Month: November 2013

You Are Wasting Your Time Making Social Media Apps and Platforms for The Chronically Ill

Jane Sarasohn-Kahn at HealthPopuli disects a recent Pew Study Chronic Disease and the Internet “The Diagnosis Difference“. Sarasohn-Kahn analysis and comments are spot on and clearly have the economists feel which is clear and to the point.

So top line, people with chronic illness even one will seek information online, participate in peer to peer social media to understand reviews on drugs/treatments and learn from other patients. BUT wait for it. Chronically ill patients are less likely to have internet access because they are older and less educated. They are not on par knowledge wise with other US adults regarding information and tech adoption. That’s a problem. 

The Pew study which those who are ill with internet access become more engage with their health and share that information with HCP at a higher rate than those without a chronic illness. The will self track  ADL, meds, etc. It works for them since they identify that this activity makes a difference on their health or those they are caring for. See the chart on the HealthPopuli. 

You’ve all seen this before, 70% of all adults look online for health information. And those with 2 or more chronic conditions are more likely to seek information at a rate of 62% vs. 52% when compared to those with no chronic condition. Here is a chart from HealthPopuli post:

There are large differences in health information seeking behaviors in chronically ill vs. healthy people especially for:

  • Specific medical treatments (53% vs. 41%)
  • A drug you saw advertised (20% vs. 13%)
  • Drug safety or recalls (21% vs. 15%)
  • Medical test results (18% vs. 13%), among others.

To fully appreciate the chronic condition category 1 in 4 US adults have at least one and 1 in 5 live with 2 or more. Here are the conditions that Pew listed.

  • High blood pressure, occurring among 25% of U.S. adults in the survey sample
  • Lung conditions, managed by 13% of U.S. adults in the forms of asthma, bronchitis, emphysema and other lung issues
  • Diabetes, among 11% of U.S. adults
  • Heart conditions, for 7% of U.S. adults (e.g., heart disease, heart failure, or heart attack)
  • Cancer, among 3% of the adult population, and
  • Other chronic conditions, for 16% of U.S. adults.

Sarasohn-Kahn makes the following points

  • Those with serious chronic conditions seek information (Think adult learning and how people seek solutions to problems they have.)
  • Most people do not self-track health via digital which enables behavioral changes and better outcomes
  • Active seekers of health information who self-track cost less. See this link here.

Ya gotta love an economist because Sarasohn-Kahn point to three links that offer health apps and phones. This is the supply side. They are:

TracFone and Voxiva, The Commonwealth Fund has paper on creating provider patient partnerships, finally NEHI shares eleven apps that offer ways to manage chronic illness.

The bigger issue is the demand side where Pew reports that few people take advantage of these tools.

This is a very important analysis of the Pew data and is something that we must solve going forward in order to change outcomes or at least improve patient care. The SM cognoscenti keep talking about how SM is the ultimate tool in our healthcare tool box. What in fact we need to do is identify this and build strategies that solve the problem. We don’t need more apps or platforms. We need answers and subsequent strategies. I still believe it is not WebMD but MyMD where true learning and knowledge occurs for both patient and HCP.

Retail Tools for Hospitals and HCPs to Monitor Patient Sentiment and Knowledge

Stephanie Miles an associate editor at the Web Sit Street Fight highlights 6 Tools Small and Medium Businesses (SMB) Can Use to Monitor Customer Sentiment. Sentiment analysis is defined as

“detecting and understanding how the audience is reacting to a brand, either positively or negatively,”

Understanding sentiment is critical to business owners for obvious reasons but more importantly these tools can help shape strategy and determine how messaging is working. For the retail industry this is an important exercise as well as an analysis tool. As I read this article I wondered how the tools Miles presents can be applied to healthcare specifically hospitals and physician practices. Patient engagement and epatients are the rage today can any of these six tools be used to improve not just the marketing but the understanding patients have of their care and their HCP? Here are the tools:

Earshot: This is a proximity-based platform that looks at social media and targets mentions that are near by. The business can use this type of data to determine real-time sentiment near locations to measure the level and quality of interactions.

VendAsta: Monitors customer sentiment over time comparing the good and the bad of customers comments on social media. It can monitor and measure week to week to determine how they are evolving. 

Radian6: This tool will analyze social media and provide sentiment for each online post. The results are positive, negative, and neutral. This is a great tool to quickly see what is circling the bowl regarding reputation and step in to fix it. 

