Commonwealth had Harris Interactive do a survey of one thousand adults and found:

• Nearly three out of four (73%) Americans report some sort of barriers accessing doctors in a timely manner.
• Nearly half (47%) report some coordination of care problems.
• Large majorities want their physicians to use a variety of HIT including electronic health records (89%), electronic prescribing (71%), whereas most consumers (91%) cannot access their medical records via the Internet, many of whom would like to do so (49%) and even more would like to be able to schedule appoints online (57%) and communicate with their doctors via email (58%).

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I noted to other colleagues that—although there was nothing groundbreaking in his remarks—there were insights gained that are probably similar to what most of us who have been blogging would have picked up. In other words, the learning process transpires through the action itself.

I thought it amusing when I was reading the Week in Review section of today’s New York Times, in which Mark Leibovich has a piece titled, “Hail to the Twitterer.” Leibovich discusses McCain’s and Obama’s use of technologies and whether differences are important for leading the country in the 21^st century.

Leibovich relays the following anecdote:

“You don’t actually have to use a computer to understand how it shapes the country,” said Mark Soohoo, a McCain aide for online matters, at a conference on politics and technology. “You actually do,” interrupted Tracy Russo, a former blogger for John Edwards.

Secretary Leavitt’s experience and lessons learned suggest that Russo is correct. We gain a lot by actively trying and doing things. The third-hand learning experience has less of an impact and shapes the way we envision the world differently.

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On average, the typical company responding to the McKinsey survey uses 3.4 Web 2.0 technologies including Web services, blogs, RSS, wikis, podcasts, social networking, peer-to-peer, and mash-ups (Web application that combines multiple sources of data into a single tool).

However, only 21% of respondents expressed overall satisfaction with Web 2.0 tools and an equal portion were dissatisfied. It wasn’t entirely clear from the data why that’s the case–though there was some suggestion based on data related to barriers to success of 2.0 initiatives–but there clearly is a long way to go (not surprisingly, given the nascent nature of 2.0).

From my perspective, the most interesting data relates to how companies have deployed 2.0 technologies to interface with customers (vs. for internal use or for interfacing with partners/suppliers). The top reasons from respondents:

• 73% — Improving customer service
• 71% — Acquiring new customers in existing markets
• 53% — Getting customer participation in product development
• 53% — Letting customers interact
• 23% — Providing for other customer interactions

These all seem like good reasons for health care organizations to deploy 2.0 technologies–both for economic and quality-of-care reasons.

It will be interesting to watch over the next three to five years to see how much of that change will come from inside or outside of traditional health care organizations. If the former doesn’t happen soon, I think it’s likely that the latter could dramatically change the way care gets delivered in this country.

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As it turns out, he made some interesting remarks–for example, these are what he perceives as some of the “side benefits of blogging” a couple of hours a week–in addition to the obvious communications outreach opportunity it provides for getting the HHS message out to the public quickly (what he referred to as a “short cut in communication”).

• He can try out ideas and see what kind of responses they generate.
• He can re-use the material he blogs about for other communications purposes.
• He can serialize extensive topics (e.g., Medicare reform, drug importation, HIT, etc.) in order to communicate themed ideas in more digestible doses–which will ultimately get all the content more widely read than if they just released a long report or white paper.

Other comments at the forum discussed how the health policy blogs will lead to a very different health care reform debate in 2009 than we had in 1993-4. All factions in the coming national debate will have far more tools and vehicles for making their case; they will do it faster, and there will undoubtedly be more public interaction.

There also is no doubt that the impact of health blogs in the health care reform debate will depend on quality of blogosphere, which is a combination of at least two things: the soundness of the arguments being offered, and the ability of the bloggers to get their message out amid the noise that exists.

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That’s the start of my post on the blog that is serving as an important input for the development of the Healthy People 2020 objectives for e-health and health communication. In addition to this post, I’ll be monitoring the input to HHS on this topic for the next two weeks, so come join the conversation over there.

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As Cunningham points out, many organizations use language to connote a focus on consumers/patients even when something besides some expressed consumer desire brought them to the solution they promote–for example, many (certainly note all) models for “consumer-directed health care,” the “patient-centered medical home,” and “personal health records” (just to name a few) were developed without any direct input from consumers themselves. Cunningham cites comments made by Ed Mendoza of the California Office of the Patient Advocate that consumer activism historically has often arisen as a negative reaction–such as to paternalistic models of care delivery.

It’s a great challenge to figure out the most effective and efficient way to integrate the true patient perspective, but some health care organizations have made great progress. One example presented to our IxAction Alliance in May was PeaceHealth’s approach to PHR development.

