Mark Dimor

Notes & Links: July 24, 2013

ScienceBlogs has an article titled “A Board Certification in “Integrating” Quackery and Pseuudoscience with Real Medicine”

The article examines new board certifications in integrative medicine.

ACIM, founded by Andrew Weil, MD and directed by Victoria Maizes, MD, was in dialogue with the American Board of Physician Specialties (ABPS) toward establishing an American Board of Integrative Medicine in collaboration with the American Board of Integrative and Holistic Medicine (ABIHM). In that time, the plan has gone forward and over the last few months has come to fruition. Now there is indeed a board certification process for “integrative medicine,” and I can’t help but take a look at it.

The board examination includes the following:

Nutrition
Dietary supplements, botanicals and other natural products
Mind-body medicine and spirituality
Complementary and alternative therapies
Whole medical systems
Lifestyle, prevention, and health promotion
Integrative approaches (including conventional medicine)
Foundations of integrative medicine
Professional practice of integrative medicine

To be honest here I am struggling to find a visceral response. I am scratching my head in wonder if this is forward thinking or quackery?

Return On Community in Healthcare

The Healthcare Marketer’s title got me right off the bat. Now to read the post.

But ROI does not help communications professionals and hospital administrator understand the significant changes that need to take place in healthcare marketing for us to establish relevance with the connected consumer. The world has changed and healthcare marketing has not kept pace. We are currently facing a crisis of relevance.

His primary point and one I agree with is that when we invest in a community in healthcare we will see a return on investment in both dollars saved and outcomes. Better patient care is driven today by communities. Those of us following #hcsm etc know how important social media is and what it is doing. Patient engagement with the HCP is key. It is smallest most important unit of learning in healthcare from there it moves to communities. Adult learning theory is the driver of this since adults will only learn and change behavior based on reflection in action when they are seeking solutions to problems. A community shares knowledge and learning and drives change. Read the post and you will be rewarded.

Marketing to Physicians? Think Education and Email

Here is the graphic on this topic. The n=124 rather small. But take a read if you have the time. Let me know what you think

Notes & Links: July 22, 2013

“The Price Of The Autism-Measles Panic, 15 Years Later“

We should send a thank you note to Jenny McCarthy for helping thin the herd. The final paragraph captures it well.

“As the Wales outbreak demonstrates, though, it takes more than parents. It also takes people–scientists and journalists–willing to use sensationalism to drum up readership and attention and money and to sideline public health in the process. And unfortunately, we have yet to develop a vaccine against simple human venality.”

“The Affordable Care Act Will Fail Without Patient Engagement”

This is a thoughtful and well measured analysis of the ACA, Patient Engagement, and cost. Adrian Gropper, MD makes the following point which I see as yet another reason to engage patients in their care. It is time to put patient centric first.

The path to health reform in the age of unlimited connectivity and mobility cannot continue to bypass the patient. EHRs are an institutional tool and they are unlikely to be either the doctor’s or the patient’s lightsaber regardless how many federal regulations, certifications and billions of dollars we throw at them.

“The Office Visit Revisited“

This is timely, important, and so spot on regarding the fact the office visit is not a drive by but part of a continuum of care. Dr. Lamberts says it well when he writes:

My care is no longer episodic, so why should my records be? I no longer need “visits” as units of commerce, and no longer need “problems” as the goods for which I am paid. This took me quite a while to figure out, and has me making some radical (crazy?) changes to how I think about care.

Read this if you want to where healthcare should be moving and why. It takes the EMR and makes it the narrative in the care. So well written and on point.

Notes & Links July 17, 2013

Don’t Trust Online Tests For Alzheimer’s Disease

Color me surprised the Internet may not be the best place to find trustworthy evidence based knowledge you can take to your HCP.

Gary Drevitch article in Forbes reminds us that reader beware is the mantra for Web based medical/healthcare knowledge.

But a new report released today at the Alzheimer’s Association’s International Conference in Boston finds such claims to be scientifically invalid and characterizes their hosts as unethical and often predatory in their pursuit of profits through sales of sketchy prevention tools to a beleaguered, vulnerable older population.