Swipp: Is a tool to gauge reaction to your social media campaign. This is not monitoring per se but actual widget embedded in online activities, posts, campaigns etc. Customers (think patients) are asked to share their opinion (think understand of an interaction with an HCP). It can so trending over time. 

Yext: Want to know quickly when they hate you? Yext tracks customer (think patients again) over time across a tone of networks and review websites. It analyzes reviews and mentions immediately and lets you know. 

ListenLogic: This is a social intelligence platform to supply the business with “strategic social insights. These include sentiment, demographics, and influencers. It is adaptive, meaning it will adjust to changing language and ideas. 

I see these tools and wonder how they can be used to not only monitor retail sentiment but identify the changing behavior of patients and caregivers as they navigate and work within the provider system or with their HCP. Recently Forbes had and article How Doctors Should Respond to Negative Online Reviews. Some of these tools may be to expensive for the solo practice. For a group practice or hospital these tools seem like they can be used off the shelf as described. Taking it a step further I am thinking these tools can be reworked to determine not just sentiment but to measure change in knowledge of patients. Can they measure the changing language and where and how patients are posting regarding their healthcare knowledge to determine change in understanding which may server as a marker for improved care. 

Patient care is at the center of healthcare. We also are seeing the moving of healthcare to retail competitive business and if we can apply tools that are successful in the retail world to improving our understanding of where the patient resides in their sentiment and knowledge we can improve outcomes.

Reviews and Ratings Are Driving Local Search: Can HCPs & Providers Use These Tools?

Joe Morsello provided a commentary on Street Fight How Reviews and Ratings are Driving Local Search that examined how searches for local businesses are including in ever increasing numbers review and ratings that we can’t miss. We all know these are subjective but a recent study of >2,000 consumers in the US and Canada showed that 79% of consumers trust online reviews as much as personal recommendations. This is up from about 67% in 2011. Add that to a recent Nielsen study of 29,000 consumers across 58 countries identified that 70% of consumers trust online reviews. And think about this from a Harvard Business School study, a one-star hike on Yelp can mean a 5-9% rise in restaurant revenue. Something else from this study that was noteworthy, they found the more reviews a business had reduces the likelihood of positive review fraud. While fewer reviews increased the likelihood to engage in positive review fraud. Makes sense since less reviews may just drive panic in the office. Here is part of the conclusion from the Harvard study:

Organizations are more likely to game the system when they are facing increased competition and when they have poor or less established reputations.For managers, policymakers, and even end-users investigating review fraud, this sheds light on the situations where reviews are most likely to be fraudulent. More generally, this casts light on the economic incentives that lead organizations to violate ethical norms.

Morsello points out that businesses should privately ask customers to review a service or product not shout it out on FB or Twitter. Further he makes the point that online reviews will be an important and significant differentiator for business since they are becoming part of the local search. To drive this point home Nielsen reports that consumer reviews are the third-most trusted form of advertising, behind recommendations from the people you know and branded websites.

Yesterday I wrote about retail tools that monitor customer satisfaction and how they will be important in helping to determine and measure patient satisfaction. That post is here. This article points to an important change in social media and online reviews and fits with the customer/patient satisfaction. It is the expression of that satisfaction or dissatisfaction that is important. Each on represents an opportunity to advance a message, meet a goal, express a strategy, or fix and issue. Online reviews and rating are gaining in importance even in the face of growing concern over people gaming the system. This article and the associated studies are showing online reviews are part of retail decision making for customer. The conversion of this to healthcare seems obvious. Patient decision making can be partially driven by making online reviews part of an overall strategy.

Hospitals are going to be providing outcomes data for patients to use to compare care and quality as well as price lists. It only makes sense that these hospitals include reviews by patients and track those reviews. Here are our clinical outcomes and here are our human outcomes up close and personal. We can do this. 

The Solution to Those Depressing End of Life Chats

Slate TV Critic Willa Paskin reviewed a new HBO offering Getting On. A comedy about a stopover facility for the elderly recovering from surgery and strokes and more.

On the 36-bed ward, old people poop on chairs, screech in foreign languages, curse out the staff, copulate in public spaces, vomit, fall, and die. ButGetting On is not a drama, it’s a deadpan, absurdist comedy. I’ve never laughed so hard about the frail and failing.The Golden Age of TV may be over, but Getting Onsuggests no one has told the people writing parts for women yet.

This will be DVR’d only because I need to laugh at my future and counter point to death with dignity chats, end-of-life discussion. Perhaps writers and producers are addressing our fears with humor.

