Talk delivered at the Samsung Cancer Center to describe the potential of Connected Health approaches in solving many of the last mile problems in cancer care.

1. Bradford W. Hesse, PhD
Chief, Health Communication and Informatics Research
National Cancer Institute, Bethesda MD USA Samsung Cancer Center, Seoul South Korea

2. “Stronger”

3. Founded: February 14, 2005
Entries: 48 hours / minute
8 years / per day
Available in: 54 languages
Reach: 37 % global Internet*
Founded: January 15, 2001
Active Users: 33,201,183
Available in: 285 languages
Reach: 14 % global Internet*
* Total Global Internet Users (December 31, 2011): 2,267,233,742

4. Founded: September 4, 1998
Revenue: $109.65 billion
Distribution:World wide
Reach: 48 % global Internet*
* Total Global Internet Users (December 31, 2011): 2,267,233,742
Founded: February 4, 2004
Registered Users: 2.2 billion
Distribution:World wide
Reach: 45 % global Internet*

5. 0"
10"
20"
30"
40"
50"
60"
70"
80"
1991" 1992" 1993" 1994" 1995" 1996" 1997" 1998" 1999" 2000" 2001" 2002" 2003" 2004" 2005" 2006" 2007" 2008" 2009"
United"Arab"Emirates"
Brazil"
United"States"
Marshall"Islands"
China"
India"
Saint"KiBs"and"Nevis"
Source: http://data.worldbank.org/indicator/IT.NET.USER.P2 (through www.gapminder.org)
Internet Users (per 100 people)
Rapid Diffusion
Web Makes Internet “User
Friendly;” NSF Backbone
opened for public
Google Founded:
Web is searchable
YouTube Founded: User-
generated content
Wikipedia Goes Live:
Birth of “Crowd-sourcing”

6. 0"
50"
100"
150"
200"
250"
1986" 1987" 1988" 1989" 1990" 1991" 1992" 1993" 1994" 1995" 1996" 1997" 1998" 1999" 2000" 2001" 2002" 2003" 2004" 2005" 2006" 2007" 2008" 2009"
Mobile'cellular'subscrip.ons'(per'100'people)''
United"Arab"Emirates
United"States"
Marshall"Islands"
India"
China"
Brazil"
Saint"KiBs"and"Nevis"
Mobile Cellular Subscrip8ons (per 100 people)
Cellular “2nd Generation
(2G)” introduced
Blackberry Popularizes
“Smartphone” Functionality
Steve Jobs announces
“iPhone”

7. An Extraordinary
Opportunity
1999-2000

8. Experts recommend na8onal survey program on
changing communica8on environment
Cancer Risk Communication:
What We Know and What We Need to Learn
- NCI Monograph, No. 25, 1999.
• Changes in health information environment
• Usage across channels and sources nationally
• Combine channel usage with knowledge,
attitudes, behaviors
• Build an evidence base for planners,
administrators, communicators, practitioners,
and policy makers

9. The Health Information National
Trends Survey (HINTS)
(2003 - 2018)

10. Source: Hiatt, R. A. & Rimer, B. K. (1999). A new strategy for cancer control research. Cancer
Epidemiology, Biomarkers, and Prevention. 8, 957-964.
Cancer Control
Framework
Purpose is to inform fundamental research,
interven8on research, and program delivery

11. See also: Hesse BW, Nelson DE, Rutten LF, Moser RP, Beckjord EB, Chou W-YS. National Health Communication Surveillance Systems. In:
D. K. Kim ASGLK, ed. Global Health Communication Strategies in the 21st Century: Design, Implementation, and Evaluation. New
York, NY: Peter Lang; In Press.
Health Situa8onal Awareness

