Invited talk at Breakaway Healthcare Forum, held in conjunction with TEDMED, April 16, 2013. View abstract and video here: http://cognitivecomputing.wordpress.com/2013/04/16/the-patient-portal-conundrum/

1. The Patient Portal Conundrum
Ashwin Ram, PhD, Innovation Fellow
"Software is eating the world. Over the next 10
years, I expect many more industries to be
disrupted by software.
Healthcare and education are next up for
fundamental software-based transformation.”
—Marc Andreessen, WSJ Essay
ashwin.ram@parc.com
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2. The Business of Breakthroughs®
laser printing EthernetPC workstation
Alto
WYSIWYG, GUI
corporate
ethnography
multi-beam
laser diodes
ubiquitous
computing
collaborative
filtering
AI/ model-based
systems
content-centric
networking
socio-cognitive
computing
cleantech printed & flexible
electronics
content-centric
networkingincorporated 2002
founded 1970
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3. “What people say
Margaret Mead
what people do
and what people say they do
are entirely different things.”
New models
for business
Human behavior
and context
Leading
technology
and know-how
Breakthroughs aren’t
(just) about technology
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4. Healthcare Crisis
Obesity Rates
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5. Where’s the problem?
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6. The healthcare challenge
of our generation: Chronic conditions
7 out of 10 deaths
among Americans each year are
from chronic diseases
Source: CDC
More than 75% of health care costs
are due to chronic conditions
Source: CDC
Employers’ spending on health
coverage for workers
rose 9% in 2011, tripling the growth in 2010
Source: Kaiser Family Foundation and the Health Research & Educational Trust
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7. Opportunity
50% of factors related to
personal health are due
to lifestyle.*
Sources: *CDC **Hartman PARC | Ashwin Ram | 7
68% of adults are actively
trying to prevent at least 1
major chronic illness.**
Well
People
(68% adults)
Personal
Lifestyle
(food, exercise)
Active
Prevention
(behavior change)

8. How do people get healthcare info?
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9. Healthcare Information
Internet is the leading source
of health and wellness information.
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10. “Meaningful Use”
Stage 1
• EHR
Stage 2
• Portals
Stickiness
• Quality of Care
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11. Health 1.0 à Health 2.0
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A recent survey from health-care research firm
National Research found that 96% of the nearly
23,000 consumers it surveyed use Facebook to
gather information about health care, with 28%
using YouTube and 22% using Twitter. Hospitals,
health-care providers and private insurers also are
seeing social media as a tool to engage consumers.
NPR Marketplace calls it “the biggest threat to
healthcare portals like WebMD”.

12. The Patient Portal
Conundrum
Stage 1
• EHR
Stage 2
• Portals
Stickiness
• Quality of Care
Engagement?
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13. Healthcare Goes Social
relevant
info
game
rewards
social
graph
“Behavior is social. When someone
loses weight, quits smoking, or
increases exercise, the people in
their trusted social network are 34%
more likely to do so.”
—Dr. N. Christakis, Harvard School of Medicine
72% of consumers rely
on the Internet for
health information
100s of millions of
consumers interact
and share health
experiences online
100s of hospitals use
social media
1000s of health
communities
$100M investment in
gamification of health
People require health
information that is timely, relevant,
reliable, and easy to understand.
— Picker Institute Europe
Consumerism
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14. Trends
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“The consumer is the CEO
of their own health.”
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15. “Meaningful Use”, revisited
Information
Engagement
Behavior
Change
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Stage 1: EHR
Stage 2: Portals
Stage 3: Quality

16. Concept
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A team social network with personal coach
to engage consumers and change behaviors…
…to improve health outcomes and reduce
healthcare costs…
…at scale (millions of people).
personal
model
mobile
coach
social
team

17. Sensors + Analytics + Context + Social
Data
aggregation
Goal
setting
Personalized
Coaching
Social
support
Source: Healthrageous.com
= sustainable engagement and
behavioral change
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18. Why Mobile?
For the first time in history…
more smartphones and
tablets will be sold than
PCs worldwide
Source: Deloitte Canada, 2011
A smartphone in 2011
has as much compute power
as a laptop in 2001
Source: C. Arthur, Guardian UK, 2011
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19. Why Social?
(Christakis & Fowler, 2009)
• Entire clusters
quit in concert
• 25% more likely
to quit if your
sibling quit
• 67% more likely
to quit if your
spouse quit
• 34% more likely
to quit if your co-
worker quit
• 36% more likely
to quit if your
friend quits
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20. Improved
Outcomes
& Lifestyle
Adoption
Achievable
Goals
Fun
Peer
Support
In The
Moment
Easy,
Natural
Proper Goal Setting
Social Sciences
Ethnography
Underlying Science
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Goal
Outcome-goal Behavior-goal
Food-goal Activity-goal
Lose 40 lbs
Path-goal
Duration-goal
Eat breakfast
Every day
Exercise 5 days/
week for 5 weeks
(+H <habit-name>
goal: <what it achieves>
cues: <location, time, people,
preceding-action, thoughts/mood>
knowledge: <relevant knowledge/ability>
actions: <behavior-spec>)
(+H-parameters <habit-name>
difficulty: δ
expectancy: <P>
cost: <C>
successes: s
failures: f)
log(odds(success(Habiti ,Personj )))
= match(c, j)
c
∑ + θikwjk + rikwjk
k
∑ + α log(t) + vf sfi
f
∑ + pf sfi
f
∑
k
∑
f (θi
,w j ,ρij ) = θ0ρij +θi1wi1 ++θiT wjT

21. Consumer
Engagement
Social Network
Just-In-Time
Information
Personalization
Behavior
Change
Gamification
Platform
Modeling & Analytics Platform
Decision
Support
Cognitive
Modeling
Social
Analytics
Semantic
Analysis
Behavior
Modeling
Monitoring Platform
Context/
Activity
Web/Social
Network
Ethnography/
Field Studies
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22. Wellness Application
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fittle.org
Team social network with personal coach
to engage consumers and change behaviors…

23. Vision
Consumer
• Engagement
Relevant Information
• Behavior Change
DashboardDashboard
Ethnography Analytics/Social Media Context/Activity Tracking
Company
Portal
Provider
Portal
Modeling &
Analytics
Platform
Food /
Nutrition
Alternative
Medicine
Medicine /
Supplements
Exercise /
Activity
Apps
Wellness Drivers
PARC
Competitive Edge
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24. Contact
linkedin.com/in/ashwinramwww.parc.com/ashwinram
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ashwin.ram@parc.com