Consumer Health
  Informatics
  & Pharmacy


   Kevin A. Clauson, PharmD
Note
The following slide deck is from
   the introductory lecture of
 Consumer Health Informatics
  and Web 2.0 in Healthcare
  (NSU College of Pharmacy)
Objectives
Explore assumptions about
pharmacy and roles in consumer
health informatics (CHI)
Define terminology and concepts
used in CHI
Objectives
Explain the philosophical shift in
healthcare with the participatory
medicine model

Review the evolution of:
Web 1.0 -> Web 2.0 -> Web 3.0
What will the
  future of
pharmacy look
    like?
Is the
 profession’s
future limited
   to this?
Or will it feature more of this…
…and maybe look more like this?
http://vimeo.com/14032810
Contact lenses that change
color with variations in glucose
and can dispense medications




      Advanced Functional Materials 2008;18(13):1912-21.
Assumptions about Pharmacy


     Ass u me
Question:
What
percentage of
pharmacists
work in
community
settings?
(e.g., CVS, Duane
Reade, Walgreens)
65%*
                                                                                                 Answer:




*of the 269,900 pharmacists in the US
   Source: Bureau of Labor Statistics, Occupational Employment Statistics (29-1051), May 2010.
Location quotient of pharmacists by area




                                                                                             Location quotient

                                                                                                 0.40 – 0.76

                                                                                                 0.77 – 0.89

                                                                                                  0.90 – 1.00

                                                                                                 1.01 – 1.10


                                                                                                 1.11 – 1.28

                                                                                                  1.29 – 2.07

Source: Bureau of Labor Statistics, Occupational Employment Statistics (29-1051), May 2010
Q: How many pharmacists in the US
have a Doctor of Pharmacy (Pharm.D.)?
2009 National Pharmacist Workforce Study




     A: Only about 1 in 4
(proportion increased from 13.9% in 2000 to 21.9% in 2009)
Terminology
Informatics


 “’Use of computers to manage
   data and information’ and
represents the nexus of people,
 information, and technology”


   Building Core Competencies in Pharmacy Informatics, 2010.
                Am J Pharm Educ 2011;75(5):93.
Pharmacy Informatics

“Use and integration of data,
information, knowledge, and
  technology involved with
 medication use processes to
     improve outcomes”

     Am J Health-Syst Pharm. 2007;64(2):200-203.
          Am J Pharm Educ. 2008;72(4):89.
Consumer Health Informatics
           (Eysenbach Definition)

   “analyses consumers' needs for
   information;
   studies and implements methods of
   making information accessible to
   consumers;
   and models and integrates consumers'
   preferences into medical information
   systems”


            BMJ 2000; 320(7251):1713-6.
CHI Definition
     “any electronic tool, technology, or
  electronic application that is designed to
  interact directly with consumers, with or
    without the presence of a health care
      professional that provides or uses
 individualized (personal) information and
 provides the consumer with individualized
assistance, to help the patient better manage
         their health or health care.”
          AHRQ Publication No. 09(10)-E019, October 2009
AMIA CHI WG Definition

 “…the field devoted to informatics
 from multiple consumer or patient
views. These include patient-focused
   informatics, health literacy and
        consumer education.”


              www.amia.org
Consumer Health Informatics
Field that studies and incorporates
  patient preferences, behaviors,
tools, and technologies in order to
help inform their decision making
     and manage their health
            Adapted from www.amia.org
Assumptions about Patients


    Ass u me
What if I told you there was a technology to
allow drugs to be inhaled instead of injected?
Pfizer dumps
 Exubera bong

“Is that Exubera in your pocket, or are
you just happy to see me?”

                  - Amy Tenderich
                    Diabetes Mine




                         Nature Biotechnology 2007;25(12):1331-2.
Why did this #FAIL
   cost Pfizer
  $3 BILLION?
A paternalistic approach to healthcare*




*Ok, so some other factors may have contributed as well…
“The obedience of a
patient to the prescriptions
of his physician should be
prompt and implicit.