12. The HINTS Program: Open Science Community
(34)
9

13. 2003 2005 2007 2009 2011 2013 2015 2017 2019
List-assisted RDD
- C.A.T.I
N = 6369
RDD - C.A.T.I
+ Web
N = 5586
Dual Frame:
• RDD - C.A.T.I.
• Postal Sample
N = 7674
4-1 4-3 4-4
HINTS I HINTS II HINTS III HINTS IV
Postal Frame
n=3959 n=3630 n=3185 n=3677
4-2
Timeline: NCI Funded
Puerto Rico
HINTS V
Postal Frame
5-1
n=3,191
5-2
n=tbd
FDA
n=5414
Hualapai
Guam
Republic
of China
Hong
Kong
Appalachia
Delaware
CDC
Republic
of China
Germany
+ External Partners

14. Does Smoking
Increase Chances of
Cancer?
[Yellow low
agreement]
Age-Adjusted Death
Rates for Lung &
Bronchus Cancer.
Dark Red indicates
high death rates.
Combining HINTS + SEER Registry DataSurveillance

15. Tracking Health Informa8on Seeking in a
Changing Communica8on Environment
Source: Hesse BW, Nelson DE, Kreps GL, et al.Trust and sources of health information: the impact of the Internet and its implications for health care
providers: findings from the first Health Information NationalTrends Survey.Arch Intern Med. Dec 12-26 2005;165(22):2618-2624.
Surveillance

16. Where would you prefer to go for cancer informa8on?
Source: Hesse BW, Nelson DE, Kreps GL, et al.Trust and sources of health information: the impact of the Internet and its implications for health care
providers: findings from the first Health Information NationalTrends Survey.Arch Intern Med. Dec 12-26 2005;165(22):2618-2624.

17. Where did you go for cancer informa8on?
Source: Hesse BW, Nelson DE, Kreps GL, et al.Trust and sources of health information: the impact of the Internet and its implications for health care
providers: findings from the first Health Information NationalTrends Survey.Arch Intern Med. Dec 12-26 2005;165(22):2618-2624.

18. Source: Hesse BW, Moser RP, Rutten LJ. Surveys of physicians and electronic health information. N Engl J Med. Mar 4 2010;362(9):859-860.
Trends: 2002-2003, 2005, 2008

19. Extending Trends a`er “Meaningful Use” Legisla8on
for Health Informa8on Technology in U.S.

20. Adjusted Target
Source: Hesse, B.W., et al. (2014). "Meeting the healthy people 2020 goals: using the Health Information National Trends Survey to monitor
progress on health communication objectives." J Health Commun 19(12): 1497-1509.
Na8onal Goals: Healthy People 2010 & 2020
Objec8ves for Public Internet Access
Surveillance

21. Source: Hesse, B.W., et al. (2014). "Meeting the healthy people 2020 goals: using the Health Information National Trends Survey to monitor
progress on health communication objectives." J Health Commun 19(12): 1497-1509.
Age
Education
Gender
Race /Ethnicity
Healthy People 2010 & 2020 Goals:
The Digital Divide
Surveillance

22. The Rise of MobileSurveillance

23. Nearly eight in 10 individuals have a smartphone, and a majority of
individuals own 2 or more devices.
23
Percent of individuals who have a basic cell phone, electronic
monitoring device, smartphone, or tablet, 2017.
Number of devices individuals report owning, 2017.
0.0%
25.0%
50.0%
75.0%
100.0%
Basic Cell Tablet
78.9%
61.6%
34.0%
21.6%
0.2739
0.4427
0.2496
0.0338
No devices 1 device 2 devices 3 or more devices
Note: Examples of an electronic monitoring device include Fitbit,
blood glucose meters, and blood pressure monitors.
HINTS 2017 Data

24. More than four in 10 individuals reported having a health & wellness
app on their smartphone or tablet.
24
4.24
51.3
44.45
Percent of individuals who reported having health & wellness apps
on their smartphone or tablet, 2017.
HINTS 2017 Data

