All Center for Information Therapy blog posts for 2008 and going forward can be found at the IxCenterBlog.

The Center for Children and Families at the Georgetown Health Policy Institute has just released a series of issue briefs on “Strengthening Medicaid.” I authored one of these papers, “Health Information Technology: Innovative Applications for Medicaid,” which discusses strategies that states can use to improve the quality and efficiency of Medicaid programs. The paper addresses how HIT relates to health disparities, health literacy, and the digital divide.

To see more about these issues, see the robust Ix discussion on the patient-centered health information technology (PCHIT) blog.

I will be doing a considerable amount of my blogging about information therapy (Ix) at the now-live Patient Centered Health Information Technology (PCHIT) blog. The Center for Information Therapy’s (IxCenter’s) new PCHIT Initiative will have an active learning community of clinicians hosted by me and Ted Eytan, MD, the IxCenter’s Senior Visiting Fellow, who is currently on sabbatical from Group Health Cooperative in Seattle, where he serves as Medical Director for Health Informatics & Web Services.

–Josh

You can now find a Summary of 6th Annual Ix Conference at the IxCenter Web site. PowerPoint presentations and videos will be posted there soon.

A colleague out in Seattle posted a great story, Information Therapy on the Go, about his experience in despensing information therapy (Ix) in taxis. The end of his post raised some questions: What is an information therapist? Who can be an information therapist? How can we train people to be information therapists in order to meet the great need that’s out there for them?

I, too, get asked to prescribe Ix to family, friends and randome people with considerable frequency (and I’m more than happy to help if I can). Even though I’m not a physician like Ted, as my at-the-time, 3-year-old Ben said, I am a “question doctor,” perhaps a colloquial version of information therapist.

The colleague I mention above is Ted Eytan, MD (Medical Director, Health Informatics & Web Services, Group Health Cooperative), who is on his way to Washington next week for a sabbatical. He’ll be spending quite a bit of his time serving as a Visiting Senior Fellow here at the Center for Information Therapy (IxCenter), and we’re thrilled to have him working with us more closely. Since he’s been one of the greatest Ix champions in the country, we’ve been working with him ad hoc since the birth of the IxCenter six years ago, but having a greater mindshare is going to be a fantastic opportunity for the IxCenter.

Stay tuned for much more on this in the near future…

–Josh

Will the biggest disruption in health care be an Internet-based health care industry?  We already know that more consumers get answers to their health care questions on a daily basis from the Internet than from their doctors.  But do we think that online tools will evolve enough to allow consumers to organize and make sense of that information without trained professionals?

Will the trend toward “convenience care” (pharmacy- or mall-based walk-in clinics) have the greatest impact on how providers organize care delivery?  Will they need to re-think the way they practice medicine to meet new consumer expectations?

Maybe CMS’s requirement that hospitals begin publicly reporting patient experience data in 2008 will forever change how hospital view patient-centered care.  Will hospitals finally find that being truly patient-centered has a business ROI?

Will consumer control over their own health information via personal health records (PHRs) alter the historical information asymmetry and allow them to control their own health care lives?  What needs to be done to make sure that PHRs actually fulfill their potential as a disruptive force given that personal health data availability by itself will have a marginal impact?

Will the evolution of electronic health records (EHRs) and a robust interoperable health information exchange dramatically change health care by increasing connectivity among systems, providers, and others?  Or, will we just create a process for transferring 1’s and 0’s on top of poor models of health care delivery?

Will the boom in biomonitoring/wireless devices (the so-called “healthcare unbound” space) revolutionize health care by allowing consumers to access the health care they need anytime, anywhere, and any way they want it?

Maybe the answer lies in more ubiquitous technologies.  Could expanded use of cell phones and the application of tailored automated telephony allow us to reach a broader audience more conveniently, thus increasing the likelihood that average consumers will be more activated about their health care needs?

Can we more effectively engage consumers in better managing their own health by learning from Hollywood or video games about how to draw people in through entertainment?  By doing so, can we make health care “fun” or at least truly engaging?

Can we find new payment structures to eliminate the perverse incentives that plague our current health care delivery system?  Or, will people find ways to game any new system we design…or will entrenched interests simply prevent new systems from coming into fruition?

Is there any hope at all for finding a way to cover the growing number of uninsured in the country given the politically changed environment in Washington?

What is the role of information therapy (Ix) in each of these potentially disruptive forces?

Which of these developments will have the biggest impact on health care?  Beyond that, will any of them actually change a system that has so many challenges and problems?

Many of these questions will be tackled at our upcoming Ix conference October 8-10 in Park City (see http://guest.cvent.com/EVENTS/Info/Agenda.aspx?e=f586de48-3d6e-4064-8543-1c7037b58890 for the full conference agenda).  I hope you’ll join us.

–Josh

There was an interesting piece in last Wednesday’s USA Today, “Communication now part of the cure“. They published a Letter to the Editor I wrote (Continue reading “Get an ‘Ix’ with a Rx” ») on July 27 (page 10A).  Here’s the text:

Get an ‘Ix’ with a Rx

Joshua Seidman, president – Center for Information Therapy; Bethesda, Md.

USA TODAY’s article “Communication now part of the cure” about the importance of discussions between doctors and patients makes several good points (Life, Wednesday).

Since research shows that 40%-80% of everything a doctor tells a patient in the office is forgotten, taking along a patient advocate is a great strategy. Unfortunately, it is not always an option or sufficient. In order to ensure effective communication, every patient should leave the doctor’s office with an information prescription (Ix). This after-visit summary reinforces what transpired in the clinic and outlines the person’s next steps for self-management and interaction with the delivery system.

