePatientDave Mon 13 Dec 2010 09:39:38RT @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 Im hoping to hear more about clinical integration of patient reported *information* (PRI not the same as PRO) #sgshealth andrewspong Mon 13 Dec 2010 09:40:14RT @doctorblogs: Patients...The Greatest Untapped Resource in Healthcare? SharedDecisionMaking conf 12-17Dec 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 doctorblogs Mon 13 Dec 2010 09:48:28 Page  3
  4. 4. Salzburg  Global  Seminar  on  Informed  Medical  Decision  Making,  Dec.  12-­‐17  2010Text Username CreatedRT @doctorblogs: Patients...The Greatest Untapped Resource in Healthcare? SharedDecisionMaking conf 12-17Dec http://bit.ly/eXV9qc #sgshealth manteln Mon 13 Dec 2010 09:48:53New 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 @garyschwitzer @glynelwyn @rmoynihan doctorblogs Mon 13 Dec 2010 09:59:56@manteln Salzberg shared-decision making conf:follow #sgshealth @ePatientDave @FIMDM @LaylaMcCay @garyschwitzer @glynelwyn @rmoynihan doctorblogs Mon 13 Dec 2010 10:00:19@dr_fiona Patients...The Greatest Untapped Resource in Healthcare? SharedDecisionMaking conf 12-17Dec http://bit.ly/eXV9qc follow #sgshealth doctorblogs Mon 13 Dec 2010 10:03:27RT @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 10:12:55RT @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 10:13:25Next: Angela Coulter author of "The Autonomous Patient: Ending Paternalism in Medical Care" http://amzn.to/hGvUeF #sgshealth ePatientDave Mon 13 Dec 2010 10:17:54RT @ePatientDave: Next: Angela Coulter author of "The Autonomous Patient: Ending Paternalism in Medical Care" http://amzn.to/hGvUeF #sgshealth jkerrstevens Mon 13 Dec 2010 10:18:49Coulter introduces Jennifer Dixon of UKs Nuffield Trust for Resch&Policy Studies http://bit.ly/9rCD69 by video #sgshealth ePatientDave Mon 13 Dec 2010 10:21:08RT @ePatientDave: Coulter introduces Jennifer Dixon of UKs 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 10:22:14Nuffield 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 10:25:23Another common finding: the need to boost primary care in developed and poorer countries (e.g. UK and Uganda) #sgshealth ePatientDave Mon 13 Dec 2010 10:26:36Angela Coulter The Autonomous Patient: Ending Paternalism in Medical Care http://amzn.to/hGv #sgsHealth #opnHealth #hcsmeu kgapo Mon 13 Dec 2010 10:27:32Jen Dixon howto involve individuals in SDM examples fm various countries #sgsHealth #opnHealth #hcsmeu kgapo Mon 13 Dec 2010 10:28:32Singapore talked about variety of insur systems state pays for; they use health savings accts. #sgshealth ePatientDave Mon 13 Dec 2010 10:28:43I believe this is the Nuffield Trust report Jens talking about http://bit.ly/gyblna #sgshealth Sept 2010 ePatientDave Mon 13 Dec 2010 10:29:55Finland in cutting deficit cut HC slowly. India cut cardiac care by streamlining hospital processes #sgshealth ePatientDave Mon 13 Dec 2010 10:31:40Sweden: Community engagement in *design of new hospital* was crucial; result was *consumer* value for money. #sgshealth ePatientDave Mon 13 Dec 2010 10:32:57Lesson 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 10:33:08Community engagement in designing local hospitals seems to improve efficiency (Sweden) #sgshealth LaylaMcCay Mon 13 Dec 2010 10:33:11Good ideas should be adapted not just adopted (in different countries) #sgshealth LaylaMcCay Mon 13 Dec 2010 10:34:04Variations 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 10:34:46Design of the system can have significant effect on value - how we organize the care #sgshealth ePatientDave Mon 13 Dec 2010 10:35:12Report 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 10:35:56Emergency admissions rise by 3-4% each year in England; not related to increased illnessand most for <1 day #sgshealth LaylaMcCay Mon 13 Dec 2010 10:37:58Dixon: a large amount of quality of care simply cant be measured. One reason for large variations in care. #sgshealth ePatientDave Mon 13 Dec 2010 10:39:10discretion 