Dr. David Sobel, Medical Director, Patient Education and Health Promotion for The Permanente Medical Group takes the podium.
Quote of the week: "There's a lot of magical thinking out there if you could just get the incentives aligned."
David tells us to look at information therapy as if it was a drug. Followed by a whole lot of other mumbo jumbo, but interesting analogy.
This is a great way for hospital exec teams to examine HIT. Look at adverse reactions. Complications. Contraindications. Dosage. How would the system administer it? Target it via 'personalized medicine' approach?
Also an excellent way to look at collaborative efforts within social networks/media...if you're a Health 2.0 company looking at partnerships, pretend you're a drug. Now - what (or who) is contraindicated? What gets in the way of your delivery channel? How do you surmount the blood-brain barrier?
Another great question about behavior and measuring efficacy of information therapy...Is the active ingredient in medical therapy actually the medical content? Is it really the content of the program that changes the outcomes? I'd argue NO before even knowing his answer, it's content + community that changes behavior.
Yep, right on. Sobel says it didn't matter what the content is, if the process of engaging the patient doesn't increase sense of control, self-efficacy.
Active ingredient is not JUST changing behavior...Dr. Sobel relates research study in chronic disease self-management.
Findings:
1. Changes in health behaviors were not predictive of improvements in health outcomes ("I felt better, I felt more in control" - those with poor outcomes said "It doesn't matter if I feel better, I'm not in control")
2. Self-efficacy or confidence was associated with positive health outcomes.
Content itself, when well done, can also change people's thoughts and feelings.
Confidence itself can influence the decision to change a behavior - and that influences thoughts and moods.
So Sobel's Rx for Information Therapy is similar to the Nexthealth basic parameters of Health 2.0 -CONTENT + COMMUNITY (for a more complete definition, check out Ted Eytan's blog).
First time I've heard a discussion based completely (and statistically) around the role of confidence and control in improving health outcomes.
Sobel mentions that people who are optimistic, confident, etc. are not 'immune' from illness, but tend to statistically have better outcomes.
Information Therapy (Sobel's term), or nexthealth (our term) on steroids looks like this:
1. More than content and medical information.
2. It's about decisions and behaviors, but also about thoughts, feelings, attitudes, moods, and emotional connection (consumer firms, Apple, Whole Foods, Starbucks, Virgin America - they all get this).
Sobel says: "A lot known about human health and behavior that has yet to inform or revolutionize the way we provide care."
His prediction: Changes in health information therapy research and solution offerings will come NOT from medical sphere, but from behavioral sciences and consumer-marketing organizations.
You heard it here first folks (well, except for the gajillions of other times THCB, Health 2.0, and many bloggers on the blogroll at left have hosted posts discussing consumer-centric care evolution). And pay attention. Kaiser is often at the forefront of trends in HIT adoption and care delivery modification.
Technical difficulties: David wanders back to the computer - "Take a deep breath. Pausing in silence is not hemorrhage."
At Wired, there is a whole lot of chatter about 'talking' with patients and 'revising the healthcare conversation.' Sobel's point is a good one.
Take a deep breath. The system IS hemorrhaging.
To stop the bleed, it takes knowing when to speak and when to pause in silence. You can't plan for what's next in the middle of noise pollution.
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Many American health systems are significantly underinvested in quality management Infrastructure, Process, and Organization. In order to achieve breakthrough improvements in quality, patient safety and resource utilization, hospitals and health systems must develop a "world class" quality management foundation that includes:
Strategy: including a clear linkage of quality and patient safety to the organizational strategy and a Board-driven imperative to achieve quality goals.
Infrastructure: incorporating effective quality management technology, EMR and physician order entry, evidence based care development tools and methodologies, and quality performance metrics and monitoring technology that enables "real time" information.
Process: including concurrent intervention, the ability to identify key quality performance "gaps," and performance improvement tools and methodologies to effectively eliminate quality issues.
Organization: providing sufficient number and quality of human resources to deliver quality planning and management leadership, adequate informatics management, effective evidence based care and physician order set development, performance improvement activity, and accredition planning to stay "survey ready every day."
Culture: where a passion for quality and patient safety is embedded throughout the delivery system and leaders are incented to achieve aggressive quality improvement goals.
My firm has assisted a number of progressive health systems to achieve such a foundation, and to develop truly World Class Quality.
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