He should never permit his
own crude opinions as to
their fitness to influence his
attention…”

 - Original AMA Code of Medical Ethics
        J Participat Med 2011;3:e27.
Q: How do we dodge this
type of outcome in the future?
A: Engage with empowered
 patients who want to be
partners in their healthcare
Participatory
 Medicine
  www.participatorymedicine.org
“As opposed to the
                          doctor-centric,
                          curative model of
                          the past, the future
                          is going to be
                          patient-centric and
                          proactive.”
Elias A. Zerhouni, M.D.
Former Director of the
National Institutes of
Health (2002-2008)
Patient                   ePatient
Passive role              Active (engaged) role

Information is given to   They seek out
 them                       information (Internet)

Top down delivery of      Partner in their
 healthcare                 healthcare

Paternalistic medicine    Participatory medicine
eHealth Literacy Scale
      (eHEALS)
           Literacy



     Health Literacy



    eHealth Literacy
      J Med Internet Res 2006;8(4):e27.
eHealth
Literacy Lily
   Model



J Med Internet Res 2006;8(2):e9.
Q: When is speaking like a professor bad?




 http://www.colbertnation.com/the-colbert-report-videos/312658/june-17-2010/obama-s-simplified-bp-oil-spill-speech
A: When it prevents you from communicating
your message effectively to your target audience




    http://www.colbertnation.com/the-colbert-report-videos/312658/june-17-2010/obama-s-simplified-bp-oil-spill-speech
Q: Are people
   ready to be
   ePatients?



   J Med Internet Res 2011;13(2):e35.
A: It depends.
    Identification/
    quantification

    Factors
     Access
     Literacy
     Personal
      responsibility

  J Med Internet Res 2011;13(2):e35.
Q: What type of patient Is this?
A: Watch the video.




   http://youtu.be/21TL94NEzvg
Online Health
 Information
   Seeking
  Behaviors
US population with Internet access




  Legend

                 No Internet access                                                          74% with
                                                                                              Internet
                 Has Internet access
                                                                                               access
Source: Pew Internet & American Life Project. The Social Life of Health Information, 2009.
Q: What % of online adults search the
   Internet for health information?
Internet users (%) who searched online
         for specific health information by type
                                     45
         45
         40                34                                        35
         35                                                28
         30
         25                                                                      18    20     2002
         20                                                                                   2008
          15
         10
           5
           0
                  Info about RX or                Info about CAM               Info about
                     OTC meds                                               experimental Tx


Source: Pew Internet & American Life Project. Fall Tracking Survey, 2008.
66% looked online
                                                   for info on a
                                                specific disease or
                                                 medical problem




Source: Pew Internet & American Life Project.
The Social Life of Health Information, 2009.
Treatment #1                 Treatment #3




                                                 Source: Pew Internet & American Life Project, 2009.
 Q. What % of patients report that what they
find online affects their treatment decisions?
Treatment #1                Treatment #3




                                                  Source: Pew Internet & American Life Project, 2009.
60% of e-patients said health information found
 online affected their treatment decisions
What will the
future of online
     health
  information
 seeking look
      like?
It is a fertile area for research
Internet users who
                                     do not look online
Social media activity    ePatients     for health info
                           (%)                    (%)

  Consult Wikipedia         53                      17
Use social networking       39                      17
 site (e.g., Facebook)

 Read someone’s blog        37                     10
Create/write own blog       13                       4


 Use Twitter or other       12                       4
   update service
                                        Source: Pew Internet & American Life Project.
                                        The Social Life of Health Information, 2009.
Mobile is going to be the real
   GAMECHANGER
Web 2.0/
Social Media
How does Web 2.0 fit in?
Evolution of the Web
Web 1.0 (one-way Web)
   Static, pull

Web 2.0* (two-way Web)
   Dynamic, push
   Collaborative, participatory

Web 3.0/3D/Semantic Web (TBD)

         *Web 2.0 is often used interchangeably with "social media"
Q: Is Social Media a Fad?




  http://www.youtube.com/watch?v=nPYrbSUqr2k
A: Watch the video and decide.




     http://www.youtube.com/watch?v=nPYrbSUqr2k
One Final Query

     How did
   purposefully
limiting access to
this creation cost
millions of lives?

 SuperFreakonomics: Global Cooling, Patriotic Prostitutes, and
   Why Suicide Bombers Should Buy Life Insurance, 2009.
Summary Points
 Pharmacy needs to evolve with patient-
  driven changes altering healthcare delivery

 Part of our challenge with CHI is to
  facilitate interested consumers who want
  to be ePatients

 Online health information seeking
  motivations and behaviors need to be fully
  characterized to develop best interventions
Images
•   http://vimeo.com/14032810

•   http://vimeo.com/14032810

•   http://www.patientslikeme.com/patients/view/96860?patient_page=12

•   http://www.bls.gov/oes/current/oes291051.htm

•   http://www.adcouncil.org/files/ahrqhhsbrand_full.jpg

•   http://www.amia.org/programs/working-groups/programs/consumer-health-informatics

•   http://www.nature.com/nbt/journal/v25/n12/images/nbt1207-1331-I1.jpg



•   http://www.goremasternews.com/wp-content/uploads/2010/04/Leonard-Nimoy-as-Spock.jpg

