Mayo presentation 2016
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Transcript of Mayo presentation 2016
Bradford W. Hesse, PhDChief, Health Communication and Informatics Research Branch
The Role of Information Technology and Health Communication in Health Care
Delivery: The Case of Cancer
“The millions of dollars of biomedical research … aimed at a disease that was costing 10’s of thousands of dollars to treat and it ultimately relied on the actions of a skinny, weak, scared 20-year old to have its impact.”
Jessie Gruman
“Those of us with multiple chronic conditions may consult many physicians in the course of a year. Last year, I saw 11. Not one of my doctors has ever communicated directly with another… I am the sole arbiter of who gets what information in what format and when.”
Jessie Gruman
Question:
How do we connect our systems for patients — and on behalf of patients — to ensure reliable, proactive, and error-proof communications?
“Almost half of the Internet users in 1997 reported looking for health information”
-- Rice & Katz
Source: Rice RE, Katz JE. The Internet and health communication : experiences and expectations. Thousand Oaks, Calif.: Sage Publications; 2001.
Search Term % Using TermDepression 19%Allergies/sinus 16%Cancer 15%Bipolar disorder 14%Arthritis/rheumatism 10%High blood pressure 10%Migraine 9%Anxiety disorder 9%Heart disease Sleep disorders
8% 8%
Terms Searched
Source: Rice RE, Katz JE. The Internet and health communication : experiences and expectations. Thousand Oaks, Calif.: Sage Publications; 2001.
Search Term % Using TermDepression 19%Allergies/sinus 16%Cancer 15%Bipolar disorder 14%Arthritis/rheumatism 10%High blood pressure 10%Migraine 9%Anxiety disorder 9%Heart disease Sleep disorders
8% 8%
Terms Searched
Source: Rice RE, Katz JE. The Internet and health communication : experiences and expectations. Thousand Oaks, Calif.: Sage Publications; 2001.
Wherewouldyouprefertogoforcancerinforma6on?
Source: Hesse BW, Nelson DE, Kreps GL, et al. Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey. Arch Intern Med. Dec 12-26 2005;165(22):2618-2624.
Wheredidyougoforcancerinforma6on?
Source: Hesse BW, Nelson DE, Kreps GL, et al. Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey. Arch Intern Med. Dec 12-26 2005;165(22):2618-2624.
See: Rutten LF, Moser RP, Beckjord EB, Hesse, BW, Croyle RT. Cancer Communication: Health Information National Trends Survey. Washington DC: National Cancer Institute. 2007.
*51.6% looked for self *45.7% looked for others
2003*
Lila Rutten Mayo Clinic
Rick Moser NCI
Ellen Beckjord U of Pittsburgh Med
Diffusionofonlinehealthinforma6onseeking
See: Rutten LF, Moser RP, Beckjord EB, Hesse, BW, Croyle RT. Cancer Communication: Health Information National Trends Survey. Washington DC: National Cancer Institute. 2007.
*51.6% looked for self *45.7% looked for others
2003*2005*
*58.4% looked for self *59.4% looked for others
Lila Rutten Mayo Clinic
Rick Moser NCI
Ellen Beckjord U of Pittsburgh Med
Diffusionofonlinehealthinforma6onseeking
Source: Hesse BW, Moser RP, Rutten LJ. Surveys of physicians and electronic health information. N Engl J Med. Mar 4 2010;362(9):859-860.
HINTSTrends:NewEnglandJournal2010
Lila Rutten Mayo Clinic
Rick Moser NCI
Source: Hesse BW, Moser RP, Rutten LJ. Surveys of physicians and electronic health information. N Engl J Med. Mar 4 2010;362(9):859-860.
HINTSTrends:NewEnglandJournal2010
Lila Rutten Mayo Clinic
Rick Moser NCI
Source: Hesse BW, Moser RP, Rutten LJ. Surveys of physicians and electronic health information. N Engl J Med. Mar 4 2010;362(9):859-860.
HINTSTrends:NewEnglandJournal2010
Lila Rutten Mayo Clinic
Rick Moser NCI
Source: Hesse BW, Moser RP, Rutten LJ. Surveys of physicians and electronic health information. N Engl J Med. Mar 4 2010;362(9):859-860.
HINTSTrends:NewEnglandJournal2010
Lila Rutten Mayo Clinic
Rick Moser NCI
TrendsTowardConsumerEngagementCon6nuetoClimb
Source: Hesse BW, Greenberg AJ, Rutten LJ. The Role of Internet Resources in Clinical Oncology: Promises and Challenges. Nature Reviews; Clinical Oncology (in press).
Lila Rutten Mayo Clinic
Allie Greenberg Mayo Clinic
Tracking&Adjus6ngHP2020Goals:AccesstotheInternet
Source: Hesse BW, Gaysynsky A, Vieux S, et al. Meeting the Healthy People 2020 Goals: Using the Health Information National Trends Survey to Monitor Progress on Health Communication Objectives. Journal of Health Communication. 2014;19(ISS12).