We need to create projects where we are teaching people how to critical appraise healthcare information. Even a well written article in a fairly mass media outlet will not reach everyone. And who is letting HCPs know that this is an issue?

Ya Gotta Love Marco Arment

There’s a new app he created while sitting around which looks like a must have. It quickly draws arrows and boxes on screen shots so you can email them and the reader can quickly find what you are referencing.

It’s called Bugshot. Love it

Clipboard: 4 of 5 MA Groups in Medicare Experiment Save Money

Boston.com in the blog White Coat Notes

Four of the five — Partners HealthCare, Steward Health Care, the Beth Israel Deaconess Physician Organization, and the Mount Auburn Cambridge Independent Practice Association — said Tuesday that they spent less on patient care than the Medicare target for 2012, in part by reducing expensive hospital stays. The groups split the savings with Medicare.

This is not clearly a huge win since it is early but it shows we can make a difference within a system of so many moving parts and people and goals.

Notes & Links July 16, 2013

Jenny, Jenny, oh Jenny

David Kroll has a wonderful piece in Forbes titled “Jenny McCarthy Is A Dangerous Medical Celebrity” As you can guess from the title is shakes the reality of allowing someone with “Mommy instincts” to present medical and scientific advice as if it was evidence based medicine. Clearly stating opinion vs. evidence is critical to helping learner acquire knowledge and make life critical decisions.

Giving McCarthy an unrestricted and highly-visible platform to continue her record of pseudoscience views on issues critical to child health is both irresponsible and dangerous.

We Know Cost Kills People

“Cost Prevents People from Seeking Preventive Healthcare” is posted on HealthPopuli It reviews a TeleVox survey of over 1,015 US adults titled “A Call for Change: How Adopting a Preventive Lifestyle Can Ensure a Healthy Future for More Americans”

Some of the data HealthPopuli pulls

Only 1 in 3 people in he US have spoken with their personal doctors about their medical history and risk factors for diseases
Only 33% have had cholesterol checks
In the past two years, only 26% of people have been screened for diabetes
She ends with:

Making prevention cool, beautiful, smart – whatever motivates the prevention-poor patient – is the must-do for health plans, providers, payors (employers, unions and government health insurance sponsors). And to do that requires asking people the very question: what will lead you to actually seek prevention.

AHRQ and Improving Patient Physician Engagement

I was tooling around the ‘net’ (read killing time) and I stopped by AHRQ.gov to see what’s up. I stumbled on “Questions To Ask Your Doctor” The pages opening paragraph says:

“Asking questions and providing information to your doctor and other care providers can improve your care. Talking with your doctor builds trust and leads to better results, quality, safety, and satisfaction.”

That’s mom, apple pie, and the stars and stripes all rolled into two sentences. Further down the page you’ll see:

Which links to deeper insights and questions. Overall these are excellent and accurately address the key needs to improve patient physician engagement. They are well done and thought through. AHRQs even includes a video from patients and physicians why this is important.

I am very curious about this page and the information it offers patents. How many hits a month they have? How many are unique? Who is the average page viewer, age, gender, education, etc? What do they do with these questions? What is their expectations with their HCP? And what happened when they did go to the HCP with the questions? And what does the HCP think when asked these questions? That would tell us so much about patient physician engagement. How is executed? Do sites like AHRQ help improve it or does this fall on deaf ears therefore requiring a different tactic?

Second, I am wondering if this page and information is reaching as many people as it should? How is AHRQ promoting the page? Does it just fall into the overall AHRQ promotion if there is any?

Additionally I think that many of these questions are not limited to AHRQ. I suspect most if not all hospital systems and providers have web sites that feature similar questions. Mayo Clinic when you search ‘questions to ask your physician‘ has a myriad of links for disease specific questions. See here.

Now what I don’t know since I am sitting out here and not inside these organizations do they know if these questions are used? Why? Why not? Do using these questions have an impact on patient care? Outcomes? Are they measuring impact?

To know this information would do much to help improve the work flow (i.e. patient physician engagement) of the HCP and the patient. As a marketing problem we need to know what is happening, how it is being used, and what it’s accomplishing. Once that is done we either pat ourselves on the back or scrape it and rebuild it to meet the needs of patients and HCPs.