•   http://3.bp.blogspot.com/__KTfFRApx8I/TUwkLe5ULzI/AAAAAAAAADI/LXpTiOKOFFY/s1600/soccer+ball+t
    o+the+face.jpg

•   http://survivethejourney.blogspot.com/
Images
•   http://www.ua.edu/features/findyourpassion/diabetes.html



•   http://epatientdave.com/about-dave/

•   http://bushofdoctors.blogspot.com/



•   http://www.phlaunt.com/diabetes/bio.php



•   http://www.sixuntilme.com/about/


    http://askmanny.com/wordpress/wp-content/uploads/2010/02/Manny_Mucubaji.jpg



•   http://rawarrior.com/about/


•   http://www.alliancehealthnetworks.com/company/management-team


•   http://en.wikipedia.org/wiki/File:Elias_Zerhouni_close-up_official_photo.jpg
Images
•   http://www.colbertnation.com/the-colbert-report-videos/312658/june-17-2010/obama-s-simplified-bp-oil-spill-
    speech

•   http://www.colbertnation.com/the-colbert-report-videos/312658/june-17-2010/obama-s-simplified-bp-oil-spill-
    speech

•   http://youtu.be/21TL94NEzvg

•   http://images5.cpcache.com/product_zoom/387303425v0_480x480_Front_Color-Black_padToSquare-true.jpg

•   http://leomessiofficial.com/wp-content/uploads/2011/04/leo_messi_wallpaper4.jpg

•   http://www.jopm.org/opinion/letters/2011/08/08/one-step-forward-two-steps-back-why-can%e2%80%99t-we-
    protect-doctors-who-put-patients-first/


•   http://www1.sciencemuseum.org.uk/hommedia.ashx?id=8903&size=Small




                                    Unreferenced photographs
                                       are licensed images
WebCT
Discussion Board
Email

Other contacts
Direct email
Office telephone
Meeting via Skype
NSU office meeting
Required Readings for Lecture
1. Eysenbach G. Consumer health informatics. BMJ.
   2000;320(7251):1713-6.

2. Van De Belt TH, Engelen LJ, Berben SA, Schoonhoven
   L. Definition of Health 2.0 and Medicine 2.0: a
   systematic review. J Med Internet Res. 2010;12(2):e18.

3. Ferguson T and e-Patient Scholars Working Group.
   Chapter 1. Hunters and gatherers of medical
   information. e-Patients: how they can help us heal
   healthcare 2007:1-20. Available at:
   http://e-patients.net/e-Patients_White_Paper.pdf.