More on Exercise and the Web: Patients with Knee & Hip OA

Effectiveness of a Web-Based Physical Activity Intervention in Patients With Knee and/or Hip Osteoarthritis: Randomized Controlled Trial Bossen, Veenhof, EC Van Beek, et. al have an original paper published at JMIR. Yesterday I posted another study from JMIR “Electronic Word of Mouth on Twitter About Physical Activity in the US: Exploratory Infodemiology Study” which looked at how Twitter and Twitter users drive and support exercise. This study examined a fully automated Web-based physical activity in patients with knee or hip osteoarthritis compared to a control group. The authors measured improved levels of physical activity and self-perceived effect.

Here is the closing paragraph from Principle Findings section. When you consider the authors note that to date their are no Web-based physical activity interventions for these patients this study seems be pointing to a step forward. 

As there is no cure for OA, self-management is considered a key element in the nonpharmacological treatment of knee and/or hip OA. Self-management aims to motivate OA patients to undertake changes necessary to improve physical and psychological well-being. Although the importance is generally acknowledged, provision of self-management is underutilized. Given the clinically relevant benefits and the self-help format, Join2move could be a key component in the effort to enhance self-management in sedentary patients with knee and/or hip OA. Considering the unique potential to reach large populations through Join2move, even the small effects observed in this study could have clinical public health consequences. Besides the focus on outside-care populations, patients in a care setting may also benefit from Join2move. Therefore, future work should integrate and investigate Join2move in a health care environment.

Notes & Links: November 20, 2013

Electronic Word of Mouth on Twitter About Physical Activity in the United States: Exploratory Infodemiology Study

Zhang, Campo, Janz, et. al. took a long, hard, and well designed look at Twitter in promoting health behaviors. Their study published in JMIR is important to those of us who advocate for SM and Health Communications and using social media to improve patient engagement. The paper addresses physical activity an important surrogate marker for healthcare and Twitter because it opens our thinking about how to identify communications strategies for not just physical activity but all healthcare. The authors also present how we can use Twitter on how people talk about physical activity. 

Objective: In order to provide insights into designing health marketing interventions to promote physical activity on Twitter, this exploratory infodemiology study applied both social cognitive theory and the path model of online word of mouth to examine the distribution of different electronic word of mouth (eWOM) characteristics among personal tweets about physical activity in the United States.

Results: Tweets about physical activity were dominated by neutral sentiments (1270/1500, 84.67%). Providing opinions or information regarding physical activity (1464/1500, 97.60%) and chatting about physical activity (1354/1500, 90.27%) were found to be popular on Twitter. Approximately 60% (905/1500, 60.33%) of the tweets demonstrated users’ past or current participation in physical activity or intentions to participate in physical activity. However, social support about physical activity was provided in less than 10% of the tweets (135/1500, 9.00%). Users with fewer people following their tweets (followers) (P=.02) and with fewer accounts that they followed (followings) (P=.04) were more likely to talk positively about physical activity on Twitter. People with more followers were more likely to post neutral tweets about physical activity (P=.04). People with more followings were more likely to forward tweets (P=.04). People with larger differences between number of followers and followings were more likely to mention companionship support for physical activity on Twitter (P=.04).

In their section on Principle Findings the authors point out that physical activity is different from other commercial activity which shows 60% of tweets positive, 12% neutral, and 25% negative. In their study 85% of tweets were neutral. They attribute this finding to the fact buying something is a transaction that people can easily and quickly identify likes, dislikes, pluses, and minuses. While it takes longer to identify tangible results with physical activities. The authors offer an alternative explanation

… people might be less willing to comment or have more difficulty commenting on their own behaviors than on commercial products. When people comment on a product or service, they evaluate third-party providers, which is a relatively easy task. When discussing physical activity, however, they have to evaluate their own behaviors and their own selves, which may be more difficult cognitively

This is important as we move forward in SM and HC. how do we help or identify patients willingness to self identify their own health behaviors. More importantly how do we understand what and how patients are doing with data gathered on the internet or via social media? 