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 10:39:14Jennifer 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 10:39:22Payment systems can enourage inflated use of care (supplier-induced demand) #sgshealth LaylaMcCay Mon 13 Dec 2010 10:39:37in 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 10:40:22Govt has been unlikely to attack variation by going at medical profession; more likely to use hospital payment as lever #sgshealth ePatientDave Mon 13 Dec 2010 10:40:27RT @LaylaMcCay: Payment systems can enourage inflated use of care (supplier-induced demand) #sgshealth #opnHealth #hcsmeu kgapo Mon 13 Dec 2010 10:41:23Governments would rather change systems than address physician behaviour.What other professional groups incite such reticence? #sgshealth LaylaMcCay Mon 13 Dec 2010 10:42:08Dixon: govts in Europe reluctant to tackle clinical behavior/variation instead focus on payment reform and cost-sharing #sgshealth FIMDM Mon 13 Dec 2010 10:42:18RT @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 10:42:50Coulter: 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 10:47:25Need to adapt good practices from various countries and not just adopt them #sgshealth #opnHealth #hcsmeu kgapo Mon 13 Dec 2010 10:47:56RT @LaylaMcCay: Community engagement in designing local hospitals seems to improve efficiency (Sweden) #sgshealth kgapo Mon 13 Dec 2010 10:48:41Dixon: learned one reason for surging ED admissions: doc not confident about out of hospital care. #sgshealth ePatientDave Mon 13 Dec 2010 10:49:31Jennifer Nixon UK Nuffield Trust: time when govts. can ignore huge variations in health care is long gone. #sgshealth garyschwitzer Mon 13 Dec 2010 10:49:34The 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 10:49:48RT @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 10:50:11Dixon: it appears (not confirmed) ER admission rates are related to whether beds are available. Lower where beds were cut. #sgshealth ePatientDave Mon 13 Dec 2010 10:50:18RT @ePatientDave: Clinical appropriateness s/b based on evidence; medical necessity s/b based on informed pt choice #sgshealth drtonyah Mon 13 Dec 2010 10:51:28Dixon video finishes; Coulter leading discussion. #sgshealth ePatientDave Mon 13 Dec 2010 10:52:32@KGApo: in Greece practice variation is NOT denied/debated - its 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 #sgshealth ePatientDave Mon 13 Dec 2010 10:53:37RT @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 10:54:23Jennifer Dixon (correct) UK Nuffield Trust: time when govts. can ignore huge variations in health care is long gone. #sgshealth garyschwitzer Mon 13 Dec 2010 10:55:41Greek 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 10:55:53RT @kgapo: integrate patient preferences in EBM guidelines M Barry #sgshealth @FIMDM drtonyah Mon 13 Dec 2010 10:56:53In 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 "Youre getting this surgery" no discussion allowed #sgshealth ePatientDave Mon 13 Dec 2010 10:58:05RT @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 10:58:09Is shared decision making too much of a luxury to implement in resource-poor countries? #sgshealth LaylaMcCay Mon 13 Dec 2010 10:59:33RT @ePatientDave: @KGApo No shared decision making in Greece - doc says "Youre getting this surgery" no discussion allowed #sgshealth kgapo Mon 13 Dec 2010 10:59:42RT @ePatientDave: Greek patients gaming the system: 2-3 month delay to see oncologist(!) so pts go to ED w/fictional complaint #sgshealth meducate Mon 13 Dec 2010 11:00:26How 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 11:00:32RT @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 Wennbergs point was about cases where the hosp HAS the advanced directive and ignores it #sgshealth ePatientDave Mon 13 Dec 2010 11:01:31 Page  4