25. Over one-third of individuals used their smartphone or tablet to help
them discuss, track, or make decisions regarding their health.
25
Percent of individuals who reported using their smartphone or tablet to help
discuss, track, and make decisions regarding their health, 2017.
Used a smartphone or tablet to help you…
Discuss you health with your HCP
Make a decision about how to treat an illness or condi]on
Track progress on a health-related goal
0% 20% 40% 60% 80% 100%
42%
37%
33%
Note: The denominator for this analysis was restricted to the 84% of individuals who reported
owning a smartphone or tablet
HINTS 2017 Data

26. Future Trends to Track
(2018 - 2028)

27. Improving Cancer-Related
Outcomes with Connected Health
Connected Health

28. Time is now: Internet of Things

29. Time is now: Behavioral Evidence
June 2015, Office Behavioral and Social Science Research NIH-OD

30. Time is Now: Positive Clinical
Outcome Data from PRO-CTCAE
Basch, E., Deal, A. M., Dueck, A. C., Scher, H. I., Kris, M. G., Hudis, C., & Schrag, D. (2017). Overall Survival Results of
a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment. JAMA.

31. Source: https://prescancerpanel.cancer.gov/
Improve Care, Patient
Experience, Population Health

32. Strategic Recommendations

33. Promote Empowerment,
Engagement, Better Health
Source: https://www.samsung.com/us/samsung-health/

34. Building an “electronic
safety net” between
patients and care team
Bridge Disconnections in
Fragmented Care

35. Dissolving barriers between patient,
family, & care teams
Move from “Point of Care” to
“Point of Need”

36. Source: https://insights.samsung.com/2017/04/19/home-health-agency-turns-to-telemonitoring-to-reduce-readmission-rates-and-decrease-costs/?
cid=artpromo-041916
Allow for Healing at Home,
Aging in Place

37. Source: Peterson, S. K. & Patrick, K. Creating a Health InformationTechnology Infrastructure to Support
Comparative Effectiveness Research in Cancer, in Oncology Informatics, B.W. Hesse, D.K.Ahern, and E.B. Beckjord, Editors. 2016,
Elsevier: Boston, MA. p. 373-386.
Use Smart Home Approach for
Predictive, Preemptive Action

38. Reduce Friction in Measurement
through Passive Sensing

39. Provide for Continuous, Connected
Care across Lifespan
Patient’s Life Span
Childhood Adolescence Young Adulthood Working Life

40. Encourage “Data Altruism:”
Donating Data for Science

41. Enable a Learning Oncology
System with Continuous Data
Source: Richard Schilskdy & Robert Miller. merican Society of Clinical Oncology. Accelerating progress against cancer:
ASCO’s blueprint for transforming clinical and translational cancer research (ASCO, 2011).

42. Some Concluding Thoughts: Old
Questions & New

43. 43
Old question in Communication: How do we push a
one-way persuasive message to change all behavior?

44. 44
Institute of Medicine’s
Crossing the Quality
Chasm series
“Meaningful Use”
Safety, Quality
Improvement
Patient
Engagement
Continuity of
Care
Population
Health
Privacy,
Security TRUST
* Hesse, B.W., & Shneiderman, B. (2007). eHealth research from the user's
perspective.Am J Prev Med, 32(5 Suppl), S97-103.
New question: How do we structure the communication
environment to support self-determined pathways of health for
individuals, loved ones, and communities?

45. New question: How do we optimize opportunities within the
rapidly changing environments of the “new medicine?”
Source: Topol EJ.The creative destruction of medicine : how the digital revolution will create better health care.
NewYork: Basic Books; 2011.

46. “While someday the computerization of
medicine will surely be that long-awaited
disruptive innovation, today it is just
disruptive.”
Robert Wachter, Author of “The Digital Doctor”
“The real action – and the money – will
shift to creating innovative tools to allow
patients to stay healthy & manage
chronic illness, helping clinicians do their
work better …, and turn petabytes of data
into real intelligence.”
Robert Wachter, Author of “The Digital Doctor”
New question: How do we work together across systems and
across disciplines to create efficient, user-friendly solutions?

47. New question: How do we take advantage of the best aspects of
global connectivity to work together against cancer?

48. The Promise of Uni]ng Systems