When PeaceHealth set out to develop a personal health record (or shared care plan), they took an entirely different method of development called “user-centered design.” Rather than creating fancy electronic tools and then getting input from consumers, PeaceHealth decided to start by sitting down with their patients first and directly asking them what tasks they wanted an electronic tool to accomplish. They hammered out all kinds of practical applications and specifications before writing a single line of code.

During the Patient-Centered HIT Initiative, when Ted Eytan and I went into practices, we actually spent time shadowing patients and clinicians, observing how they interacted, and what affected their communication. As I described in a post last year, this is an approach taken by some of the most successful companies on the planet (e.g., Toyota describes it as “genchi genbutsu)–go to your customers and watch them if you really want to know what they want.

It may not be practical to do this in every circumstance in health care, but it’s certainly a good goal to put out there. It’s probably the best way we can find out what consumers want without first making them furious by providing them with what they don’t.

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In it, he makes six recommendations for medical societies to help promote participatory medicine. I agree with everything he wrote, and would add two more things.

First, medical societies can provide tools their members that facilitate the delivery of information therapy (Ix) and participatory medicine. Hoch actually alludes to it earlier, based on what his own medical society (the American Academy of Neurology) has done to promote patient pages, and other forward-thinking societies have already taken steps in this direction.

Most physicians want to prescribe information to their patients to facilitate more collaborative care, but they don’t have systems in place that fit that work into the process of care delivery. If one of their most trusted sources (their professional society) can make it easy for them to do the right thing, they will probably jump at the chance.

Second, as medical societies are promoting private- and public-sector reimbursement changes to better align incentives to provide high-quality care, they can make the case that participatory medicine, Ix, and related care support should be rewarded.

Along with Hoch’s suggestions, medical societies that do this can play a critical role in advancing the practice of participatory medicine and Ix.

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That certainly is an important component of Ix, but it’s too limiting in many circumstances. When we talk about the “proactive delivery of the right information to the right person at the right time,” that has to encompass whatever the information needs of the consumer are.

What we know from talking with consumers–and from a variety of other research and projects–is that people have health- and health care-related information needs about so many things that have nothing to do with the best evidence-based health information.

• How do I find out if this procedure is covered by my insurance?
• Who should I go see for this condition?
• How do I get there?
• What can people who have had this condition tell me about what it’s like to live with it?

The list of questions is virtually endless. The point is that information therapy refers to getting good information to people for whatever the consumer needs for his or her well-being and health/health care-related decision making.

This became clear in the Medicare Health Support project designed to support the chronic care needs of the frail elderly with multiple conditions. It turned out that a majority of their needs were not clinical. They needed help getting transported to their appointments, filling medication prescriptions, getting meals prepared for them, and generally alleviating a great deal of social isolation. They still had great information needs, but they needed to be tied to other resources.

In this context, it is no less important that the Ix consists of “good information,” but it does mean that “evidence-based” is sometimes too limiting a criterion for high-quality information in the context of Ix. We need to make sure that we find ways to measure the quality of the information regardless of what kind of guidance consumers need.

The one sure way to make sure that we are truly meeting the consumer’s information needs at particular moments in care is to continue observing their behavior and asking them what would help them live healthier, higher-quality lives.

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It was a little hard to figure out how much of the behavior he’s talking about is providers vs. consumers (or others for that matter), but I do think both are critically important for addressing health care costs. Ix initiatives, of course, often are built on the foundation of the science of behavioral psychology (maybe a little more advanced than 101).

It will be interesting to see how CBO goes about understanding consumer behavior as the health care reform debate evolves over the next year-plus. It’s clear that Ix initiatives could play an important role in helping to drive behaviors that ultimately lead to more efficient and rational care delivery.

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That 11 percentage-point increase is a 44% jump in adoption over two years–a steady rise. It may signal that we’re nearing a tipping point for adoption of a technology that is a foundation of so many effective Ix applications. Secure messaging and other forms of electronic and asynchronous communication make possible so many enhancements to the traditional clinician-patient relationship.

As online communication takes hold, it will be important that delivery systems, technology companies and other organizations develop creative solutions that facilitate the integration of clinicians’ personalized notes/comments/opinions/recommendations with high-quality health content and navigation to additional resources.

The combination of clinician personalization and accurate, comprehensive, understandable and tailored content will allow for mass personalization of Ix. Paul Wallace (IxCenter Board Chair) and I wrote about strategies for doing this in an IxCenter white paper from a few years back that you can download from our Web site.

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