Changing or learning about healthcare is not like buying a car though it is moving in that direction through price transparency and the publishing of outcomes by hospitals. And consider the reality where a huge percent of adults use the internet to seek health related data and knowledge. Inquiring minds want to know. This melding of healthcare into a consumer driven decision with four parties exerting pressure on the system patient, HCP, hospital, and insurance provider is not going to go away soon. In some regards the power is moving to the patient. (I would like to see the true power couple being the patient and the HCP.) Where Twitter and other social media comes in is through the consumer seeking information and knowledge in order to make the decision regarding treatment, provider, HCP, etc. Therefore, those in the business of or providing healthcare would want to consider how does the consumer find, use, and share knowledge on their health. The authors addressed that this way:

People with more followers were more likely to post neutral tweets about physical activity. People with more followings were more likely to forward tweets. These findings suggest that people with different number of followers and followings may have different motivations for using Twitter regarding physical activity. People with fewer followers and followings might be more likely to connect with a close social network on Twitter and talk about physical activity positively for fun, whereas people with more followers and followings might be more likely to use Twitter primarily for information sharing about physical activity. However, future research is needed to further examine the reasons and confirm these suggestions.

The authors noted that the gap between following and followers is important because people with the widest the gaps were more likely to mention companionship support on Twitter. This was counter to the idea that a narrower gap may demonstrate “higher reciprocity between actual friends”. It is thought that the wider gap may mean more actual friends. Taking this outside of physical activity it could point to a way to look at caregivers seeking information and their support network where they are following many who have knowledge to share but only share with a small group of friends.

In the section on Practical Implications the authors make the following observation:

Findings about how eWOM characteristics differed among Twitter users with different networking characteristics can provide insights into segmentation of audiences in future physical activity marketing interventions on Twitter. The association between the number of followers and followings and the valence of eWOM about physical activity indicates that interventions encouraging positive discussion of physical activity could start by enrolling individuals with fewer followers and followings and observing and learning how they talk positively about physical activity.

Because people with more followings tended to forward opinions or information about physical activity on Twitter suggests that public health practitioners could target people with more followings in future physical activity marketing interventions. Public health practitioners could develop Twitter accounts to promote physical activity and encourage Twitter users to follow the accounts and retweet tweets about physical activity to their followers.

Taken out of exercise and considered for healthcare in general. These finding speak directly to ways and audiences to address specific to healthcare delivery either from the HCP or the provider. Finding the right audience who will expand the message with authority and who will help improve care is key. The authors have given us not just an analysis of Twitter and exercise but how to look at Twitter as part of a strategy to determine who, what, where, when, and how changes in healthcare can be made. 

Making Medical Decisions for Patients without Surrogates
NEJM has a perspective written by Thaddeus Mason Pope, J.D., Ph.D. which continues an article from last months New York Times “Hiring an End-of-Life Enforcer” 

In the NY Times article addresses the need to fill the gap identified in 2006 study that reported 16% of those in intensive care have no designated decision-maker and family to fill that roll. Paula Span author of the Times article talks about health fiduciaries who could guide the patient in these decisions. Pope in the NEJM addresses how the healthcare professional and the state are addressing this gap of the ‘unbefriended’ or “unrepresented’ since any decision made for this group of patients may not meet even minimally sufficient safeguards. “Consequently, health care decisions made on their behalf are at risk of being biased, arbitrary, corrupt, or careless.”

None of these decision-making mechanisms, however, can help the unrepresented. They have no POLST forms, no advance directives, no agents, and no default surrogates. And the unrepresented are a big group — including some elderly and mentally disabled patients, as well as many who are homeless or socially isolated. In many states, lesbian, gay, bisexual, or transgendered patients may have same-sex partners who could serve as decision makers but are not legally recognized as surrogates. Experts estimate that 3 to 4% of the 1.3 million people living in U.S. nursing homes and 5% of the 500,000 per year who die in intensive care units are unrepresented.

Pope notes that Georgia enacted a medical-guardian statue to help the unrepresented. A survey of Georgia probate judges show the law in ineffective because there are not enough people who want to do this work. 

One policy Pope presents is prevention. Keep patients from becoming unrepresented from the get go by supporting their ability to make their own healthcare decisions, complete advanced directives based on choices and decisions, help them find and agent, finally identify a surrogate. 

Physicians can make decisions for these patients since they are trained to but are not good surrogates and most states specifically prohibit patients from selecting their physician as surrogates. Pope sees the ethics committee who can work hard and quickly to identify the patients wishes and offer different perspectives. Here is the bad news on this, only five state have empowered multidisciplinary committees to make treatment decisions. The rest of the states can do better and should. 

So long as legally sanctioned mechanisms are nonexistent or inadequate, I believe that providers have both the duty and the discretion to design these policies.

I agree and more importantly this is the ultimate in social networking, embracing those who can’t or don’t have the ability to make end-of-life decisions. We will not find them on Twitter. They are residents in hospitals and nursing homes. How can we reach out to these institutions and offer our knowledge, capacity, and friendship to support and help those in need? Instead of having followers on Twitter perhaps we need to follow someone who is alone and dying so they do not suffer needlessly. 

