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Entries in Web & Social Media (27)

Wednesday
Sep232020

WeChat to Many, But WeDoctor to Some

By Kim Bellard, September 23, 2020

 

You’ve probably heard about TikTok, especially lately. But you may have paid less attention to what’s been going on with WeChat, another China-based app. WeChat was part of the original proposed ban, which a federal judge blocked this weekend, hours before it was due to go into effect (the Commerce Department plans to appeal). The ban is on “transactions,” which, in WeChat’s case, covers a lot of ground.

WeChat is owned by Tencent Holdings, one of China’s internet giants. It has been described as a “Swiss Army knife” app, able to do many tasks — not just messaging and social networking, but also games, shopping, and payments.

It is also important to users’ health. WeChat is, according to CMI Media, “fast becoming the #1 online healthcare destination in China.” It offers, among other things, health content (some in partnership with U.S. firms), health products, telehealth, a network of “trusted” doctors, a form of health insurance, and WeDoctor. The latter “provides online health enquiry service, psychological support, prevention guidelines and real-time pandemic reports,” and is free to the user. It is available “24/7 for people all over the world.”

If we’re worried about what information China might glean from the video-watching habits of teenagers, think about how worried we should be about China having access to what health information users sought, what medical advice they got, and what health products they ordered.

China is famed for its “Great Firewall,” which restricts which outside internet platforms — like Google or Facebook — can be used within its borders. Equally important, the Chinese government monitors what happens on WeChat and other internet platforms/apps, and does not allow news or opinions it finds objectionable, or subversive.

There are estimated to be 19 million U.S. users, out of WeChat’s 1.2 billion users; most are people with family or friends in China, who rely on the app to stay in touch. The U.S. may argue it is worried about what financial and personal information might be going to the Chinese government, but it should be equally worried about what “information” is being served to U.S. users.

Think, for example, what it might tell U.S. users about COVID-19 vaccines.

The U.S. moves make some worry that we’re becoming more like China, leading to the “splinternet” where, as Vox explained, “your experience of the internet increasingly depends on where you live and the whims of the ruling parties there.”

It is the opposite of the open access, no borders version of the internet that most of us have believed in for the past thirty years. Aaron Levie, CEO of cloud-computing company Box Inc, warned in The Wall Street Journal: “U.S. tech companies have far more to lose if this becomes a precedent. This creates a Balkanization of the internet and the risk of breaking the power of the internet as one platform.”

Somehow, “optimal fragmentation” isn’t how I want to think of my internet experience; I suspect that fragmentation won’t be so optimal.

In discussing the effect of potential WeChat bans with The New York Times, Fang Kecheng, a professor at the Chinese University of Hong Kong, said: “Information is like water. Water quality can be improved, but without any flow, water easily grows fetid.” He didn’t carry the analogy further, but I will: information is like water, in that, eventually, it will get to where it wants to go.

We don’t have a U.S. platform as versatile as WeChat; we don’t even have a health platform as capable as WeChat’s health capabilities. But, if we’re not careful, WeChat might become that platform.

This post is an abridged version of the original posting in Medium. Please follow Kim on Medium and on Twitter (@kimbbellard)

Thursday
Jul252019

Four Questions for Erin Benson and Courtney Timmons with LexisNexis Health Care: Post-Webinar Interview

By Claire Thayer

Erin Benson, Director Market Planning and Courtney Timmons, Market Planning Specialist, LexisNexis Health Care, participated in a Healthcare Web Summit webinar discussion on ways for health plans to reduce the risk of a data breach, the necessary steps to validate and verify member information, and ingredients for a strong multi-factor authentication strategy.  If you missed this engaging webinar presentation, you’ll want to be sure to watch the Webinar Video. After the webinar, we interviewed Erin and Courtney on four key takeaways:  

1. What are some of the key ways health plan members are using their member portals? 

Erin Benson and Courtney Timmons: Health plan members are increasingly using their member portals as a tool to View and get answers to coverage questions

  •  Track claims and account activity
  •  Locate providers and services
  •  Find health advice
  •  Manage their member profile
  •  Pay bills

2. With the rise of digital healthcare, there's also a rise in online fraud. Tell us more about how this impacts healthcare firms?

Erin Benson and Courtney Timmons: 

As the ways in which members access their data becomes more sophisticated, so too do the ways in which hackers are finding ways to commit fraud:

  • More than 1 in 10 new account openings are fraudulent with 60% of those accounts being created using a mobile device
  • Call center fraud is up 113%
  • A record 1 Billion BOT attacks were seen in Q1 of 2018
  • There has been a 202% growth in login attacks since 2016
  • And 88% of all ransomware attacks were against healthcare organizations in 2017 –healthcare organizations are known on the black market to pay      

When fraudsters are successful it compromises patients’ trust in the healthcare organization, increases costs if they have to remediate a breach, and potentially leads to member safety risks if any of the patient’s health data is altered and care givers then act on bad information. Not to mention members will go somewhere else if they don’t trust that you can take care of their data.

3. You've mentioned that identity is the key to solving the challenge of balancing member engagement and data security. How do these interact together?

Erin Benson and Courtney Timmons: The healthcare organization should determine when and how to communicate with the member, ensuring updated contact information is maintained to best engage them. The member’s information should be protected from fraudster access. A foundational step is for healthcare organizations to aggregate the many data points about each member into one location linked together by a unique, persistent member-level identifier to create the one golden record about the individual.

Identity management and proofing, in tandem with new technological innovation, allows organizations to:

  •  Perform intuitive linking of data points to the accurate identity
  •  Leverage cross-industry analytics that allow organizations to determine if an identity enrolling in   your plan actually exists and if all of the identity information is accurate and belongs together, and 
  •  Monitor transaction activity across a diverse array of industries from financial, retail, insurance and   government, using machine learning to build analytics, provide fraud intelligence and track   fraudulent behaviors and schemes.
     

In order to protect their data, you have to know who to grant access to and be able to verify their identities. Knowing your members will allow you to validate that the right users get access to their information, while keeping fraudsters out, and providing insight into who is accessing your site, mobile application and/or portal no matter where in the medical journey a member… or fraudster… is trying to gain access. 

4. Identity verification is complex. What are a few key considerations in selecting identity verification layers? 

Erin Benson and Courtney Timmons:  Various types of authentication methods should be used to cover different types of security vulnerabilities.  It is important to implement solutions that serve different purposes, targeting different types of fraud.

Some questions to ask as you develop your strategy are:

  • Do we have a way of preventing fraud such as BOT attacks or ransomware by scanning devices trying to gain access to our portal?
  • Can we confirm that the user requesting access to the data is the owner of that identity?
  • Does the input identity exist and do all of those data elements belong together?

We recommend putting the no to low friction solutions up front in the process and introducing solutions with increasing levels of friction later in the process so only suspicious identities are facing additional scrutiny before logging in or completing a high risk transaction. 

Thursday
Sep282017

Studies on Prescription Drugs and Social Media

By Clive Riddle, September 29, 2017

Given that prescription drugs are perhaps the most direct-to-consumer marketed U.S. healthcare service, and pharmacies perhaps the most retail oriented distribution of health care services, social media would seem to have the greatest influence on pharmaceuticals than other healthcare sectors. PrescribeWellness this week released results of its 2017 Pharmacy Social Media Survey, which "looked at how Americans choose their pharmacy, what pharmacy services they most value, and their interest in interacting with their neighborhood pharmacists online and through social media."

Here’s what the shared from their findings:

  • 37% look to Google when looking for a pharmacy, versus 34% relying on word of mouth
  • Another 18% look to Facebook to choose a pharmacy
  • 32% look for a pharmacy with a useful website
  • 78% would consider following their pharmacist on social media— and 48% already do
  • 42% percent wish their pharmacist were more active on social media.
  • 47% say their preferred social network for interacting with their pharmacist is Facebook
  • 15% prefer Twitter in this regard and 12% prefer Instagram (12 percent)
  • 34% are interested in their pharmacist’s website
  • 25% would be interested in a pharmacy email newsletter.
  • 54% would be more inclined to use a product that their pharmacist recommended on social media

Respondents say the top benefits of following their pharmacist on social media include:

  • Deals and promotions – 58 percent
  • New offerings or services – 39 percent
  • Healthcare news – 37 percent
  • Relevant news and tips about health and wellness – 37 percent
  • Seasonal vaccine reminders – 31 percent

62% use their pharmacy’s website, with 61% using the site for refill requests; 47% for online orders; 29% for medication reminders; 29% for a medication list; 20% for online appointments; and 19% to access messages from their pharmacists, 40% say their pharmacy has a mobile app, which they use to place refill requests (48%), receive refill reminders (38%) and place orders (38%).