  5. 5. Salzburg  Global  Seminar  on  Informed  Medical  Decision  Making,  Dec.  12-­‐17  2010Text Username CreatedRT @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 11:03:02China 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 its not fictional rather complaints that cld be dealt w outside ED kgapo Mon 13 Dec 2010 11:05:05China also has big issue with citizens not trusting docs thinking theyre 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 11:05:34Can people with low health literacy meaningfully engage in shared decision making? Should we take a step back? #sgshealth LaylaMcCay Mon 13 Dec 2010 11:06:29@drtonyah Got to Weinachtmarkt on Sunday before seminar started @ 3:30 #sgshealth ePatientDave Mon 13 Dec 2010 11:06:47A. 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 11:08:49South 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 11:10:13In 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 11:12:22Its fascinating to hear delegates from different countries discussing their systems. #sgshealth ePatientDave Mon 13 Dec 2010 11:12:46RT @andrewspong: @kgapo @epatientdave @LaylaMcCay hadnt even heard event. TY for bringing us into the room at #sgshealth :) #hcsmeu #hcsm MatthewBrowning Mon 13 Dec 2010 11:13:48South 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 11:14:31RT @doctorblogs: Patients...The Greatest Untapped Resource in Healthcare? SharedDecisionMaking conf 12-17Dec 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 11:15:12RT @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 11:15:59RT @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 11:16:16RT @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 11:16:45RT @ePatientDave: @andrewspong: WTHashtag stream http://bit.ly/eY2Vsp; my intro post http://bit.ly/gTwnUE #sgshealth #hcsmeu #hcsm andrewspong Mon 13 Dec 2010 11:18:11In India too there is confrontation of traditional v. modern medicine #sgshealth #hcsmeu #opnHealth kgapo Mon 13 Dec 2010 11:18:14Greece 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 11:18:58Interesting discussion of health decision making in different countries at #sgshealth. Thanks for the RT @vmontori cj_pope Mon 13 Dec 2010 11:19:03huge disparities in health in India btwn rural and urban areas #sgshealth #opnHealth #hcsmeu kgapo Mon 13 Dec 2010 11:20:33RT @ePatientDave: @andrewspong: WTHashtag stream http://bit.ly/eY2Vsp; my intro post http://bit.ly/gTwnUE #sgshealth #hcsmeu #hcsm MatthewBrowning Mon 13 Dec 2010 11:22:09India: 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 11:22:37in 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 11:23:14RT @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 11:23:24My vote 4 "tweet of the day" #totd RT @andrewspong Yes!patient-oriented evidence&outcomesnot surrogate markers #sgshealth doctorblogs Mon 13 Dec 2010 11:24:47RT @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 11:25:12RT @doctorblogs: My vote 4 "tweet of the day" #totd RT @andrewspong Yes!patient-oriented evidence&outcomesnot surrogate markers #sgshealth kgapo Mon 13 Dec 2010 11:25:32Phillipines: Catholic church attempting to intervene to block reproductive health billl to limit choice #sgshealth mollytoba Mon 13 Dec 2010 11:29:05very good presentation of hc system in Philippines #sgshealth #opnHealth #hcsmeu kgapo Mon 13 Dec 2010 11:30:35This has been one of those sessions where theres so much to think about its hard to live tweet. Lunch break now. #sgshealth ePatientDave Mon 13 Dec 2010 11:31:26after lunch exercise in SDM to understand political background #sgshealth #opnHealth #hcsmeu kgapo Mon 13 Dec 2010 11:32:36Is 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 11:43:07RT @LaylaMcCay Good ideas should be adapted not just adopted (in different countries) #sgshealth #hcsmeu wissit Mon 13 Dec 2010 11:43:25RT @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 11:43:56Morning US! #sgshealth Salzburg Global Seminar @ lunch til 8am ET. Tweet stream & event info links: http://bit.ly/eY2Vsp ePatientDave Mon 13 Dec 2010 11:44:34Via @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 11:45:39RT @cj_pope: Interesting discussion of health decision making in different countries