How would want to use these questions? As a patient or caregiver or as an HCP.

Notes & Links July 12, 2013

Jane at Health Populi takes a look at two published studies examining the state of America’s health. The first is the research from JAMA “The State of US Health, 1990-2010: Burden of Diseases, Injuries, and Risk Factors” The second is from NEJM written by Victor Fuchs “The Gross Domestic Product and Health Care Spending”

She ends with

“While the ACA nods to prevention and primary care, it doesn’t go nearly far enough into aspects of health reform that can impact, at scale, public health to move Americans above position #27 in the world’s mortality table.”

I wonder if all the small changes in healthcare, social media, patient/HCP engagement, internet, etc. will scale enough?

Using zombies to teach science. Makes perfect sense to me. Tara C. Smith notes that zombies are one hot topic and cultural cornerstone today with kids. And I would add adults as well.

“And the great thing is that these kids are *already experts* on the subject matter. They don’t have to learn about the epidemiology of a particular microbe to understand disease transmission and prevention, because they already know more than most of the adults do on the epidemiology of zombie diseases–the key is to get them to use that knowledge and broaden their thinking into various “what if” situations that they’re able to talk out and put pieces together.”

This speaks to me about teaching and making the uptake of knowledge linked to the imagination especially with kids.

My pal Scott put me on to this video ad by Ikea. Somewhat disturbing and curious to it’s strategic position. Basically the video looks at a girl who’s doll house comes alive with mom, son, dog, and has wonderful Ikea product placements. But it is worth the view.

“that Ikea’s version of a family doesn’t necessitate a happily married mom and dad, there’s something unquestionably off-putting about the entire narrative—especially considering it’s supposedly taking place in a child’s imagination.”

Thoughts & Links: 07/09/2013

Make it easier to avoid vaccines, and people will skip them

From The Incidental Economist

“The bad news is that there are more state level attempts to broaden exemptions than narrow them. The good news is that the only measures that pass seem to be those that narrow them.”

Can someone explain why states that are suppose to care for the well being of its resident try to do this? And I wonder how many families of children who were not vaccinated and got sick or died sued the state?

While on the subject of vaccines this from ScienceBlogs

“Get out the popcorn! This internecine war among antivaccinationists is getting interesting (part 6)“

“Maybe it’s because when the antivaccine movement is fighting among itself it’s wasting energy that it could otherwise be using discouraging vaccination, fear mongering, and endangering public health, and that’s a good thing. “

I would disagree that the antivaccination klan is not having an effect but I am refreshed they are trying to devour each other and gagging.

A Thicker Hope

Marco wrote the following about iOS 7 systems type font. And because type is one of the most important visuals we have it remains key in driving readership and more.

“Apple’s stated design philosophy of iOS 7 was “clarity, deference, and depth”. They nailed deference and depth, but clarity has suffered in many big and small ways.”

July 3, 2013 Interesting Reads

NEJM: Envy- Strategy for Reform England vs. US in healthcare. The focus ” on the most positive aspects of each system, the characteristics that should inspire envy, we may find solutions to each country’s challenges just an ocean away.”

This article covers some key areas that we should consider if we are going to improve our healthcare system. Well worth the read.

Incidental Economist: On What Do Health Economists Agree? This is an interesting concept looking at ‘positive (as opposed to normative) statements’ Here are a few the post is open to suggestions and comments.

Health insurance does not guarantee good health care.
Preventive care does not usually pay for itself.
Employees pay for all employer-based health benefits; they offset wages or other benefits.
Favorable tax treatment of employer-based health benefits leads to greater employer offers and more generous benefits.
Employer-based plans serve a risk pooling function.
Cost sharing reduces utilization.
Physicians influence patients’ level of utilization.

Webfonts by H&FJ: Introducing Cloud Typography

Great idea. It is a cloud technology for type where typography answers each browser with the right type and fast. I wonder if us mere mortals will notice the difference?

I Learned A Lot From PAM (Patient Activation Measure)

A few months back I posted a piece on how to improve HCP and patient engagement titled “Patient & Physician as HC Partners: The New Black in Healthcare“. The premise was ‘The question becomes how can we foster and accelerate this relationship? How can the HCP create a nutrient enriched environment where the 15-minute office visit presents greater productivity? One tool is to determine the problems the patient is seeking to solve. What are his or her healthcare issues, what do they need/want to understand, what can the HCP help guide the patient through?’