Moving on from pharmacies to pharmaceutical companies, earlier this year, the Journal of Medical Internet Research published to paper: Direct-to-Consumer Promotion of Prescription Drugs on Mobile Devices: Content Analysis, which sought to “investigate how prescription drugs are being promoted to consumers using mobile technologies. We were particularly interested in the presentation of drug benefits and risks, with regard to presence, placement, and prominence.”

Of the mobile communications they examined, 41% were product claim communications, 22%) were reminder communications, and 37were help-seeking communications (includes information about the medical condition but not the drug name. 69% linked to branded drug websites indicating both benefits and risks, 25% linked to a landing page listing benefits but no visible risks, and 6% linked to a landing page listing risks but no visible benefits.

The Frontiers in Pharmacology journal last December published the article Perspectives for the Use of Social Media in e-Pharmamarketing which among other things concluded that "in November 2015, American Food and Drug Administration (FDA) has encouraged the use of social media to improve communication and information exchange in health promotion and public health (U.S. Food and Drug Administration Social Media Policy, 2015). Foreign studies show that one in four interactions with doctor, patient, and healthcare providers in the United States is a digital contact. Patient education through social media is therefore an opportunity for the pharmaceutical industry to gain confidence in the company and increase the awareness of consumer when choosing a product. In this way, customer acquires knowledge about health, diseases, and treatment. In various social media channels it is possible to find information on any drug. This information is available on: websites of a manufacturer, social network brand fanpages, portals for white staff specialists. According to a study, conducted by Comscore, patients who are familiar with drug brand website often followed the recommendations for its use (20% of patients). Internet advertising also influenced the use of a drug (13.5% of patients; ROI Media, 2016). E-pharmamarketing activities in social media and in the network tend to increase. It is estimated that in the year 2016 the US pharmaceutical companies allocate for this purpose 2.48 billion dollars.”

Friday
Mar242017

What Hashtag to Use When Firing Off a Post on Healthcare Reform?

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By Clive Riddle, March 24, 2017

 

You want more people to read everything you have to say about whichever side of the wall you’re on in the great repeal and replace debate. Or you just want to know what trendy term to search on so you can read what everyone else is saying on the subject. What hashtag to use…what hashtag to use?

 

We compiled a list of the hashtags surrounding the debate and had them analyzed using keyhole.co, which tracks twitter usage during the past 36 hours or so. As of noon Eastern time today, here’s what we found for twenty one selected hashtags that had surfaced the most during our research, presented in alphabetical order:

 

·         #aca 705 posts | 2,191,075 reach

·         #ahca 405 posts | 18,106,544 reach

·         #BecauseOfMedicaid 500 posts | 302,037 reach

·         #coveragematters 272 posts | 448,981 reach

·         #fullrepeal 50 posts | 1,400,049 reach

·         #healthcarebill 94 posts | 4,154,646 reach

·         #healthcarereform 595 posts | 4,472,503 reach

·         #IfILoseCoverage 391 posts | 1,232,293 reach

·         #killthebill 729 posts | 2,153,734 reach

·         #MakeAmericaSickAgain 703 posts | 935,553 reach

·         #NoRepealWithoutReplace 31 posts | 28,318 reach

·         #obamacare 85 posts | 43,583,728 reach

·         #passthebill 704 posts | 48,210,419 reach

·         #ProtectOurCare 707 posts | 2,217,826

·         #readthebill 589 posts | 1,871,228 reach

·         #RepealAndReplace 706 posts | 44,990,188 reach

·         #ryancare 706 posts | 2,365,314 reach

·         #saveaca 705 posts | 2,234,518 reach

·         #SaveMedicaid 43 posts | 124,503 reach

·         #SaveTheACA 711 posts | 2,061,039 reach

·         #trumpcare 736 posts | 1,741,593 reach

 

The number of posts vs reach reflects the number of tweeters vs the number of tweetees. One tweet from @realDonaldTrump of course goes a long ways in reach.

 

The top ten hashtags in order of posts during this period were: #trumpcare, #killthebill, #savetheaca, #protectourcare, #repealandreplace, #ryancare, #aca, #saveaca, #passthebill, #makeamericasickagain. These were the only hashtags with 700+ posts, with a range of 703-736, so all are being used with similar frequency, and usage of other  hashtags in this genre really drop off after these top ten.

 

With regard to reach, #passthebill, #repealandreplace, and #obamacare were the top three, each exceeding 40 million. #ahca was fourth with 18+ million. #Healthcarereform and #healthcarebill were next, each with 4+ million and it drops off from there.

 

A number of the hashtags (#killthebill, #passthebill) will fall out of use once the #ahca legislative debate is over, while other monikers will likely have legs for some time to come.

 

So pick your hashtag and start posting or browsing.

 
Thursday
Jun162016

Two Thirds of Healthcare Stakeholders Have Faith in Consumers Using Online Tools to Engage With Their Doctor

By Clive Riddle, June 16, 2016

MCOL has conducted an e-poll, co-sponsored by Keenan, of healthcare business stakeholders regarding their opinion on consumer tools involved with healthcare costs or quality. Key questions were asked regarding consumer healthcare cost and quality tools; and ranking of applicable items with respect to overall effectiveness.

68.5% of stakeholders believe it is likely or very likely that a typical consumer will use online data/comparisons to discuss options and costs with a provider. Stakeholders not involved with online tools have a greater belief that consumers are very likely to do so (34.8% compared to 18.6% of stakeholders that are involved with online tools). However, stakeholders involved with tools have an overall greater belief that consumers are likely to do so – combining likely plus very likely responses (72.1% for involved stakeholders compared to 65.2% for stakeholder not involved with tools.)

44.4% of stakeholders feel a smartphone is the optimal vehicle to deliver such tools, while 34.7% feel a computer desktop is the optimal vehicle, and 13.9% listed a tablet such as an iPad as the optimal vehicle. Stakeholders not involved with online tools were less likely to list a computer desktop (21.7% compared to 38.1% for stakeholders involved with tools and 57.1% for stakeholders not sure if they are involved). However smartphones were the top choice for both stakeholders involved with online tools, or not involved with online tools.

Given five types of tools to rank for effectiveness, stakeholders preferred health insurance out-of-pocket costs calculators and healthcare service price estimator/comparisons. Given seven issues to rank by level of concern, relating to consumer tools, stakeholders were most concerned by accuracy/credibility of data sources, and consumer ability to understand/use tool correctly.

58.9% of stakeholders indicated they are involved with consumer tools, while 31.5% responded they are not involved, and 9.5% were not sure. The online survey of healthcare business stakeholders was conducted during May 2016 by MCOL.  Survey participants received a detailed report on the survey results.

As Tim Crawford, a Vice President from Keenan puts it, “if we want to bend the healthcare cost trend downward by making patients and their families more effective consumers, we will need to equip them with the information they need to make informed decisions. Consumers of medical services will need to know about the quality of their providers and understand the total costs involved. More than two-thirds of those responding to the survey believe that consumers will use tools that give them this information and will use the knowledge to discuss options and costs with their providers. Ideally, such tools can provide the common ground needed for patients and physicians to have a transparent dialog about medical decisions.”

Thursday
Nov132014

The Future Is Still Not Here

By Kim Bellard, November 13, 2014

US News & World Report had some fun looking back at what experts in 2004 predicted for health care in 2014.  Not surprisingly, they found that we're not quite there yet, but might be by 2025.  The future, it would appear, is always ten years away. 

Those 2004 pundits expected that health care would be one of the industries most impacted in these past ten years; specifically:

2004 prediction: In 10 years, the increasing use of online medical resources will yield substantial improvement in many of the pervasive problems now facing healthcare—including rising healthcare costs, poor customer service, the high prevalence of medical mistakes, malpractice concerns, and lack of access to medical care for many Americans.

Whoops.

To be sure, there have been several important changes in our health care system over the past ten years.  Some of the more important ones would have to include:

In terms of realizing those predictions about controlling costs, improving customer service, reducing medical mistakes, or addressing malpractice concerns: well, not so much.

The absolute number of the uninsured has only dropped from 42.0 million in 2004 to 40.7 in 1Q 2014.  Increases in spending have moderated, thank goodness, but most experts attribute this to the recent economic downturn rather than to any structural changes.  Half of Americans now have a chronic disease, and our life expectancy rates still lag most other developed nations -- and may be declining.

If this is progress, I'm not sure we can take much more of it.