Notes & Links:November 19, 2013

Cholesterol Risk Calculator Controversy: What’s A Statin User To Do?
John LaMattina a contributor to Forbes asks the question we all want to know the answer to, Now what for me?

LaMattina presents his personal reasons for continued use of Lipitor. Though he does not speak for everyone using a statin it does speak to his own logic and reasons which may help you sort out what this all means.

Study: Rapid Increase in Breast Magnetic Resonance Imaging Use
Aaron Carroll writing at The Incidental Economist (TIE) shares recent data on MRIs and breast cancer. The study is publish in JAMA Internal Medicine. It was a retrospective cohort study of 10,518 women age 20 or older. Here are the results.

Results  Breast MRI use increased more than 20-fold from 6.5 per 10 000 women in 2000 to 130.7 per 10 000 in 2009. Use then declined and stabilized to 104.8 per 10 000 by 2011. Screening and surveillance, rare indications in 2000, together accounted for 57.6% of MRI use by 2011; 30.1% had a claims-documented personal history and 51.7% a family history of breast cancer, whereas 3.5% of women had a documented genetic mutation. In the subset of women with electronic medical records who received screening or surveillance MRIs, only 21.0% had evidence of meeting American Cancer Society (ACS) criteria for breast MRI. Conversely, only 48.4% of women with documented deleterious genetic mutations received breast MRI screening.

Here’s the bottom line: most of the women who were screened for breast cancer by MRI didn’t have documentation warranting it. Many more women who did have a genetic mutation who might have benefitted from MRI screening didn’t get it.

I would point you to TIE site and this post especially for the comments. It is interesting how everyone sees something different. Isn’t science grand.

Putting Your Physicians in Focus
Dan Dunlop writing at The Healthcare Marketer shares some work from his agency and how they are connecting the consumer to the physician. He shares a new unit Physicians In Focus that focuses on producing high quality physician videos.

I’ve written here on patient physician engagement and its importance because in my mind the brave new world of epatients and how patients are using the internet, social media, and more to engage with their HCP to improve their health. We have to move from patients and caregivers looking at WebMD or chat rooms as a single all knowing resource. The most valuable resource is MyMD. A patients physician is a single most trusted resource for the patient and as such they can drive greater more durable change for those patients who are self directed learners. And let’s not forget the HCP can engage more patients to become self directed learners. Isn’t that what we want in healthcare for patients to become active in their care?

This is an excellent post that presents the objectives and strategy for doing this as well as a great example of a sample video looks like.

Generic Prescribing and Conflicts of Interest
Howard Brody, MD, PhD writing on Hooked: Ethics, Medicine, and Pharma speaks to the recent investigative report from ProPublica on Medicare wasted drug spending on branded drugs vs. generics. This comes across my desk a couple hours after listening to a Marketplace Money’s story on the ProPublica report.

This is from Brody’s post

Medicare prescribers are responsible for a hugely disproportionate excess of brand-name prescriptions and hence unnecessarily high costs. They then  proceeded to check out their Dollars for Docs tool and noted that these same docs also seemed disproportionately represented among those receiving payments from drug companies. When ProPublica reporters visited some of the offices of these docs, they could hardly get in the door for all the drug reps waiting in line to handout free samples and other goodies.

The report at Marketplace Money spoke to a NYU medical site in Brooklyn who were prescribing huge volumes of branded drugs. The director of the site pointed to the fact most of her patients wanted branded because they didn’t trust generic’s to the point of believing it killed a patient.

So I wonder where the truth resides on this, influence from pharma or demanding patients. It is noteworthy that the branded cost only a few dollars more of out of pocket costs so the taxpayer not the patient carries the weight.

I was going to link to the Podcast at Marketplace Money, sure their search engine sucks.

Coverville
I forgot all about this one of kind music site and discovered during a cleaning of my iTunes folder. Covervile is “The Cover Music Radio Show” that has been around since September 2004. I found a Podcast from November 2004. I wish I could remember how I found it. 

I was surprised to see Brian is still going strong. Check it out because some days we all need to hear covers of great songs.

No Evidence That Statins Impact Cognitive Function
Larry Husten a Contributor at Forbes addresses another concern regarding statins, cognitive function. Have statins become the new black thanks to the guidelines brouhaha. I would love to know the Q score for statins two weeks ago and today.