Members
Barbara K. Rimer, DrPH Univ.ofNorthCarolinaatChapelHill
Hill Harper, JDCancerSurvivor,Actor,andBest-SellingAuthor
Owen N. Witte, MDUniversityofCaliforniaLosAngeles
Commission and Charge
Commissionedby1971CancerAct.• ToreviewstatusoftheNationalCancerProgram,
• Toidentify“gaps”inneedofattention,
• ReportdirectlytothePresidentoftheUSwithfindings.
2014-2015 Series
ConnectedHealth:ImprovingPatients’Engagementand
ActivationforCancer-RelatedHealthOutcomes
Primary Prevention Loss to Follow-up:e.g., “70% smokers visit healthcare, but few receive adequate follow-up,” Michael Fiore (2013)
Communica6onErrorsinCancerCare
Primary Prevention Loss to Follow-up:e.g., “70% smokers visit healthcare, but few receive adequate follow-up,” Michael Fiore (2013)
Secondary Prevention:Failure to Screene.g., 56% of late stage cervical cancer cases in community hospital failed to screen (Taplin)
Secondary Prevention:Loss to Follow-upe.g., 7% labs, 8% image loss for abnormal findings at 4 weeks (Smith et al, 2013)
Communica6onErrorsinCancerCare
Primary Prevention Loss to Follow-up:e.g., “70% smokers visit healthcare, but few receive adequate follow-up,” Michael Fiore (2013)
Secondary Prevention:Failure to Screene.g., 56% of late stage cervical cancer cases in community hospital failed to screen (Taplin)
Secondary Prevention:Loss to Follow-upe.g., 7% labs, 8% image loss for abnormal findings at 4 weeks (Smith et al, 2013)
Treatment: AdherenceKondryn et al. (Lancet Onc, 2011): 63% of teens & young adults struggle with adherence to cancer Rx regimens.
Communica6onErrorsinCancerCare
Primary Prevention Loss to Follow-up:e.g., “70% smokers visit healthcare, but few receive adequate follow-up,” Michael Fiore (2013)
Secondary Prevention:Failure to Screene.g., 56% of late stage cervical cancer cases in community hospital failed to screen (Taplin)
Secondary Prevention:Loss to Follow-upe.g., 7% labs, 8% image loss for abnormal findings at 4 weeks (Smith et al, 2013)
Treatment: AdherenceKondryn et al. (Lancet Onc, 2011): 63% of teens & young adults struggle with adherence to cancer Rx regimens.
Symptom ManagementTwo month survivor benefit for late stage lung cancer patients with connected “clinician reports” (Gustafson, et al 2009)
SurvivorshipCommunication problems blamed for missed recurrence, missed new cancers, and secondary effects (IOM Lost in Transition, 2005)
Communica6onErrorsinCancerCare
JointCommissionhighlightsroleofcommunicationdiscontinuities
❑ Totalnumberofpreventablemedicalerrorsfromallsourcesexceeds17millioneachyear
❑ JointCommission’sSentinelDatabasereports70%ofallreportedeventshadcommunicationasrootcause
http://www.jointcommission.org/assets/1/18/Root_Causes_by_Event_Type_2004-2014.pdf
Accoun6ngforTwoTypesofError
Errors of Commission: Doing something wrong (root cause of detectable errors)
Accoun6ngforTwoTypesofError
Errors of Commission: Doing something wrong (root cause of detectable errors)
Errors of Omission: Failing to do something right (e.g., Pap failure - leads to more insidious consequences)
Stressesthatwilllikelyexacerbatefractures,obstructprogress
http://www.iom.edu/Reports/2013/Delivering-High-Quality-Cancer-Care-Charting-a-New-Course-for-a-System-in-Crisis.aspx
StressesonHealthcare❑ Agingdemographics
❑ Increasingchronicdisease
❑ Complexityincare
❑ Increasefordiseasesinremission
❑ Shrinkingworkforce
❑ Riseintreatmentcosts
http://www.iom.edu/Reports/2013/Delivering-High-Quality-Cancer-Care-Charting-a-New-Course-for-a-System-in-Crisis.aspx
CreatingaConnectedCareSystemforPatients&Providers(ASCO)
Creatingasystemthatis:❑ Predictive❑ Preemptive❑ Personalized❑ Participative
http://www.iom.edu/Reports/2013/Delivering-High-Quality-Cancer-Care-Charting-a-New-Course-for-a-System-in-Crisis.aspx
CreatingaConnectedCareSystemforPatients&Providers(ASCO)
FourPrimaryDimensionsofanIdealFuture
PersonalHealth
Information&DataSharing
Person&Family
CenteredCare
Devices,Sensors,&
Apps
NationalHealth
InformationInfrastructure
❑ Personalaccesstophysiologicandclinicaldatacontributestoacultureofhealthandbetterselfmanagement
❑ “DataAltruism:”researchparticipationatamassivescale
❑ PatientGeneratedHealthData(PRO’s,sensors)informpractice
PersonalHealth&DataSharing
❑ Patientandfamily-centricsystemoncologyandprimarycaresystem
❑ Patientsreportfeelingmore“connected”totheircancercareproviders-helpjustaclickorphonecallaway
Person-andFamily-CenteredCare
❑ Connectedtechnologiescreateubiquitousaccessopportunitiesacrosspopulations&acrossgeographicboundaries
❑ Behavioralsupportbuiltintodecisionalarchitecturesmakingevidence-basedmedicine&healthylivingtheeasychoices
Devices,Sensors,&AppsBuiltintotheHealthEnvironment
❑ONCreachesits2020goalofaninteroperableinfrastructurefordataflowcontrolledbyindividuals
❑ Cancerprevention,control,treatment,andsurvivorshipimproves,withgreaterconnectivityandfewerdiscontinuities
NationalHealthInformationInfrastructure/Interoperability
*Source: Jemal, A., Siegel, R., Xu, J., & Ward, E. Cancer statistics, 2010. CA Cancer J Clin, 60(5), 277-300.