By way of contrast, think about the technology world in 2004:

Why isn't health care seeing those kinds of radical changes in the landscape? 

Certainly there have been plenty of important clinical innovations in the last ten years.  Still, I'm hard pressed to think of changes that have become part of people's everyday lives the way that the above tech changes have, 

Critics might claim that smartphones, social media and video streaming don't improve the quality of life, but just dare to try to take them away from people.  By contrast, if you offered to swap health insurance plans from 2004 with today's, I bet most people would jump at the chance, since they cost about 40% less and typically had much lower cost sharing requirements (Kaiser Family Foundation).

I'm also waiting for reports of either physicians or patients being delighted by all those EHRs.

The U.S. News & World Report article mentioned telemedicine as an example that many (still) predict as a key part of the future.  Honestly, if a big breakthrough for 2024 is wider use of telemedicine, I'll be disappointed. 

Don't get me wrong: I'm a big proponent of telemedicine, but in ten years shouldn't we be hoping for something more radical -- like, say, holographic or virtual reality visits?

Or maybe the future is wearables, as everyone is trying to get in on the expected gold rush.  I suspect that wearables in 2024 will bear as much resemblance to today's as our mobile phones do to 2004's, but the real problem won't be the technology as how we'll use all that data.  By 2024 we should be using real-time data to prevent hospitalizations and other acute episodes, but who will pay for, and act on, the monitoring and interventions?

Some people might argue that other ACA initiatives, like ACOs or value-based purchasing, simply haven't had enough time to prove their worth.  That may be valid, but I'm still not seeing the where-did-that-come-from aspects of either.

If in ten years we're all getting care through integrated delivery systems like Kaiser, that might be better for us, but it wouldn't be a breakthrough.

As I wrote in Getting Our Piece of the Pie, I want to see health care's versions of Napster: innovations that are willing to wreck the system in order to reshape it.  I want to see something that connects us to our health in the way that Facebook has connected us with our social circle, that democratizes health information and even treatments like Wikipedia has done for reference, or that untethers us in the way smartphones and YouTube have.&

Let's not wait ten years.

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Tuesday
Oct212014

Google Wants to Helpout Your Health

by Kim Bellard, October 21, 2014

I suppose it was inevitable that I'd end up writing something about Google's interest in health, since recent posts have focused on efforts from Facebook and Amazon, as well as the general gold rush for health IT.  Fortunately Google has obliged me by introducing a neat health-related wrinkle on their Helpouts service.

Google's new service pops up an offer to do a video chat with one of their Helpouts physicians when you are doing health-related searches, in case you want more expert opinions and advice.  It certainly beats getting an ad for a pill or a health aid (although I don't imagine Google will stop presenting those as well).

Let's back up.  For those of you not previously familiar with it (and count me among those), Helpouts is a Google service, launched last November, that allows consumers to connect with applicable experts via live video chats. 

The new feature connects the service to search results.  You may not have Google Helpouts top-of-mind when looking for health information, but it's a pretty safe bet that you might use Google search in doing your research.  Pew says 72% of Internet users searched for health information within the past year, with 77% of them starting with a search engine. 

"Google Docs" takes on a whole new meaning now, doesn't it?

The telemedicine aspect of Helpouts is not strikingly new.  What distinguishes Google's effort, of course, that it is pro-active.  It doesn't wait for you to decide things are serious enough to seek out a doctor, but, rather, uses your search activity to trigger the offer of a consult.  I think this will be an important part of our health system's future -- not merely reacting but being proactive.  All these remote monitoring devices are pretty pointless if we don't use them to try to intervene early, instead of waiting for an acute event or an office visit to trigger care.

I have a couple of suggestions, or at least questions, on the new Helpouts feature:

  • It's not clear to me how specific the type of physician available is to the search request.  If you are searching on angina, for example, it'd be nice if you got a cardiologist to talk with rather than a dermatologist.
  • It's not clear to me if the experts are always physicians, or if they triage the experts based on the severity of the information being searched for.  

On the second point, I've written before about personal health assistants -- including Better from The Mayo Clinic -- as well as potentially using AI to provide such a service.  I think it'd be even cooler if Helpouts gave you a personal health assistant, starting with an AI agent and progressing to a specific human team if necessary, with physicians available for the most complex needs.  Maybe that's Helpouts 2.0.

Of course, Google's health interests don't end with the current Helpouts approach.  They are already pushing Google Fit as a way for Android developers to connect their health apps, and it'd be a great next step if Google could tie Helpouts to those apps, using the data mined from them to trigger an offer of a consult -- or an intervention, depending on the urgency of the need.

It'd be even better if you could opt-in your own physician(s) and health system to the Helpouts service instead of relying on Google's set of physicians.  

As long as I'm already trying to come up with more things Google could do in health, I might as well add that I'd love to see them get into the transparency business.  They try to help consumers find the best prices for other goods, and certainly health care can use all the help it can get in this regard.

Google is thinking bigger than these more modest expansions, like their "moonshot" to genetically map a healthy human body, or their new health and well-being company Calico, which has already announced the building of a major research facility.  I like that they are taking the long view, focusing on prevention and cures rather than simply more treatments, but there's still plenty of ways they can help the health care system in the short term as well.

Hmm, Google loves robots: maybe robotic surgery -- or doctors -- is next.

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Friday
Sep122014

Clinicians Embracing mHealth – but not so much if patients are involved

By Clive Riddle, September 12, 2014 

Although lagging behind many other service sectors, healthcare clinicians do continue to their march towards the inevitable professional embrace of mobile apps, social media and other web applications – typically as long as that embrace falls short of interacting with their patients. 

Wolters Kluwer Health just released survey results on nurse practitioner use of mobile health, social media and the web. The survey was conducted on their behalf by Lippincott Solutions. 

The survey found that 65% of nurses currently use a mobile device at work for professional purposes at least 30 minutes per day, and 95% of healthcare organizations allow them to consult websites and other online resources for clinical information at work. 

The survey findings also indicated:

  • 83% of nurses perceive that their organization's policy allows patient care staff access to web sites, including social media, to access general health information regarding patient conditions
  • 48% of respondents that access health information say their organization encourages nurses to access online resources; while 41% allow for occasional use; and 5% only as a last resort
  • 89% of healthcare organizations allow nurses to use online search engines at work
  • 60% of respondents say they use social media to follow healthcare issues at work
  • 86% say they follow healthcare issues on social media outside of work
  • 20% of nurses use mobile health apps for two hours or more per day
  • Among those who use mobile devices at work, Nurse Managers, at 77%, are more likely to use them than Staff Nurses, at 58% 

But their report notes that “73% of healthcare respondents say that organizational policies strictly prohibit direct patient care staff to have social interaction with patients on social media and social sites, compared to 51% say that organizational policies prohibit direct patient care staff to have access to their organizations’ own social media pages.” 

A Walters Kluwer survey of physicians last year found that 21% of doctors didn’t use smartphones in their practice, 46% used them less than 25% of the day, and 33% used them more than 25% of the day. Regarding use of tablets, 39% of doctors didn’t use tablets in their practice, 37% used them less than 25% of the day, and 24% used them more than 25% of the day. Of those who did use mobile devices at work,  24% use mhealth apps; while 33% used their smartphones to communicate with patients, and  17% used their tablets for patient communication. 

While many integrated systems like Kaiser have structured electronic interaction with patients into their system, basic impediments for many continue to be a lack of reimbursement, as well as legal concerns about doing so. 

Yet it is exactly that interaction that their customers are asking for.  For example, Harris Poll results just released for a survey commissioned by Wellocracy found that 66% of those who have used a wearable mhealth tracker or app in the past 12 months ndicated that they would be interested in receiving personalized feedback on their health data from a trusted health expert, such as a doctor, nutritionist, fitness trainer or licensed lifestyle coach, and of those respondents: 75% would be willing to pay for personalized feedback and coaching from a doctor, and 73% from a nutritionist, nurse or dietician.

Wednesday
Aug272014

What Is Amazon Up To? 

By Kim Bellard, August 27, 2014

Back in April, PwC and HRI issued a report that asked what new entrants might be healthcare's Amazon.com.  Now it appears that it might just be Amazon itself.

What we "know" is that unnamed "Amazon leadership" met in late July with Howard Sklamberg, FDA's deputy chief for global regulatory operations and policy, and other unnamed "various FDA leadership."

That's it; everything else is speculation.  Not much of a story perhaps, but, hey, without speculation there would be no point of blogs, and then I'd have to spend my time doing something else.