In the Annals of Internal Medicine Karl Richardson and colleagues found not so much evidence supporting adverse effect on cognitive function.  And a second analysis of the FDA post-marketing databases the same investigators found similar reported rates for cognitive-related adverse events. But

They concluded that the available evidence does not support concerns linking statin use to cognitive impairment. “Larger and better-designed studies are needed to draw unequivocal conclusions about the effect of statins on cognition.”

Notes & Links: November 18, 2013

Cholesterol Risk Calculator Debacle
Aaron Carroll at The Incidental Economist weighs in on the new cholesterol guidelines and the nifty online calculator to help our overworked HCP hone right in on the best treatment options based on carefully assessment using the new guidelines. Not so fast since it appears that this calculator doesn’t calculate as much as throw poop against the wall to see what sticks. Okay that is cruel. The New York Times “Risk Calculator for Cholesterol Appears Flawed” presents the information.

Carroll has the Cliff notes and the Times has the full article. Either one will make you stop and wonder WTF. Are the guidelines flawed or is the calculator flawed?

Dr. Nissen entered the figures for a 60-year-old African-American man with no risk factors — total cholesterol of 150, HDL (the good cholesterol) of 45, systolic blood pressure of 125 — who was not a diabetic or a smoker. He ended up with a 10-year risk of 7.5 percent, meaning he should be taking cholesterol-lowering statins despite being in a seemingly low-risk group.

Wow that was complex computation to do to test an algorithm/calculator. Is it any harder then putting 2 x 2 into your calculator and seeing is you get 4 or not.

5 On-Demand Fulfillment Platforms For Holiday Shoppers
Just in time for the holiday fun filled shopping craziness. Stephanie Miles at StreetFight has a cool list of on-demand fulfillment platforms. It works like this:

“…on-demand fulfillment platforms go a step beyond same-day delivery services, actually fulfilling customer requests by locating products, purchasing those items, and then quickly bringing them to the customer’s doorstep”.

WunWun: What you need. When you need it. A little elf helper selects a story, finds the booty, confirms its what you want, a price you agree to, and delivers it. How cool.

TaskRabbit: Make your list check it twice with tons of details if you want or a little and a “runner” will fill the list based on pre-negotiated price. Fee is 20% of each accepted bid.

Nearbors: A crowd-based delivery platform. I create shopping list, a vetted couriers receives and alert based on that list. The courier picks up the goods from a nearby store. Courier pays with a code charging the shopper’s account and same day delivery is set up

Postmates: This is a one-houor courier service available in Seattle, New York, and San Francisco tracked via smartphones. You post a request, using Postmates’ Get It Now service see where your goodies are all in less then an hour.

Google Shopping Express: Google helps you purchase from local retailers without leaving home.

The debate over conflicting experts
At db’s Medical Rants he links to the NY Times debate “Why Medical Experts Disagree” it addresses the cholesterol guidelines and how different experts have a particular opinion based on their own bias. db captures what this debate looks like. db has a good analysis of why they disagree and the NY Times is a good read especially in light of the calculator flaw. 

As one reads the various debaters, one can understand their contributions as resulting from the affect heuristic. One debater sees the pharmaceutical influence as a major evil – thus blames the pharmaceutical conflicts of interest (while apparently ignoring other conflicts). One debater clearly focuses on drug side effects, and cautions against using any new drugs, unless the new drug has proven major benefits.

Notes & Links: November 15, 2013

Stefan Larsson: What doctors can learn from each other
An important TED talk about creating patient value in healthcare through outcomes that matter. At the center of this talk is the very simple idea of when physicians share with each other their clinical work (i.e.say hip replacement) and through that sharing create a list of outcomes that patients value those physicians improve outcomes and lower costs. Larsson identifies this as continuous improvement since this process of meeting, sharing, and ranking physicians work happens annually. What occurs is that those physician who may be at the bottom half change behavior and move up. New techniques are introduced and those who may have moved down on measured outcomes can now move up.

What strikes me hearing this talk is that it mimics constructivism which simply stated is the process of integrating new knowledge with existing knowledge to create new. That is what is occurring here is discovery, it is linking new information to prior knowledge and helping physicians improve care.

Most TED videos are brilliant but this one touches on so much we are doing and talking about regarding healthcare.

Obamacare And The End Of Employer-Based Health Insurance
Peter Ubel contributing to Forbes does and excellent job of clearing the underbrush in our current employee based healthcare system. Next he tackles Analysis & Commentary from Health Affairs “Will Emplyers Drop Health Insurance Coverage Because of the Affordable Care Act? written by Thomas Buchmueller et. al. out of University of Michigan. What is interesting in this analysis by Ubel is that he demonstrates why large companies can afford to keep giving health insurance and small ones don’t.