Providers that have implemented after-visit summaries — both in print form and available through a secure Web portal — have found that patients love them. The summaries provide something tangible to take home, guidance that is practical, and a bridge to the next visit or to a referral to another clinician.

Non-profit and government organizations such as the Center for Information Therapy, American College of Physicians and National Library of Medicine have been advocating information prescriptions for years.

Next time you go to the doctor, make sure to get an Ix with your Rx.

Lots of interesting Ix-related stories have been in the media recently, but none more dramatic than the study from the Archives of Internal Medicine that demonstrated a significant relationship between inadequate health literacy and all-cause mortality in seniors. In fact, Baker et al (7/23/07; abstract at http://archinte.ama-assn.org/cgi/content/short/167/14/1503) found that literacy is a more powerful predictor of death than education.

The authors also highlight past research that links inadequate health literacy to less knowledge and worse self-management skills for people with chronic disease.

This research should reinforce the call to action to deliver information to people that is tailored to their individual needs. Although using plain language is one useful strategy, effective tailoring requires multiple tactics–such as understanding individual needs and preferences better, addressing different learning styles, and delivering information through different media (print, electronic, video, audio, phone, etc.).

With the support of the California HealthCare Foundation, the United Hospital Fund, Kaiser Permanente, and the Group Health Community Foundation, IxCenter will launch a Patient-Centered Health Information Technology Initiative later this year. We will be assisting a diverse range of organizations in implementing HIT applications that focus on engaging consumers in care delivery. Although it will surely come up with all sites, particularly in our work with safety-net populations, we anticipate learning a lot about how to overcome health literacy barriers with innovative solutions.

In the interim, I’d love to hear your ideas for delivering tailored information in such situations.

–Josh

The IxCenter published a white paper a few years ago entitled, “The Ix Evidence Base: Using Information Therapy to Cross the Quality Chasm” (available at http://www.ixcenter.org/publications/whitepapers.cfm). In it, we detailed the emprical evidence that supports the Ix role in addressing each of the 10 rules that Institute of Medicine (IOM) laid out for health care delivery system redesign.

As Ix has matured, we have found new ways that Ix has directly addressed the IOM/Quality Chasm call to action. Perhaps most importantly, the IOM’s first rule for system redesign was to have “Care based on continuous healing relationships.” Rather than just interacting with health care professionals in traditional visits specific to a particular acute issue, people should have mechanisms for ongoing contact wherever and whever they need it.

In this graphic, iom-rule-1-continuous-cycle-w-20.ppt, I offer one way to think about how Ix can advance continuous healing relationships. Specifically, Ix for visit preparation can be used to better prepare patient and clinician for an in-person clinical encounter. Since we know that 50% to 80% of everything a doctor tells a patient is completely forgotten by the time the patient gets home, the Ix after-visit summary is critically important for reinforcing the key pieces of information that transpired during the visit. Through PHRs and other patient-centered HIT tools, Ix can then be delivered for health promotion, risk reduction and ongoing care management to help maintain a continous cycle of care.

It raises some questions worthy of discussion…

Efficacy of the Model: Does you think this model works? Can it move us from episodic, disjointed encounters with the delivery system to continuous healing relationships?

Reimbursement and Infrastructure: Does an infrastructure exist to support this cycle of care? Does the current reimbursement system create too many perverse incentives to prevent this model from flourishing? Can the patient-centered medical home model (being advocated by the primary care medical societies and others) provide an effective mechanism for encouraging this kind of care delivery?

Fit with Health 2.0 Innovations: What do you think about the potential role of the various Health 2.0 activities (e.g., targeted search, content tagging, social networks, etc.) that I have laid on top of this model? Are there new tools that exist (or will soon) that will help to get us there more quickly than working through the traditional care delivery system?

I’ll be interested in your thoughts.

–Josh

In response to a column in The New York Times last week (http://www.nytimes.com/2007/05/24/fashion/24Cyber.html), I wrote the following letter to the editor (for which they apparently aren’t publishing any letters):

Regarding “Visits to Doctors Who Are Not in, Ever” (May 24), democratization of information has made health content widely available—some would describe this a blessing and others a curse. The question is how do we steer people to information that is accurate, comprehensive, relevant, understandable, and useful?

Empirical research we’ve conducted on diabetes Web sites suggests that the guidance offered by most “experts”—such as a “trustworthy” sponsor, the currency of the content, or the process for updating it—provides little insight into the content’s actual accuracy or comprehensiveness.

Innovative collaborative filtering approaches can be effective, but they also have limitations—in part due to the complexity of medical science and its pace of change. Objective, systematic instruments now exist that could be scaled to provide critical guidance to consumers. These two approaches can complement each other and help people navigate life-and-death matters for themselves and their loved ones.

Since I get more than 150 words here, I’ll expand a bit….  First some quick background: The research I refer to is summarized in a white paper on “The Mysterious Maze of the World Wide Web” on the www.ixcenter.org Web site and the more scientific papers are available from the peer-reviewed Journal of Medical Internet Research (www.jmir.org).

It’s reasonable to approach the evaluation of Web site information quality like many other scientific questions where the answers (to “what is high-quality content?”) are not always straightforward. We can triangulate by using multiple methods to answer the question.

Specifically–and as I proposed in the original research–we can combine three kinds of measurement: structural measures of quality to give a generic content threshold test; performance measures of accuracy and comprehensiveness for specific conditions; and assessment of consumers’ perspectives on content in terms of functionality, understandability and overall utility.

In my original work (before the “Health 2.0″ space existed) , I had envisioned this being done more though random consumer survey methods, but the collective filtering approach is considerably more efficient, even if less scientific.

Bringing these different strategies together will provide everybody with a lot more guidance about health information quality, the first ingredient for good information therapy.

–Josh