Still, the speculation is interesting, especially with a company like Amazon that has repeatedly demonstrated its ability to disrupt markets.

They already outsource their cloud services (Amazon Web Services, or AWS), their distribution capabilities, and their payment systems, the latter now being expanded to in-store payments, going up against the likes of Visa and Mastercard.  In a smartphone world dominated by Apple, Samsung and other established manufacturers, they fearlessly have introduced their own version, the Fire.  I could go on in various other spheres, but the point is clear -- they're not afraid of anyone.

So now health care?

Here are three ways that I would love to see if Amazon could add value to health care:

Reviews: OK, all you Amazon shoppers -- and there are a lot of us -- how many of you buy a product (even if not on Amazon) without first checking out the Amazon reviews?

Their reviews already cover various medical supplies/devices sold on Amazon, but wouldn't you love it if those reviews applied to, say, physicians or hospitals?

Recommendations: Amazon is noted for their personalized shopping recommendations, based on user's shopping and purchase history on the site and a lot of Big Data collaborative filtering.  Whether it is a recommended item, the "also viewed" products, or the "frequently bought together" combo suggestions, the recommendations are pretty effective in helping boost Amazon's sales.

Imagine if Amazon applied this to health care products, services, and even providers, recommending ones that they believe might best fit you, and possibly helping map out the various steps of a treatment plan (as they are "frequently bought together").

Medical tourism:  No, I don't mean the out-of-country packages of lower-cost health care services often thought of as medical tourism (although I'm not excluding them).  I mean more broadly making services or packages of something that consumers actively shop for, and breaking the traditional pick-the-closest doctor/hospital mindset that most consumers have gotten used to.

It's fun to speculate what Amazon might do, but the real benefit of them coming into health care in a bigger way would be that they might do something truly unexpected and unique, without health care industry blinders limiting their creativity.

They haven't asked for my advice -- and please feel free to get word to them that they should -- but what I'd urge Amazon

  • Keep it retail: Amazon made its reputation as a retail company, and yet health care has stubbornly resisted being truly retail -- Remember your roots!
  • Make people mad: I hope the AMA, AHA, and the state medical boards are furious, that individual health systems and health care professionals are scared to death, and there generally is a lot of arm-waving and teeth gnashing.

If everyone is applauding, Amazon didn't go far enough.

If all Amazon wants to do in health care is to make it easier for us to buy even more of the things we already buy too much of, and pay too much for, I wouldn't be surprised, but I will be disappointed.  We have plenty of companies who can help us tinker around the edges of the status quo, but all too few companies

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Monday
May132013

Games (Some) People Play

By Kim Bellard, May 13, 2013

I have to admit that I am a child of the television age, with movies as a close second.  I never really got into video games, like PacMan, Tetris, Mario Brothers, Call of Duty, Grand Theft Auto or even Madden NFL, and am only now belatedly becoming addicted to Angry Birds.  As I suspect is true of many of us old health care pros, I am also late to the potential revolution that video games offer for health care.  I’m glad others in the field have been paying more attention.

The video game industry is not for teenagers, and its size is shocking – it dwarfs the music industry, and, depending on which source one uses, either has surpassed or soon will surpass the movie industry.  It’s helping to drive the chip, PC, and mobile phone industries; none can afford to fail to deliver the speed and video quality that modern gamers demand.  We’re talking about a soon-to-be $70 billion industry here; still only a fraction of the health care industry, but much bigger, for example, than spending on health IT

The video game industry itself faces its own challenges; for example, the era of game consoles may be ending, as more gaming is done on mobile devices and with other options for player control.  That’s not to say the era of video games is passing, but rather that it continues to change rapidly.  Hand-held games were revolutionary when first introduced, as were game consoles, PC-based games, the Wii controller, Kinect, to name a few.  Video game companies who do not innovate can find themselves quickly left behind.  This “evolve-or-die” mindset is one that I wish was more prevalent in health care, whose attitude is more often “we know best” and/or “not too fast!”

Always looking ahead, the Robert Wood Johnson Foundation started its Games for Health project back in 2004.  They have given grants of over $9 million, and have an active conference and information sharing presence in the health/gaming intersection.  They’re not just spurring development of games and games technology, but also funding research on the games’ effectiveness through their Health Games Research program. 

The research is showing some results.  There are many reports about the health benefits of video games, such as a recent study that found video games can slow or even reverse mental decay, and a broader list of positive impacts that include motion skills, stress reduction, pain relief, vision and decision-making skills.  Apparently, both seniors and kids can benefit. 

An example of how game principles can be applied in health care is Mango Health, which turns the problem of medication management into a game, complete with rewards that can be turned into gift cards or charitable donations.  It is not the first or only such example, but is illustrative of the potential games offer.

The Entertainment Software Association, perhaps sensitive about criticism that violent videogames can have adverse impacts, prominently touts video games’ role in health care (along with family life, art, the economy, education, social issues, and the workplace – boy, these guys really are defensive, aren’t they?).  Two of the key areas it cites are in rehabilitation and in training.  For example, USC’s Institute for Creative Technologies researchers developed Jewel Mine to provide customized rehabilitation to people with a variety of neurological and physical injuries.  Other efforts use out-of-the-box gaming systems, like Wii or Xbox, to make rehab more enjoyable.  And there is an organization, Games4Rehab, that tries to tie users, developers, clinicians, and researchers together in this area.

One of the innovators in training that ESA cites is the University of Maryland Medical Center’s Advanced Simulation, Training, Research, and Innovation Center (MASTRI).  MASTRI has been working for over six years now on high tech simulation and training for health care.  Even ONC is using video games for training, as is Darpa (in their case, mobile medical training for first responders). 

One recent study found that surgeons who used the Wii – not on any specific medical games but just using standard Wii games -- outperformed their peers in laparoscopic simulators, due to improved spatial attention and hand-eye coordination.  My favorite study, though, was the one that found gamers did better at simulated surgery than medical residents.  Maybe the wrong people are doing those kinds of surgeries.

Surprisingly, payors haven’t all been late to this particular game.  Humana, in particular, was a pioneer, focusing on video games as far back as 2007.  Aetna  and United have joined the movement, and last year the Wall Street Journal summarized various insurer efforts.  One senses they’re not quite sure what they should be doing, but don’t want to get left behind.

People have coined the term “gamification” to include game-like features into non-game pursuits.  Author Jane McGonigal wrote a fascinating book called Reality Is Broken, the subtitle of which is “Why Games Make Us Better and How They Can Change the World.”  She doesn’t confine herself to video games, nor does she talk much about their applications for health care, but the mind-set she describes -- which include overcoming obstacles, rewards, collaboration, interaction, voluntary participation, and feedback -- is very much something people in health care should be incorporating more. 

The health care system does often seem like a maze, but it’s not one that most people have any fun navigating, nor one where many people emerge thinking they are winners.  This is an industry where, for example, use of outdated communications technologies like pagers waste an estimated $8.3 billion annually.  This is an industry that demanded, and is getting, hundreds of billions of dollars from the federal government to bring their medical records into the 20th century (and I mean that), largely still in siloed, mainframe EHRs that can’t talk well with each other and whose requirements for “Meaningful Use” are being delayed again.  It is not, in short, an industry that would seem an early adaptor of the lessons video games can teach.

Video games are no panacea for health care.  Not everything is a game, not everything should be approached like a game, and not everyone likes games.  Still, there are a couple of important lessons we should draw from them:

  • To each his own: for a not insignificant and growing portion of the population, games are a familiar and preferred medium.  If we want to educate, motivate, and influence behavior for that segment, game-like approaches are the way to go.  The likelihood of reaching serious gamers through, say, a telephonic disease management program would seem to be very low.  The point is not to use video games for everything for everyone, but to use the right media for the right populations.  We now have lots of options to reach people, including not just games but also social media, text, email, mobile.  The challenge to providers, health systems, and health plans is to figure out how to best use each tool for which portion(s) of the population.   
  • Take advantage of the technology and design:  Video games are in an arms race for better experience, and, as with arms races, there can be spillover benefits to other sectors.  High quality simulated images (even 3-D), on-demand, motion-sensing, multimedia, multi-person, and, above all, relentlessly interactive – all describe modern game capabilities and should be describing applications for health care, even if not used for games themselves.  Maybe health care organizations should hire fewer mainframe programmers and more game designers to work on their B2C efforts. 

Excuse me, but I better go play some games…for my health, of course!