Consumer Health Informatics & Pharmacy

  • 1.
    Consumer Health Informatics & Pharmacy Kevin A. Clauson, PharmD
  • 2.
    Note The following slidedeck is from the introductory lecture of Consumer Health Informatics and Web 2.0 in Healthcare (NSU College of Pharmacy)
  • 3.
    Objectives Explore assumptions about pharmacyand roles in consumer health informatics (CHI) Define terminology and concepts used in CHI
  • 4.
    Objectives Explain the philosophicalshift in healthcare with the participatory medicine model Review the evolution of: Web 1.0 -> Web 2.0 -> Web 3.0
  • 5.
    What will the future of pharmacy look like?
  • 6.
  • 7.
    Or will itfeature more of this…
  • 8.
    …and maybe lookmore like this?
  • 9.
  • 11.
    Contact lenses thatchange color with variations in glucose and can dispense medications Advanced Functional Materials 2008;18(13):1912-21.
  • 12.
  • 13.
  • 14.
    65%* Answer: *of the 269,900 pharmacists in the US Source: Bureau of Labor Statistics, Occupational Employment Statistics (29-1051), May 2010.
  • 15.
    Location quotient ofpharmacists by area Location quotient 0.40 – 0.76 0.77 – 0.89 0.90 – 1.00 1.01 – 1.10 1.11 – 1.28 1.29 – 2.07 Source: Bureau of Labor Statistics, Occupational Employment Statistics (29-1051), May 2010
  • 16.
    Q: How manypharmacists in the US have a Doctor of Pharmacy (Pharm.D.)?
  • 17.
    2009 National PharmacistWorkforce Study A: Only about 1 in 4 (proportion increased from 13.9% in 2000 to 21.9% in 2009)
  • 18.
  • 19.
    Informatics “’Use ofcomputers to manage data and information’ and represents the nexus of people, information, and technology” Building Core Competencies in Pharmacy Informatics, 2010. Am J Pharm Educ 2011;75(5):93.
  • 20.
    Pharmacy Informatics “Use andintegration of data, information, knowledge, and technology involved with medication use processes to improve outcomes” Am J Health-Syst Pharm. 2007;64(2):200-203. Am J Pharm Educ. 2008;72(4):89.
  • 21.
    Consumer Health Informatics (Eysenbach Definition) “analyses consumers' needs for information; studies and implements methods of making information accessible to consumers; and models and integrates consumers' preferences into medical information systems” BMJ 2000; 320(7251):1713-6.
  • 22.
    CHI Definition “any electronic tool, technology, or electronic application that is designed to interact directly with consumers, with or without the presence of a health care professional that provides or uses individualized (personal) information and provides the consumer with individualized assistance, to help the patient better manage their health or health care.” AHRQ Publication No. 09(10)-E019, October 2009
  • 23.
    AMIA CHI WGDefinition “…the field devoted to informatics from multiple consumer or patient views. These include patient-focused informatics, health literacy and consumer education.” www.amia.org
  • 24.
    Consumer Health Informatics Fieldthat studies and incorporates patient preferences, behaviors, tools, and technologies in order to help inform their decision making and manage their health Adapted from www.amia.org
  • 25.
  • 26.
    What if Itold you there was a technology to allow drugs to be inhaled instead of injected?
  • 27.
    Pfizer dumps Exuberabong “Is that Exubera in your pocket, or are you just happy to see me?” - Amy Tenderich Diabetes Mine Nature Biotechnology 2007;25(12):1331-2.
  • 28.
    Why did this#FAIL cost Pfizer $3 BILLION?
  • 29.
    A paternalistic approachto healthcare* *Ok, so some other factors may have contributed as well…
  • 30.
    “The obedience ofa patient to the prescriptions of his physician should be prompt and implicit. He should never permit his own crude opinions as to their fitness to influence his attention…” - Original AMA Code of Medical Ethics J Participat Med 2011;3:e27.
  • 31.
    Q: How dowe dodge this type of outcome in the future?
  • 32.
    A: Engage withempowered patients who want to be partners in their healthcare
  • 33.
    Participatory Medicine www.participatorymedicine.org
  • 34.
    “As opposed tothe doctor-centric, curative model of the past, the future is going to be patient-centric and proactive.” Elias A. Zerhouni, M.D. Former Director of the National Institutes of Health (2002-2008)
  • 35.
    Patient ePatient Passive role Active (engaged) role Information is given to They seek out them information (Internet) Top down delivery of Partner in their healthcare healthcare Paternalistic medicine Participatory medicine
  • 36.
    eHealth Literacy Scale (eHEALS) Literacy Health Literacy eHealth Literacy J Med Internet Res 2006;8(4):e27.
  • 37.
    eHealth Literacy Lily Model J Med Internet Res 2006;8(2):e9.
  • 38.
    Q: When isspeaking like a professor bad? http://www.colbertnation.com/the-colbert-report-videos/312658/june-17-2010/obama-s-simplified-bp-oil-spill-speech
  • 39.
    A: When itprevents you from communicating your message effectively to your target audience http://www.colbertnation.com/the-colbert-report-videos/312658/june-17-2010/obama-s-simplified-bp-oil-spill-speech
  • 40.
    Q: Are people ready to be ePatients? J Med Internet Res 2011;13(2):e35.
  • 41.
    A: It depends. Identification/ quantification Factors Access Literacy Personal responsibility J Med Internet Res 2011;13(2):e35.