John Seffrin, CEO American Cancer Society
“We know what kinds of things need to be done to increase the number of people who
survive from 350 per day to1,000.”Lives saved (annually): 1975 to 2005
RichardSchilskyChiefMedicalOfficer,ASCO
1. The Learning Oncology System
AprilOhNationalCancerInstitute
2. Reducing Disparities, Pop Health
RichardSchilskyChiefMedicalOfficer,ASCO
1. The Learning Oncology System WarrenKibbeNationalCancerInstitute
3. Precision Medicine
AprilOhNationalCancerInstitute
2. Reducing Disparities, Pop Health
RichardSchilskyChiefMedicalOfficer,ASCO
1. The Learning Oncology System WarrenKibbeNationalCancerInstitute
3. Precision Medicine
AlexKristVirginiaCommonwealth
4. Patient Engagement
AprilOhNationalCancerInstitute
2. Reducing Disparities, Pop Health
RichardSchilskyChiefMedicalOfficer,ASCO
1. The Learning Oncology System WarrenKibbeNationalCancerInstitute
3. Precision Medicine
KatherineKimUCCaliforniaDavis
5. Point of Need
AlexKristVirginiaCommonwealth
4. Patient Engagement
AprilOhNationalCancerInstitute
2. Reducing Disparities, Pop Health
StephenTaplin,MDMPH
Chapters6-10
GlenMorgan,PhD
BradfordHirsch,MD
AmyAbernethy,MD,PhD
Chapter 6 Chapter 7 Chapter 8
StephenTaplin,MDMPH
Chapters6-10
GlenMorgan,PhD
BradfordHirsch,MD
AmyAbernethy,MD,PhD
EllenBeckjord,PhD,MPH
LoriDuBenske,PhD
Chapter 6 Chapter 7 Chapter 8
Chapter 9
Chapter 10
Chapters11&15DataVisualiza:on&Human
Percep:on
Chapter 11
EberechukwuOnukwugha,PhD
BenShneiderman,PhD
CatherinePlaisant,PhD
Chapters11&15DataVisualiza:on&Human
Percep:on
Chapter 11
EberechukwuOnukwugha,PhD
BenShneiderman,PhD
CatherinePlaisant,PhD
Chapter 15
ToddHorowitz,PhD
Chapters12-13BehavioralInforma:cs&
Communica:onChapter 12
DavidAhern,PhD
Chapter 13
BradfordHesse,PhD
Chapters14AdvancesinSurveillance
Advanced Natural Language Processing
Chapter 14
LynnePenberthy,MDMPH
Chapters16-19TheNewEcosystem
16. Health 2.0: Smart Patients
17. Crowdsourcing: Patients Like Me
18. Big Data: New Methods
Chapters16-19TheNewEcosystem
16. Health 2.0: Smart Patients
17. Crowdsourcing: Patients Like Me
18. Big Data: New Methods
19. Cyberinfrastructure: MD Anderson
TheFCCTackles“Connec6on”asCrucialInfrastructureinHealth
Source: https://www.fcc.gov/about-fcc/fcc-initiatives/connect2healthfcc
TheFCCTackles“Connec6on”asCrucialInfrastructureinHealth
Source: https://www.fcc.gov/about-fcc/fcc-initiatives/connect2healthfcc
Source: Gee PM, Greenwood DA, Paterniti DA, Ward D, Miller LM. The eHealth Enhanced Chronic Care Model: a theory derivation approach. J Med Internet Res. 2015;17(4):e86.
NeedNewModelsofConnectedCare