Because of their large size, these companies are able to negotiate lower premiums with insurance companies, because they have enough employees to reduce their actuarial risks. If a company employing 10 people is unlucky enough for one of their employees to experience a serious cancer diagnosis, for example, the insurance company offering coverage for this company will lose money on that company’s business. By contrast, there is not much chance that a company with 5000 employees will have 500 of their employees develop cancer over the next year. Big numbers reduce risk. And reduced risk means lower insurance premiums.

So on my reading large companies are behaving in classic free market economics. They can afford to offer insurance since there is a pooled risk. Small companies can’t. Therefore small companies can’t compete.

Offering healthcare to all and trying to make it affordable we are improving competition. Though the cost, which Ubel presents in the next few paragraphs works against the small company due to wages paid. On some level we need to consider ACA as a tool to help not just people live longer and better, we need to think of it as a way for small companies to compete for talent with the large companies.

Performance measurement and the new cholesterol guidelines
Rcentor at db’s Medical Rants takes a moment of clarify the new cholesterol guidelines and put them into perspective.

The new cholesterol guidelines have responded to a series of studies and analyses that have made clear that lowering the cholesterol is not the magic goal, rather statins (which clearly lower cholesterol) are “magic” but probably because of their pleiotropic effects.

The primary consideration here is that doing performance measurements based on guidelines may miss the point and it takes time to correct course. Once you’ve read the new guidelines take a look at this for its measured thoughts on why these new guidelines are important.

What Closed Circuit TV Can Tell Retailers About Customers
Streetfight interviews Steve Russell the founder of Prism Skylabs that is a startup in Sand Francisco who offers retailers software to analyzes video streams looking at traffic, heat maps, etc. It is interesting that those CC videos used to catch shoplifters at Barney’s, Wrongly. Can not be used to analyze customers behavior.

It’s a shame that we can’t use this to measure the behavior of patients on learning about their health and what they do with data. It can be done but not as easily as watching a video tape.

The Myth of Patient-Centered Care
Steve Wilkins posting at Healthworks Collective makes a cogent and important argument and solution to

Findings from BJM Quality and Safety article, and other like it, suggest that health care providers today are no more patient-centered in the way they communicate with patients than they were 30 years ago when research into the dynamics of physician-patient communication first began.

Even though physicians failure to inquire about patients expectation is not about understanding how important it is. It was lack of communications skills and know how. They do what they did 30 years ago which is not much.

But Wilkins jumps into the fray with a solution

Helping raise awareness of the state of physician-patient communications in the U.S. is why I have taken the lead in bringing together some of the leading authorities in the physician-patient communication filed to organize the Adopt One! Challenge. Adopt One! challenges physicians across the country to take the first step by committing to adopt one new patient-centered communication skill in 2014.

It is nice to see people looking at strategic solutions based on data.

America’s cancer care crisis-is Europe any better?
Lawler, Duffy, La Vecchia, et. al. writing in The Lancet points out that America’s cancer care crisis and how optimum health care and raising costs are driving inequalities in treatments and outcomes. The authors examining the International Cancer Benchmarking Partnership (ICBP)  that those issues demonstrated in America exist in Australia, Canada, and Sweden. And cancer mortality remains higher in central and eastern Europe than the rest of the continent, largely due to delayed diagnosis or access to treatment.

Another issue common to the IOM and ICBP reports is inequality in treatment of elderly people with cancer. Ageism in intention to treat could have profound negative effects on cancer outcomes, particularly in view of recent projections of population ageing. Unless our philosophy for treating older patients changes fundamentally, the welcome increase in cancer survivors that we are currently experiencing will be reversed.

Hard to consider that any gains we’ve made in cancer diagnosis and treatment may reverse. Well I guess we can say here is one statistic where we on par with other developed countries.

Notes & Links: November 13, 2013

The Complex Relationship of Realspace Events and Messages in Cyberspace: Case Study of Influenza and Pertussis Using Tweets
Nagel, Tsou, Spitzberg, et. al publishing an original paper in JMIR examine the internet and real time surveillance. The authors focused on Twitter. They wanted to explore the interaction between cyberspace message activity specific to Tweets and real world occurrence of influenza and pertussis.