Thursday
Feb282013

Involved But Not Committed

By Kim Bellard, February 28, 2013

There’s an old joke about the difference between bacon and eggs: the chicken is involved, but the pig is committed.  Perhaps the problem in health care is that when it comes to being engaged in our own health, most of us are chicken.  Maybe the wrong people have been cooking.

Patient engagement -- along with its many synonyms, such as shared decision-making or consumer-directed care – continues to be a favorite strategy for many health pundits.  I am biased towards it myself, although exactly what it means, or will mean in the future, is not entirely clear.

The prestigious journal Health Affairs recently devoted an entire issue to the topic.  In one study, Judith Hibbert and colleagues reported that patient activation scores help predict costs: lower activation levels were tied to higher costs, even after adjusting for risk.  A separate study, also by Hibbert, reviewed the literature and concluded that patients with higher activation levels had better health outcomes and care experiences, although the evidence was more inconclusive about the effect on costs. 

The trick, of course, is how to “activate” patients – is it all self-motivation, or can providers and other third parties (such as employers) encourage it?

One common method to influence patient engagement is an employer wellness program.  A recent National Business Group on Health survey reports that almost 90% of employers offer wellness-based incentives, spending an average of over $500 per employee on the programs.  Employers are getting tough too: 15% directly tie health plan eligibility to a health activity such as taking a risk assessment or biometric screening.  Almost two-thirds already tie employee contributions to completing such activities.  And 41% include, or plan to include, outcomes-based measures (e.g., lowering blood pressure) as part of the program.

Another strategy employers are using is increased employee cost-sharing, such as in consumer-directed health plans (CDHPs).  Critics accuse them of simply shifting costs to employees, but there are plenty of studies that indicate they may actually change employee behavior and help control costs.  For example, Cigna recently claimed that their CDHP members improved their health risk profile 12% while their health cost trend was 13% lower than traditional members.  Cigna CDHP members were also more likely to take health risk assessments, to use cost and quality tools, to choose generic drugs, and to seek preventive care. 

Consumers may be starting to take cost into account, but they don’t like it.  A study by Sommers, et. alia, reported on focus groups of insured patients.  The focus groups indicated that patients don’t like cost considerations to be part of health care decisions, and revealed that several stereotypes remain all-too-common, including that more expensive care is better care, and choosing more expensive care is some sort of victory over insurance companies (not realizing that, in the end, they and other insureds pay for that care).  Patients still don’t really know how to weigh risk versus cost. 

We treat health care costs much like we treat the deficit: costs come from other people, cuts should come from other people, other people should pay, and, oh-by-the-way, let’s think about it tomorrow.  That has to change. 

One thing that offers new hope for patient engagement is that the options for it have never been broader or more robust – mobile, electronic records, telemedicine, and social media, to name a few.

There are estimated 40,000 mobile health apps.  It seems you can get an app to do just about anything you can think of, plus many things you probably hadn’t.  The health apps vary widely not only in purpose but also in audience and quality.  A company called Happtique has just introduced a certification for health apps that will hopefully give consumers a better comfort about which apps to use, or for physicians to know which to recommend to patients.  They see the program not as a rating mechanism but as kind of like a Good Housekeeping seal of approval, assuring that at least a set of minimum standards have been met.  This could spur adoption.

It does appear that physicians are joining the mobile revolution, according to CompTIA.  Their recent survey indicated that one in five physicians is using a medical or health-related app daily, and 62% expect to be regular users with a year.  The trick will be how they incorporate them into their practice, for patient care and/or patient engagement.

EHR/PHRs provide yet another option to engage consumers.  To date, consumer adoption of PHRs have been disappointing, to say the least – even when they are available.  A recent study by Ritu Agarwal and colleagues, aptly titled “If We Offer it, Will They Accept?”, explores this issue and concludes that use depends on a number of factors – not just existing consumer preferences but also satisfaction with the patient-provider relationship, provider support for patient use of the PHR, and specific communication strategies to encourage use.  HITECH funding and “meaningful use” requirements may drive availability of patient EHRs, but persuading patients to use them will require some effort.

Telemedicine seems be exploding, both in terms of easing of regulation and in terms of payor coverage, so it is not surprising that there are a plethora of companies making their mark in this space.  These include American Well, Cardiocom, HealthSpot, NowClinic, or Virtuwell, to name just a few.  These may not provide your personal physician, but they offer physician expertise at your convenience – 24/7, from your house or even mobile device, not restricted to a physician’s hours.  That’s got to help improve patient engagement.

The IOM just hosted a workshop on partnering with patients, and one of the conclusions was that physicians and health systems need help in developing those skills, plus they may need additional incentives to engage in the kind of dialogue patient engagement requires (why am I not surprised?).  When you think about it, though, relying on physicians, or even nurses, to drive patient engagement doesn’t seem realistic.  We can spend time and resources on training them, but we still face the barrier of the projected shortages in both professions (physician, nurse), especially with the baby boomers just starting to crash the Medicare barrier.  Primary care providers may just be too scarce, especially in rural and other already underserved areas.  Not everyone agrees with these dire forecasts, but the point remains, though: the health professional to patient ratio doesn’t scale well into an era of higher patient engagement.

And maybe it doesn’t need to.  Maybe it really is up to us as patients to take responsibility.  Fortunately, we still don’t have to go it alone.

Social media, for example, may not even rely on a provider-patient model.  Health care providers are still trying to figure out social media.  An infographic by Demi & Cooper advertising/DC Interactive Group suggests that only 26% of hospitals use social media (most commonly Facebook), while over 80% of individuals 18-24, and 45% of those 45-54, would share health information via social media.  Meanwhile, Patientslikeme has been breaking new ground for social media use in health care for many years now, using patient-to-patient expertise and experience.  We’re only begun to scratch the surface of what patient engagement looks like in a social media world.

Artificial intelligence could be the real game changer in patient engagement.  IBM has made a big bet on AI in health care via Watson, and a recent study from Indiana University reaffirms that use of AI has the potential to both improve outcomes and lower costs.  Widely available health content on the Internet started this ball rolling, but health care professionals start to look like just another option – a preferred option, to be sure, but no longer the only option – to getting health information, advice, perhaps even diagnoses.  And I’ll have to save discussion of robotic surgery for another blog…

We’re already got a mobile stethoscope app, remote monitoring options for conditions like diabetes or blood pressure, medication and other reminder apps, and increasing ability for AI to evaluate and diagnose.  Who needs health coaches or even physicians to drive patient engagement?  Maybe in the not-too-distant future the model for patient engagement will increasing look like patients simply using their mobile devices: i.e., when Siri marries Watson.

At the end of the day, the person who has to be committed to patient engagement has to be the patient.

Thursday
Nov082012

Some Lessons from Sandy

By Kim Bellard, November 8, 2012

I have no doubt that many very smart people, and especially ones who were more directly impacted by Sandy than I was, will be doing extensive debriefings about Sandy’s impacts, and coming up with lots of far-reaching recommendations for next big disaster.  Still, I wanted to throw in a few thoughts about a couple lessons Sandy has for HIT.

One of the unexpected learnings from hurricane Katrina in 2005 was a boost in the perceived need for electronic health records, as many paper records were lost or destroyed by the storm, and as Louisiana residents widely dispersed across the country.  The paper and place systems for health information were found severely lacking, and Katrina was a clarion call to move health information into the 21st century.

Seven years later, we have, in fact, seen much progress on that front.  HITECH was passed to stimulate the adoption and “meaningful use” of EHRs.  Over 300,000 physicians and4,000 hospitals received HITECH incentive payments through 3Q 2012 – some $7.7b.  Those numbers are expected to grow rapidly, and the increasingly tough meaningful use standards will drive better use of the data in the EHRs.

That’s all good news, and it would be easy to see how HIT should have helped mitigate some of the woes from Sandy.  Instead, what we’ve seen makes me wonder if we’ve learned anything at all. 

Sandy caused hundreds of hospitalized patients transferred, with some entire hospitals closed due to flooding.  That’s obviously not good for patients, but understandable under the circumstances.  I couldn’t help but wonder what was happening with their records.  Did all their information travel to the new hospitals, or was everyone forced to start from scratch? 

Best case scenario, the patient might have transferred to a sister hospital that used the same systems.  The worst case scenario, of course, was that the records were only on paper which was lost or destroyed.  The most frustrating scenario, though, would be that both the old and new hospital had electronic records, but that the respective hospitals couldn’t communicate.

Unfortunately, this latter scenario is all too likely.  David Whitlinger, the health of SHIN-NY, the statewide HIE for New York, cited disasters such as Sandy as why we need health information exchanges (HIEs).  He’s exactly right, of course – but even he couldn’t say how many of the impacted New York hospitals were participating in SHIN or were able to take advantage of its capabilities.  I suspect that if they had any big success stories from Sandy, they would be touting them.