at #sgshealth. Thanks for the RT @vmontori vmontori Mon 13 Dec 2010 11:47:48Okay help me now. Whats #sgshealth? Doctor_V Mon 13 Dec 2010 11:54:18RT @Doctor_V: Okay help me now. Whats #sgshealth? <-- See @epatientdaves 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 11:58:11RT @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 12:15:01RT @andrewspong: RT @Doctor_V: Okay help me now. Whats #sgshealth? <-- See @epatientdaves tweet: http://bit.ly/fWHIfN #hcsm MatthewBrowning Mon 13 Dec 2010 12:17:13RT @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 12:21:07RT @ePatientDave: @andrewspong: WTHashtag stream http://bit.ly/eY2Vsp; my intro post http://bit.ly/gTwnUE #sgshealth #hcsmeu #hcsm zenofbass Mon 13 Dec 2010 12:27:15Repeat: #sgshealth Salzburg Global Seminar @ lunch til 8am ET. Tweet stream & event info links: http://bit.ly/eY2Vsp ePatientDave Mon 13 Dec 2010 12:31:41RT @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 12:40:21RT @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 12:40:31RT @ePatientDave: Repeat: #sgshealth Salzburg Global Seminar @ lunch til 8am ET. Tweet stream & event info links: http://bit.ly/eY2Vsp mkmackey Mon 13 Dec 2010 13:02:00Were back. Woot - BMJ just invited 400 word blog posts from participants. Will I? Lemme think. :-) #sgshealth ePatientDave Mon 13 Dec 2010 13:08:23Whoo: were 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 13:09:38By all means RT @ePatientDave: Were back. Woot - BMJ just invited 400 word blog posts from participants. Will I? Lemme think :-) #sgshealth westr Mon 13 Dec 2010 13:10:11RT @ePatientDave:Were back. Woot - BMJ just nvited 400 word blog posts frm participants. Will I? Lemme think. :-) #sgshealth I suspect yes LeanThinker Mon 13 Dec 2010 13:12:03RT @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 13:19:26Is this on @doc2doc Dave? RT @ePatientDave: Woot - BMJ just invited 400 word blog posts from participants. #sgshealth Colleen_Young Mon 13 Dec 2010 13:21:40RT @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 Page  5
  6. 6. Salzburg  Global  Seminar  on  Informed  Medical  Decision  Making,  Dec.  12-­‐17  2010Text Username CreatedRT @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 13:35:05RT @ePatientDave: Were back. Woot - BMJ just invited 400 word blog posts from participants. Will I? Lemme think. :-) #sgshealth MatthewBrowning Mon 13 Dec 2010 13:48:01RT RT @ePatientDave: Were back. Woot - BMJ just invited 400 word blog posts from participants. Will I? Lemme think. :-) #sgshealth Seanlogok Mon 13 Dec 2010 13:48:30RT @cj_pope: Interesting discussion of health decision making in different countries at #sgshealth. Thanks for the RT @vmontori #healthcare consultdoc Mon 13 Dec 2010 14:32:25Were 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 15:21:11Wow Johnstons a smooth spokesman! Hes 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 15:22:36Johnston has chronic pain uses cane/wheelchair walks w/difficulty; gentle smile humor. Impressive. #sgshealth ePatientDave Mon 13 Dec 2010 15:22:41Gr8 coverage by @ePatientDave of Salzburg Global Health: http://bit.ly/gTwnUE |Twitter stream http://bit.ly/eY2Vsp #sgshealth #patiented janicemccallum Mon 13 Dec 2010 15:22:45RT @kgapo: #sgshealth #opnHealth #hcsmeu SAnjay Biwje working with gov made a good point addressing the "Minister" kgapo Mon 13 Dec 2010 15:24:03Now 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 15:29:05RT @ePatientDave: Greek patients gaming the system: 2-3 month delay to see oncologist(!) so pts go to ED w/fictional 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 15:31:25Thx @ePatientDave 4 #sgshealth Salzburg Global Seminar on informed medical decision making. Tweets & info links: http://bit.ly/eY2Vsp LynetteMPH Mon 13 Dec 2010 15:31:35Presenting result of our case study - "Minister of Health" @ table listens to advisors 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 15:40:01How 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? Wheres 