In general, correlation coefficients were stronger in the flu analysis compared to the pertussis analysis. Within each analysis, flu tweets were more strongly correlated with ILI rates than influenza tweets, and whooping cough tweets correlated more strongly with pertussis incidence than pertussis tweets. Nonretweets correlated more with disease occurrence than retweets, and tweets without a URL Web address correlated better with actual incidence than those with a URL Web address primarily for the flu tweets.

The authors concluded that keyword choice is critical in how well tweets correlate with disease occurrence. Makes sense.

Dead Man Walking
NEJM has perspective from Stillman and Tailor that speaks to the real reasons we need healthcare in the country and why the screaming voices wanting to shutdown the ACA or pointing out the problems with the web sites are missing the reality, we as a nation needs to care for and serve Americans, all Americans not just the ones who are lucky enough to have health insurance.

Public Reporting, Consumerism, and Patient Empowerment
Huckman and Kelley writing in the NEJM offer insight and hope for what we are seeing in the press and online. Perhaps, just perhaps we are at a tipping point in our American healthcare mess. Patients are becoming healthcare consumers and are beaming more and more empowered based on reporting by healthcare providers.

Consider this, healthcare providers are reporting cost and quality metrics. What the authors contend may be needed is data needs to help patients determine is the treatment/procedure the option for my need, budget, and personal and family situation?

The rub here is that who is going to explain this to the patients/consumers? HCP are not getting paid for cognitive services. And there is a cost associated with developing and sharing this information. And will they hire old marketing communications pro’s like me to do this so they can deliver care?

6 Lies We Tell Ourselves
No, two of them are not those. Digital Tonto makes us stop and take a hard look at our business strategy acumen. Here are the six. Hope over to see the details.

1. I’m Rational And Make Decisions Based On Facts
In reality, we rarely have the time or inclination to think things through, so we take shortcuts called cognitive biases.

2. I’m Above Average
Research in a variety of has consistently shown that when people are asked to rate themselves on just about anything—their professional skill, driving ability, honesty— a majority believes that they are better than most.

3. My Competition Will be Static As I Transform
“The same fundamental error is also common in business life.  Strategy sessions are big on charts and graphs, but you rarely see any scenario planning.”

4. My Employees Love (And I Inspire Them)
“The truth is that power relationships are inherently mistrustful because one side can more easily opt out.  People who work for us have a strong incentive to make us believe they like us a whole lot more than they actually do, but research has shown that employees opinions are rarely aligned with their superiors.”

5. I Have The Right Information
“We’re wired to jump to conclusions if our evidence is consistent, even if is incomplete.”

6. It’s Not My Fault And I Deserve All the Credit
“When things go well we feel a justifiable sense of pride.  We worked hard, we worked smart and we prevailed.  We believe that we should be rewarded and are angry if we are not.  On the other hand, when things don’t go our way, there are always mitigating circumstances and we don’t think we should be penalized.”

Greg does his usual excellent job at making us all stop and see the reality not the unicorn rainbows.

Quote: Uwe (Need I say More?)
Austin Frakt has a quoted from Uwe Reinhardt in JAMA. I will take the liberty of copying it here since it is some important that I would hate to see you not jump to it.

[T]he often advanced idea that American patients should have “more skin in the game” through higher cost sharing, inducing them to shop around for cost-effective health care, so far has been about as sensible as blindfolding shoppers entering a department store in the hope that inside they can and will then shop smartly for the merchandise they seek. So far the application of this idea in practice has been as silly as it has been cruel. […]

In their almost united opposition to government, US physicians and health care organizations have always paid lip service to the virtue of market, possibly without fully understanding what market actually means outside a safe fortress that keeps prices and quality of services opaque from potential buyers. Reference pricing for health care coupled with full transparency of those prices is one manifestation of raw market forces at work.

Why Local Marketers Need to Start Thinking About Their Instagram Strategy
Okay I confess I have been a long time fun maker of Instagram calling it Twitter for people who can’t read. ( I am hearing the G and T of GTFH reminding me that good marketing and communications that captures attention uses graphics with copy). Street Fight makes a great argument on why we, no I, need to consider it.

More than anything, Instagram presents an unparalleled opportunity to build and share a brand — to show a different side by leveraging this highly visual medium. Plus, the rate of customer engagement is off the charts compared to other social channels

Great read but I would guess most of you are already heavy users of Instagram. If not see why and what a local business, healthcare provider, physician practice, etc. should consider it part of a social media strategy.

Video Break for the Day
GoPro: Combing Valparaiso’s Hills

Just watch it. Makes you want to be a 20 something again this time sans the 60s drama.