I’m not picking on SHIN-NY.  HIEs are facing problems in many places.  In Michigan, for example, there are two statewide HIEs, which can’t communicate with each other.  According to the eHealth Initiative, HIEs biggest concerns included developing a sustainable business model, and competition from other HIEs.  Most of them still aren’t doing anything as sophisticated as transmitting entire patient records.  It would be comical if it wasn’t so depressing, and if my federal tax dollars weren’t subsidizing these efforts.

HIEs are supposed to ensure interoperability and transmission of patient and clinical data, but those battles are still being fought.  A recent report from KLAS Research indicates that providers express dissatisfaction with their HIE vendors, including their ability to move data between multiple EMRs.  Respondents mentioned, for example, that Epic scores well for connectivity, but not with non-Epic installations…which sort of makes the capability moot.

Then there is mHealth, a term that was only just beginning to be used when Katrina hit in 2005.  It’s now a big deal: the mHealth market is estimated to double in 2012, to over $1.3b, with literally thousands of mHealth apps on the market, from the trivial to the FDA-approved.  It is no wonder that mHealth has taken off; over half of the U.S. population now has a smartphone, with two-thirds of new purchases being smartphones.  According to the Pew Internet & American Life project latest findings, almost 20% of smartphone users have health apps.

Sandy showed us that we’re not quite ready for prime time on this front either.  Let’s start with the availability of mobile networks.  The New York Times reported on the spotty service and infuriated customers.  As one impacted resident said, “not having hot water is one thing, but not having a [cell]phone? Forget about it.”   The Times pointed out that one of the recommendations from Katrina was better emergency back-up mechanisms for the wireless carriers, such as longer-lasting emergency batteries, which have not been widely adopted.  The wireless carriers have resisted many of the regulators’ efforts, and were not routinely providing their outage statistics the way, say, the power companies were during Sandy.  The Wall Street Journal had a similar story

So much for having any of those fancy mHealth apps; just think about any chronically ill patients who might have been being remotely monitored by their physicians when Sandy hit.  The wireless carriers are not yet seeing their mission as providing life-critical support to their customers, and it is getting harder and harder to understand why.

Sandy emphatically illustrated that wireless service is one that emergency planners will have to take very seriously going forward.  It has obvious implications for contacting friends and family, getting status updates on the disaster and recovery efforts, and helping direct affected people to assistance.  I only hope they take mHealth equally into consideration.  Not just for the things it does every day, but how to further take advantage of its capabilities when providers and their places of care are unavailable or limited.  Just think of how telehealth, remote monitoring, prescription history, and other applications could be useful in the aftermath of a Sandy.

Sandy has also firmly re-enforced Katrina’s lesson about health records.  We heard that lesson, and have spent much time, effort, and money on it since Katrina, but we find ourselves not much better off in making health records more fluid.  The EHR/HIE industries and their various customers need to step up their efforts and fix this problem -- hopefully before the next Sandy. 

I like the point that Brian Dolan of Mobihealthnews made in a recent post: technology is forcing us to rethink the classic concept of “point-of-care,” focusing more on where the patient is, not where the provider is, or even if the patient and provider are physically in the same place.  He was writing more from a mHealth perspective, but the paradigm shift applies broadly, as those evacuated Sandy patients could attest.

In the 21st century, health information can’t be tied down to paper or even to place, but has to be able to follow the patient wherever he/she receives care.

Thursday
Sep202012

Three Ways Health Plans are Using Twitter to Engage Their Members (and Potential Members)

By Marshall Riddle, September 20, 2012

Case Studies in Health Care Social Media

Last month MCOL released its 2012 update to its Benchmarking Healthcare Social Media Learning Kit. The base of the learning kit is a white paper which covers a study on 216 social media accounts representing 58 healthcare organizations from five sectors and takes data from Twitter, Facebook and YouTube. A number of benchmarks and ratios were developed for the study including the Twitter engagement ratio which measures the “quality” of an organization’s followers. Quality in this case pertains to an audience who interacts and is more likely to be interested in the content an organization is tweeting about. The engagement ratio is the percent of followers who are of “quality”. If a health plan’s goal in using twitter is to engage and be engaged by their members (and potential members), then this ratio is a relevant way to measure whether their approach to Twitter is effective.

Based on Twitter accounts utilized by health plans that were looked at in this study there are three basic approaches to using twitter in this industry sector:

1. Promoting company brand and activities: tweeting what would normally go out in a company press release

2. Customer Assistance: helping plan members with questions and navigation of their coverage whether solicited or not

3. Health/wellness/fitness advice: promoting the well being of their members in order to create a positive and interactive brand image

One account type not listed here and not focused on in the study were those which focused on job listings. This type of account does not have the goal of engaging with consumers and thus is not relevant to this list.

The 36 Twitter accounts from eight health plans that were included in this study spanned all three approaches. Examples of each are detailed below.

Promoting Company Brand and Activities

As Twitter has become as much a news aggregator as a social media platform, some health plans have focused their use on this aspect which was a natural progression from posting press releases in the media section of their website.

One plan which operates an account that spotlights its brand is Health Care Service Corporation (@HCSC). @HCSC tweets about:

Company achievements:

Company Programs:

How the company supports the community

@HCSM will also occasionally send out tweets with wellness and health information, though many of them link back to one of their plan’s press releases.

@HCSM has an engagement ratio of 1.58% which is below the average engagement ratio of plans included in the study at 2.83%. While @HCSM’s audience is not as engaged as other plan’s its maintenance takes much less effort than the other two approaches health plans are using on Twitter.

 

Customer Assistance

Whether a company has a presence on twitter or not, people will be talking about them, usually to complain. When a health plan has a customer service style account and someone tweets a complaint (or insult) at them or about them they are able to respond with an offer of help. Kaiser Permanente is one plan which does this with their @kpmemberservice account.

They respond to:

Negative references:

Questions or help with member services sent to any of their organization’s accounts:

And the very rare compliment:

@kpmemberservice has an engagement ratio of 4.15% which is above the health plan average of 2.83%. While this is a high engagement ratio for a health plan (most accounts of this style are similarly high), some of the engagements driving this are negative as seen above.

 

Health/wellness/fitness advice

Some health plans choose to focus one of their twitter accounts (or there whole twitter presence) on creating a positive brand image rather than promoting their company or services. They do this by tweeting about healthy living, nutrition, and fitness. Much of the time they tweet in the form of questions in order to start a conversation about a positive non controversial topic.

Humana has been using this approach with their @humanavitality account. Their positive tweets include:

@humanavitality has an engagement ratio which falls more towards the average at 2.96%. This is a lower engagement rate than what you would get from a customer service style account, but on the whole, the engagements with users are positive.

Each approach has its pros and cons. Promoting company brand and activities puts out the exact information a plan wants to and is low maintenance, but has limited engagement with consumers. Customer Assistance has a very high engagement ratio but does attract negative comments (though the negativity much of the time is already out there.) Health/wellness/fitness advice accounts have a good engagement ratio and have mainly positive engagements. The only drawback to the advice accounts is the plan is not able to offer material information on their plans and services.

To see how your plan stacks up to plans with similar accounts and to learn more about the study and benchmarks used check out The Benchmarking Healthcare Social Media Learning Kit 2012 (https://www.managedcarestore.com/ymcol/HCSM.htm). 

Monday
Oct102011

Top 5 reasons that members ignore disease management messaging

By Laurie Gelb, October 10, 2011

1.  It's inaccurate and/or inapplicable. "Our records indicate that you have not filled a prescription for ... [recently sent to pt continuously on drug for 8Y w/ no sampling] Reverse-gender content is common. 

Variable data printing is a wonderful thing! Information can be stratified by database variables such as gender, age, zip, fills, dx and more. And it's much better to present the information standing free than the usually-unnecessary but still Orwellian "our records [about you]."

If VDP won't work, segregate stratified info and ID it with a revealing heading, so members can skip past it easily. A general newsletter directed toward all household members can do this, although it's time to question the ROI of this approach. PR, podcasts, videos, etc. should be target-specific and clearly titled, for the same reason. 

2.  It's wordy. Most Americans do not read a daily newspaper, nor read extensively in their daily activities. Data suggest the reading ability and habits of even college grads have declined. A full-page, single-spaced letter is seldom digested in full, let alone acted on. 