The key point supporting this was the recommendation that a simple inventory be done with each patient to determine their learning inventory. It was overly simple but at the time I thought it had value in a rudimentary way.

These past couple of days I have been researching patient physician engagement in order to outline a study I think may have some value in mental health. Well guess what I found? Go on guess. There exists a validated tool that is reliable called the Patient Activation Measure (PAM). It was created by Judith H. Hibbard and has been widely used to determine what it means to be activated with your HCP as a patient. It showed that activation of patient engagement involves four stages

1. Believing the patient role is important

2. Having confidence to take action

3. Actually taking action to maintain and improve health

4. Staying with it under stress

This is a very interesting tool and one that appears simple to administer but provides a great deal of information for both the HCP and the patient. My take away when finding this was “Oh darn I am so behind the times” But I now see this as a tool that can be adapted and worked with to really determine how patients learn and who would engage more readily and who would less and what can be done move those with lower desire or knowledge to activate.

There is always something new to learn and this must be what patients face as they navigate an illness or caregiving. That is why I still believe and support the need for patient HCP engagement and measure.

Learner First and Foremost, Patient Second

I’m a staunch believer in adult learning and how when the theory is put into healthcare practice it can improve patient care and create durable outcomes for the patient, aid the HCP in improving patient management, and help lower utilization costs.

This weekend I read with rapped attention Jim Rutenberg’s article in the New York Times Magazine “Data You Can Believe In” and last week I listened to Jonathan Alter’s interview on Fresh Air about the Obama reelection. Both spoke in great detail about how the analysis and use of data was the difference in victory for the Obama win the 2012 election.

What does this have to do with healthcare outcomes? I was struck by how the Obama campaign accessed Facebook data, identified people who supported the President, and were able to have those supporters reach out to friends on the fence or not active become active. Further they were able to identify better tools to find and reach uncommitted voters by comparing TV cable box data with lists of uncommitted voters in order to change their behavior.

In healthcare we have been striving to improve physician patient engagement while recognizing that more and more patients and caregivers are searching the WWW to learn about their health. All the while providers and HCP are moving toward EMR. This is creating one the richest databases in healthcare.

The questions becomes; how can we analyze current patient files within a provider system (I would submit that is being done), and take subsets of that data to identify areas where learning would yield the greatest improvement in patient care, and finally how do we identify (think set top box) who would be the most active learners and least active? How can using data as they did in the Obama campaign improve patient physician engagement?

We can look at data within the provider system to determine which patients are yielding the best outcomes with the lowest utilization cost. And as we move further away from best outcomes to not so good outcomes within the same CD9 code we can identify what the differences are in age, gender, socioeconomic data etc. This will yield a picture on who is doing well and who is not while hinting at why and what are the differences between great and not great. We have a map per disease of behaviors and a model relative to outcomes identifying key demographics.

I don’t believe we will learn what learning behavior or motivation is present from this analysis. What we need to add to patient EMR is data on the patient as an active learner, how, why, where, etc. This is a simple and easy to administer inventory which becomes our set top box of user behavior around learning. It tells us who is learning and where. Are they active learners or not. It’s that extra bit of knowledge that can be used to intervene in disease management and its progress. Matching learning behavior with outcomes with patients would be powerful tool to know where we want to apply pressure to foster and drive healthcare change at the patient level.

Keep in mind I’ve lead this post with the patient first and added patient as a learner. Now let’s reverse that to lead with the learner as a patient. It would be easy to use this data to identify the characteristics of learners who wants to know more about their disease, think active learners.

Now consider a provider or HCP offering this well identified and targeted group improved knowledge access and uptake. Not just better care but becoming learning partner with the patient. If providers can target learners better and either bring new patients into their system or better anchor current patients to improve outcomes and lower cost. Isn’t that what we want from healthcare, a long-term productive and learning driven relationship? Healthcare is not passive; it is an active learning relationship between peers with different skills sharing decision-making.

The proviso for all of the above, any data analysis would work within HIPAA guidelines etc.