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 15:44:09Focus on providing holistic care:primarysecondary and tertiary;educate that tertiary care doesnt always equal best care #sgshealth LaylaMcCay Mon 13 Dec 2010 15:44:28RT @LaylaMcCay: Focus on providing holistic care:primarysecondary and tertiary;educate that tertiary care doesnt 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 15:46:24PR is important tool in reducing unwarranted excess use of healthcare. Need to engage with media to educate public. #sgshealth LaylaMcCay Mon 13 Dec 2010 15:47:54Major barrier in implementing shared decision making is perception that its 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 15:52:10Journalists 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 15:53:06The 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 15:54:01RT @ePatientDave: Analysis of prostate surgery (TUR) outcomes showed it *didnt* 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 http://bit.ly/eXV9qc #sgshealth doctorblogs Mon 13 Dec 2010 17:42:48@Mtnmd Patients...The Greatest Untapped Resource in Healthcare? SharedDecisionMaking conf 12-17Dec Salzberg http://bit.ly/eXV9qc #sgshealth doctorblogs Mon 13 Dec 2010 17:43:24Okay folks - #sgshealth is done for the day. (Forgot to tell yall 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 18:55:49RT @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@LaylaMcCay @wissit @QiCProgramme @MatthewBrowning @andrewspong @ePatientDave @mollytoba @drtonyah @drtonyah #sgshealth #sgshealth kgapo Mon 13 Dec 2010 20:43:51RT @ePatientDave: @KGApo: in Greece practice variation is NOT denied/debated - its just taken as "this stuff happens" #sgshealth kgapo Mon 13 Dec 2010 22:05:15RT @ePatientDave: @KGApo: Greece 1 of first nations to legislate patient rights (1992). Can select hospital & specialist they want #sgshealth kgapo Mon 13 Dec 2010 22:05:25RT @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 22:06:21RT @mollytoba: Phillipines: Catholic church attempting to intervene to block reproductive health billl to limit choice #sgshealth jamespope Mon 13 Dec 2010 22:12:00RT @ePatientDave: Greek patients gaming the system: 2-3 month delay to see oncologist(!) so pts go to ED w/fictional complaint #sgshealth fredtrotter Tue 14 Dec 2010 01:22:36Day 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 08:07:29First session today: @GarySchwitzer of @HealthNewsRevu on impact of media & internet on consumer/patients #sgshealth ePatientDave Tue 14 Dec 2010 08:10:41Day 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 #sgshealth ePatientDave Tue 14 Dec 2010 08:11:33Moynihan: why cover how media covers health? Medias a key info source not just for pts but media & HC professionals #sgshealth ePatientDave Tue 14 Dec 2010 08:12:17Media is key source of health info for patients health professionals and policymakers but are hugely flawed #sgshealth LaylaMcCay Tue 14 Dec 2010 08:12:31Moynihan: there are fundamental flaws in the mechanisms of media info flow resulting in *false* inaccurate wrong stories #sgshealth ePatientDave Tue 14 Dec 2010 08:12:47He realized in the 90s there were many forces feeding info to media - drug cos machine vendors etc #sgshealth ePatientDave Tue 14 Dec 2010 08:13:41RT @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 08:14:38RT @ePatientDave: First session today: @GarySchwitzer of @HealthNewsRevu on impact of media & internet on consumer/patients #sgshealth calliopeconsult Tue 14 Dec 2010 08:14:38RT @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 08:15:09Advertising and promotion often dressed up as news and journalism: big problem in health #sgshealth LaylaMcCay Tue 14 Dec 2010 08:15:11Moynihan & 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 08:15:40NEJM 2000 reported results. 200 news stories. How were benefits covered? Risks/harms? Conficts of interests covered? #sgshealth ePatientDave Tue 14 Dec 2010 08:15:54 Page  6
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