Use active verbs and state the facts, using gradual reveals even in print.  "For recipes and tips, call 800 VEG 4NOW or go to veg4now.com." Footnote or link the legalities rather than filling the page body.

3.  It's condescending. "You may feel that eating five servings of vegetables is too difficult, but did you know that a 6 oz glass of tomato juice is one full serving?"

Best practice: a sidebar or callout with examples of popular, little-known or tasty veg choices, without airing your assumptions about people you've never met. 

Stock photos of happy, multiracial people clusters, whether in print or on line, are a similar turnoff. Perfect people can't get sick. Picture something from real life that matters (examples in our next installment). 

4.  It's impersonal. "Some patients may..." 

Best practice: Use "you" if/when it makes sense. "You may feel dizzy, nauseated and even vomit after your first dose of an x drug."

5.  It's contradictory. Messaging about the high sodium in tomato juice has appeared adjacent to praise for vegetables and their juices. Fruit juice often suffers from the same fate. 

Choose your core objectives based on member and epi data and follow through. One well-supported message makes more impact than four throwdowns. And "lower-sodium" can modify every mention of tomato juice. As for fruit juices, recent evidence is more positive, apart from drug interactions to avoid, so why not give them their due?

-------

Each of these reasons is a way to ice the dialogue before it begins. Does the car salesman approach you and say "You look like a luxury buyer" or "I'll bet you can barely afford a beater"? No, she generally asks what you have in mind, because that's her quickest path to a sale. The more interaction, the more specific the stimuli you can present. Content that's personalized, urgent, relevant and engaging (PURE) drives behavioral change.

Tuesday
Jun072011

Coming Down from Cyberchondria, part II

By Laurie Gelb, June 7, 2011

Actual hyperchondria, by definition, entails inappropriate self-dx and/or care-seeking (fueled by what Microsoft’s paper calls “the escalation of medical concerns”).

So what escalates concerns, whether you’re buying a car or selecting a health plan? Feeling like you’re being played by self-interested advisors. Being unable to get “a straight answer.”  Reading legal disclaimers instead of declarative sentences that apply to your situation. Looking at your organization’s health content, can you honestly deny any reasons for user frustration?

What we can foster via the social Web is appropriate self-dx and care-seeking. Let’s do our best not to conflate the two.

The danger in making any important choice has always been relying on any single information source, from your best friend in the cave to a medicine show huckster – or, today, your physician or a blog post.

Recent adherence literature gives us more reason to believe what common sense reveals, that patients who believe they receive all their disease information from physicians are less compliant. If you can’t internalize your health status by and for yourself, you can’t act on it appropriately.

Two decades past the launch of the health Web, many of its content providers still occupy one of two counterproductive positions:

  1. Displays polite aloofness, with “keeping our distance” copy, stock imagery and very little to address anyone’s information gap. Syndicated, bland content meets the barest of localized/personalized functionality.
  2. Genially hosts “”whatever people want to talk about.” Want to believe that whatever you have, it’s really Lyme disease? Blame your parents for all your allergies? Your headaches on your soda habit? There’s a board for you. Hosts chat boards/rooms/live chats on which spam posts, obsession with “censorship” and a few self-appointed experts constantly duel for position.

The net effect of Model 1, where people with questions get general platitudes, is to reroute them to [the more appealing] Model 2, where reason is often drowned out by the “squeaky wheels” with personal agendas other than the truth. Dr. Oz’ gradual descent from evidence-based innovation to mystical conventional medicine critic is an example, sadly enough.

How constructive is either of these models? Is there an ROI for doing anything about it? Let Dr. Oz answer from his April 26 show:

“Do drugs and surgery work? Yeah, they often work pretty well, and they have side effects... But the difference for me is a bow and arrow, a stealth approach to getting exactly what you want to get that works in you versus the ballistic missile approach that we have so often become comfortable with.”

MCOs: do you want to pay in goodwill or dollars for the implementation and/or consequences of the “stealth approach” Dr. Oz advocates here, which has included everything from reiki to a delayed immunization schedule? Or do you want to invest in worthwhile personalization of interventions with better track records – for you and members?

The fork in the road lies before you – choose wisely!

Wednesday
Jun012011

Coming Down from Cyberchondria, part I

By Laurie Gelb, June 1, 2011

In 1998, Harris Interactive came up with the above term to describe health Web information-seeking, and has been popularizing the phenomenon ever since. HI’s official definition states that this dread disease applies to hypochondriacs for whom the Web contains “too much information,” i.e. they become convinced from Googling “headache” that they have a brain tumor.

Might someone who honestly convinces herself, with or without the Internet’s help, that every headache is a tumor, demonstrate an impaired belief system in other respects? But it’s trendy to blame the Net for neuroses, just as we once convinced ourselves that allowing women to read would only breed or worsen hysteria.

According to many reports, it’s a closed circle. If you research symptoms on line, you’re diagnosing yourself. And if you’re diagnosing yourself, you’re a…no, I can’t say it.

Predictably, Microsoft published a white paper on “cyberchondria” in 2009 and recently it made TV news again as a new phenomenon. What’s the next hot ticket – hula hoops?  

So it’s OK to self-diagnose your dishwasher’s or car’s ills on line, and seek appropriate care, but not your body, because…wait a minute, what do I know about cars? Well, I’ve mastered filling up at the gas pump, and my skills at clearing a fogged windshield are unmatched. But neglecting my car can’t kill anybody, right? Oh, hold on…

Can we draw a line that includes reasonable presumptive dx? When your members think they have a simple headache that’s not life-threatening, most of them pop two NSAID tabs. That’s totally appropriate self care. Do you want patients to rush to their docs for simple headaches so you won’t judge them as cyberchondriacs? Or because you just did?

Self-diagnosis and care, to a point, relieve strain on our overcrowded system, produce cost-effective outcomes and improve health status. We spend a lot of money on decision support to help patients understand that point –and rightly so.

In 2011, asserting that the Web fuels hypochondria is akin to lambasting the existence of motor vehicles for encouraging speeders. Like it or not, the health Web is not the pool room south of downtown that respectable people shun. It is the commons of your world. If you want another planet, I hear Mars is lovely in the spring.

We miss opportunities to play a win/win role in millions of health-related explorations that can and should improve care and outcomes – and on which any rational sufferer will embark -- when we glibly apply the language of disease and switch the burden of proving “appropriate” exploration to the user – while at the same time preaching minimalist self-care. If you’re concerned with the reliability of what’s out there for member consumption,  don’t shoot the messenger, improve the landscape.

 

Monday
Apr252011

Researching the Real

By Laurie Gelb, April 25, 2011

While the rest of the social Web is constantly redesigning itself based on user context and needs, the health Web lags. Personalization, filtering, sorting, non-linear exploration and other “Web-standard” capabilities on sites like Amazon is lacking as yet.

Why?

One possible reason is that surveys of health Web users commonly manifest a “how much” obsession, neglecting the who, when, where, what, how and why. This creates misleading constructs for action, which we will continue to explore in future posts.

Let’s examine on just one question that Pew asks [not picking on Pew, just that its survey is widely quoted]:

Q32 Overall, who do you think is more helpful when you need... [INSERT FIRST ITEM] – health professionals like doctors and nurses, OR other sources, such as fellow patients, friends and family?  And who is more helpful when you need... [INSERT NEXT ITEM; RANDOMIZE]?  AS NECESSARY: Professional sources like doctors and nurses, OR other sources, such as such as fellow patients, friends and family?  

a. An accurate medical diagnosis

b. Emotional support in dealing with a health issue

c. Practical advice for coping with day-to-day health situations 

d. Information about alternative treatments

e. Information about prescription drugs

f. A quick remedy for an everyday health issue

g. A recommendation for a doctor or specialist 

h. A recommendation for a hospital or other medical facility

 

1 Professional sources

2 Other sources

(VOL) Both equally

(DO NOT READ) Don’t know

(DO NOT READ) Refused

Beyond the ambiguity ("day to day health situation") and heterogeneity in some of these question items (you might have a different process for researching someone/ somewhere to remove an ingrown toenail vs. a CABG), we can summarize the problem here with two words: false dichotomy. 

How actionable can these answers be, even when tracked over time? The answer items are all binary, they relate to categories rather than actual resources and the unaided “both equally” option is a copout/source of social bias rather than a reality. 

What Pew could be asking:           

Have you or anyone whom you help make health decisions, such as a family member, ever faced  [specific situation]?

[if yes]

How recently did you or someone you care for face [specific situation]?