  • 42.
    Q: What typeof patient Is this?
  • 43.
    A: Watch thevideo. http://youtu.be/21TL94NEzvg
  • 44.
    Online Health Information Seeking Behaviors
  • 45.
    US population withInternet access Legend No Internet access 74% with Internet Has Internet access access Source: Pew Internet & American Life Project. The Social Life of Health Information, 2009.
  • 46.
    Q: What %of online adults search the Internet for health information?
  • 48.
    Internet users (%)who searched online for specific health information by type 45 45 40 34 35 35 28 30 25 18 20 2002 20 2008 15 10 5 0 Info about RX or Info about CAM Info about OTC meds experimental Tx Source: Pew Internet & American Life Project. Fall Tracking Survey, 2008.
  • 49.
    66% looked online for info on a specific disease or medical problem Source: Pew Internet & American Life Project. The Social Life of Health Information, 2009.
  • 50.
    Treatment #1 Treatment #3 Source: Pew Internet & American Life Project, 2009. Q. What % of patients report that what they find online affects their treatment decisions?
  • 51.
    Treatment #1 Treatment #3 Source: Pew Internet & American Life Project, 2009. 60% of e-patients said health information found online affected their treatment decisions
  • 52.
    What will the futureof online health information seeking look like?
  • 53.
    It is afertile area for research
  • 54.
    Internet users who do not look online Social media activity ePatients for health info (%) (%) Consult Wikipedia 53 17 Use social networking 39 17 site (e.g., Facebook) Read someone’s blog 37 10 Create/write own blog 13 4 Use Twitter or other 12 4 update service Source: Pew Internet & American Life Project. The Social Life of Health Information, 2009.
  • 55.
    Mobile is goingto be the real GAMECHANGER
  • 56.
  • 57.
    How does Web2.0 fit in?
  • 58.
    Evolution of theWeb Web 1.0 (one-way Web)  Static, pull Web 2.0* (two-way Web)  Dynamic, push  Collaborative, participatory Web 3.0/3D/Semantic Web (TBD) *Web 2.0 is often used interchangeably with "social media"
  • 59.
    Q: Is SocialMedia a Fad? http://www.youtube.com/watch?v=nPYrbSUqr2k
  • 60.
    A: Watch thevideo and decide. http://www.youtube.com/watch?v=nPYrbSUqr2k
  • 62.
    One Final Query How did purposefully limiting access to this creation cost millions of lives? SuperFreakonomics: Global Cooling, Patriotic Prostitutes, and Why Suicide Bombers Should Buy Life Insurance, 2009.
  • 63.
    Summary Points  Pharmacyneeds to evolve with patient- driven changes altering healthcare delivery  Part of our challenge with CHI is to facilitate interested consumers who want to be ePatients  Online health information seeking motivations and behaviors need to be fully characterized to develop best interventions
  • 64.
    Images • http://vimeo.com/14032810 • http://vimeo.com/14032810 • http://www.patientslikeme.com/patients/view/96860?patient_page=12 • http://www.bls.gov/oes/current/oes291051.htm • http://www.adcouncil.org/files/ahrqhhsbrand_full.jpg • http://www.amia.org/programs/working-groups/programs/consumer-health-informatics • http://www.nature.com/nbt/journal/v25/n12/images/nbt1207-1331-I1.jpg • http://www.goremasternews.com/wp-content/uploads/2010/04/Leonard-Nimoy-as-Spock.jpg • http://3.bp.blogspot.com/__KTfFRApx8I/TUwkLe5ULzI/AAAAAAAAADI/LXpTiOKOFFY/s1600/soccer+ball+t o+the+face.jpg • http://survivethejourney.blogspot.com/
  • 65.
    Images • http://www.ua.edu/features/findyourpassion/diabetes.html • http://epatientdave.com/about-dave/ • http://bushofdoctors.blogspot.com/ • http://www.phlaunt.com/diabetes/bio.php • http://www.sixuntilme.com/about/ http://askmanny.com/wordpress/wp-content/uploads/2010/02/Manny_Mucubaji.jpg • http://rawarrior.com/about/ • http://www.alliancehealthnetworks.com/company/management-team • http://en.wikipedia.org/wiki/File:Elias_Zerhouni_close-up_official_photo.jpg
  • 66.
    Images • http://www.colbertnation.com/the-colbert-report-videos/312658/june-17-2010/obama-s-simplified-bp-oil-spill- speech • http://www.colbertnation.com/the-colbert-report-videos/312658/june-17-2010/obama-s-simplified-bp-oil-spill- speech • http://youtu.be/21TL94NEzvg • http://images5.cpcache.com/product_zoom/387303425v0_480x480_Front_Color-Black_padToSquare-true.jpg • http://leomessiofficial.com/wp-content/uploads/2011/04/leo_messi_wallpaper4.jpg • http://www.jopm.org/opinion/letters/2011/08/08/one-step-forward-two-steps-back-why-can%e2%80%99t-we- protect-doctors-who-put-patients-first/ • http://www1.sciencemuseum.org.uk/hommedia.ashx?id=8903&size=Small Unreferenced photographs are licensed images
  • 67.
    WebCT Discussion Board Email Other contacts Directemail Office telephone Meeting via Skype NSU office meeting
  • 68.
    Required Readings forLecture 1. Eysenbach G. Consumer health informatics. BMJ. 2000;320(7251):1713-6. 2. Van De Belt TH, Engelen LJ, Berben SA, Schoonhoven L. Definition of Health 2.0 and Medicine 2.0: a systematic review. J Med Internet Res. 2010;12(2):e18. 3. Ferguson T and e-Patient Scholars Working Group. Chapter 1. Hunters and gatherers of medical information. e-Patients: how they can help us heal healthcare 2007:1-20. Available at: http://e-patients.net/e-Patients_White_Paper.pdf.