These decisions never stop [they don't, for someone w/ chronic illness/injury, often neglected in these surveys but also often your high utilizers]

Dealing with that now

Within the last month

A month or two ago

A few months ago

About a year ago

More than a year ago

 

When situation X most recently arose, from which of the following did you receive information before making a final decision? Please check all that apply. [randomize order w/ selected anchors]

  • Your or the patient's physician
  • A staff member in that physician's office or clinic
  • A brochure or video in a physician's office or clinic
  • The Internet
  • A magazine or newsletter
  • TV or radio program
  • Friend or family member who works in health care
  • Friend or family member who does not work in health care
  • Other (please specify)

Often, we then zoom in on that recent situation and dissect how well the search process (or lack thereof) worked out in terms of needs vs. outcomes.

What else can we ask Web users, that we don’t know the answers to, that we can actually use to design stronger decision support?  An example…when we look at choices that are being made NOW – which we will need to branch into – we can find out:

  • Who helps whom (for example, what percentage of the sample is currently influencing (1) health decisions on a child’s behalf (2) health decisions on an adult’s behalf other than themselves. This and the next item will aid subgroup analysis/tracking.
  • Is the current decision process around self-care or accepting a professional’s recommendation?
  • Where/how do they think they need to research, if anything before making or accepting a choice?
  • If the decision process is ending, is it by choice or necessity?
  • How well do they think they are succeeding in getting what they need? This is categorical like in real life -- not at all to it's done.
  • What else do they need to know, that they do not yet? This can be structured, open-ended or both.
  • What are the barriers to getting what they think they need? (e.g. not enough time, not sure how to search, overwhelmed with info, didn't have long enough chat w/ doc, not sure if insurance will cover…)

Does this sound really nitpicking? It’s really no worse than the research process we go through for cereal or paint – just that instead of keying on the purchase process, we are keying on information-seeking. User-driven branching and filtering moves the respondent through quickly. BUT – we should never assume prework. If I walk into CVS like a robot and walk out with my default OTC analgesic, you should know that as well.

It's always a worthy goal to keep your information specific, your verbs active and your sentences short. If you wouldn't say it, apart from legal disclaimers, why write it? 

Friday
Apr152011

Cartoons for Health Care Professionals

by Clive Riddle, April 15, 2011

As a child I recall looking forward to Saturday mornings, filling a bowl full of cereal and sugar before my parents were awake, and plopping down in front of the television to view an endless parade of my favorite cartoon characters.

Now, anyone involved in the business of health care can sort of re-experience this feeling (bowl of cereal and sugar optional) by consulting YouTube and browsing through an increasing stream of short animated features created to for the professional.

Of course you’ll have to wade through an even larger river of health care animation created by the masses to comment on health care reform, politics and hospital visits. But here are some recent mainstream efforts at delivering health care business information in a new format, often with a dose of humor:

Milliman calls the stars of their animated features “Droids” and offers three items so far in their Healthcare Town Hall:

  • Droids discuss health insurance rate setting process
  • Droids discuss cost shifting
  • Droids discuss individual mandate

Jeremy Engdahl at Milliman says they’ve “been exploring how animation can help educate people on misunderstood components of the health system in general and health care reform in particular.” He notes the videos have been peer reviewed by actuaries and are backed by published Milliman research.

Kaiser Family Foundation recently released Health Reform Hits Main Street which comes with the following description: “Confused about how the new health reform law really works? This short, animated movie -- featuring the ‘YouToons’ -- explains the problems with the current health care system, the changes that are happening now, and the big changes coming in 2014. Written and produced by the Kaiser Family Foundation. Narrated by Cokie Roberts, a news commentator for ABC News and NPR and a member of Kaiser's Board of Trustees.”

Accountable Care Organizations have perhaps been the topic of the greatest number of health care business animations. Leading the pack in viewership, with 77,000+ views,  is a piece by CenturaHealth entitled In Search of an Accountable Care Organization (ACO) which the hospital organization describes as: “Clueless health care executive tries to learn about accountable care organizations in the age of health care reform.”

The Disease Management Care Blog has a YouTube Channel featuring several animated pieces including “Setting Up An Accountable Care Organization” and “Disease management saves money.”

Alan Genicoff, MD JD who offers a Law Doc blog has a YouTube Channel which includes the “healthcare fraud cartoon parody: The Medicare RAC audit” in which we’re told to “watch Dr Abel squirm as the Medicare RAC auditor takes him to task about possible overbilling of Medicare.”

And of course I’d be remiss if I didn’t mention that MCOL has entered the fray, and features a number of animated pieces in it YouTube Channel: MCOLdotcom.

Now, does anyone remember the words to the theme song from Scooby Doo or the Banana Splits?

Friday
Apr082011

Life in the Web: What Page Are You On? (part II)

By Laurie Gelb, April 8, 2011

In our last installment, a typically-networked physician was driven to distraction by his patients’ reliance on the Internet for personalized health advice, and an MCO director struggled to understand why her network’s disease management materials were failing to influence member behavior.

Both might benefit from a better understanding of how, when, where and why members of the lay public utilize online medical resources. These questions have seemingly been the subject of much research. However, surveys have primarily focused on scope -- “how much”—rather than the deconstruction of how and why.

To put the question another way, what does the social Web (an umbrella term for social networks/the Web/mobile media) offer that a physician’s appointment or disease management brochure doesn’t?

Unlimited time and bandwidth. The ability to filter and search, with the hope of greater personalization. Diverse opinions. Colorful, unequivocal language. Identification of and interaction with trusted resources on demand 24/7 from any Internet-connected device. Hyperlinks to explore more quickly and less linearly. Ability to go from structured resources like encyclopedias to Facebook and back again. Social bookmarking that eliminates the need to “start from scratch.” If you have two more hours, we can keep going.

To what extent has research into health Web use helped us to better utilize the physician’s medical expertise and communication skills to design better health information portals and tools? Apply the MCO director’s knowledge of demography, utilization and trends?

Not so much.

And to what extent are social Web-savvy content developers in charge of creating health advice on the Net, self-help tools or member disease management communiqués?

Not so much.

Now, going back to our Net-savvy physician – how much money has gone into e-prescribing, clinical tools, formulary references that he uses every day…as compared with the resources that a patient would use? How much connectivity is there between MedicAlert or  Microsoft HealthVault and the answers patients get to their health questions on the Net?

Not so much.

In short, content and tool developers have pretty much failed to bridge the gaps between what their masters (us) want to convey and where their so-called audiences want to be. Is it surprising that people don’t particularly want to be “herded” into a maze for which they write none of the rules, that they would rather be setting the terms of engagement?

Yes, the process of accessing information, care and reimbursement for said care is currently perceived as adversarial. And battles lines are being drawn…from the receptionist’s window and business office to your Web site and shiny new brochures. And no one else gives a flip about your communication strategy. Most agendas read, “Pay less, get more and never have to say ‘I’m sorry.’”

So now what? If you want to play to win (i.e. to improve the odds that someone receives optimal care), you need to gather and then use some intel, some real insights, not the pablum of yesteryear. We’ll discuss how to do this, next time.

Tuesday
Feb152011

Life in the Web: What Page Are You On? (part I)

By Laurie Gelb, February 15, 2011

A physician turns to a nurse between patients and snorts contemptuously. "Dr. Google convinced my last patient that she should stop taking her beta blocker because she might get dizzy. Why do these people believe everything on the Net and nothing I tell them?"

"Maybe because the Net isn't you," the nurse half-jokes.

She brushes past him to place some educational brochures (which include a list of URLs for patients to visit) into the waiting room rack, as he double-checks a digital database for drug interactions  while going into the sample closet for a waiting patient. 

When he returns to the exam room with a sample pack, the patient is tapping her iPhone. She says, "Should I be taking that since there's a precaution for people my age?"

As the physician fumes inwardly, he explains, "Your kidney and liver function are normal, and you're in excellent health overall. So I think on balance, this is the best choice." 

She arches a skeptical eyebrow, then opens an e-mail window to remind herself to ask the same question of her brother, a podiatrist in another state.

Meanwhile, an MCO executive is wincing at dismal performance metrics for her network's latest disease management initiative. The letters and brochures looked so pretty and inspiring in the shipping boxes, but failed to produce results. Follow-up calls found that they barely generated awareness, let alone action. 

She makes a note to consider a new vendor for next quarter's program, with a reduced budget. Her thoughts wander to text messaging and e-mails, which might be more effective. She recalls that an agency contact said something last week about a Twitter feed and puts that on the next meeting's agenda.

Shaking her head at the futility of it all, she reaches for the latest cost trend reports and considers another espresso.

--to be continued---