PODCAST/TECH/QUALITY: Don Kemper podcast

Here’s the transcript from the recent podcast with Don Kemper. Interesting stuff from a real pioneer.

Matthew Holt: So welcome to another THCB podcast. Today we’re very lucky to have Don Kemper, who is the President, CEO and certainly the joint founder of Healthwise, and also, although he’d be too bashful to say it, probably the main individual in America who has been behind the information therapy movement, which now has its own separate Center for Information Therapy, the one that Don I believe founded. So Don, welcome to The Health Care Blog.

Don Kemper: Thank you, Matthew. I’m pleased to be here. You’re very kind.

Matthew: Those of you who’ve been reading the blog have noticed that over the years I’ve both been to a couple of information therapy conferences, partly because they’re held in Park City, Utah, which is a beautiful and lovely place to go where I have friends (even though I left most of my left knee there in the trees some years ago and am just steadily getting it put back together) but also because I’m pretty convinced and a firm believer that the concept of information therapy is one that is going to be of significant importance no matter what happens in the future health care reform debate. And it’s something that, as people are developing new and different forms of information technology to support those patients and physicians, information therapy is going to be an important part of that.

So, with that, Don, why don’t you take us back to the early days. Tell us a little about what Healthwise does, how that started, how the Healthwise Handbook got going, and then perhaps just tell us a bit about Information therapy to start off with.

Don: It all started, Matthew, when I was a lieutenant in the U.S. Public Health Service back in 1970, and I heard a talk by the assistant secretary for health education and welfare in those days, Vern Wilson. He said the greatest untapped resource in health care is the consumer. And that was at a time when nobody was thinking about what a patient could do for themselves, and I though, "That’s a good idea." I had a little baby at home and somebody had given me a Dr. Spock, and I thought, "Well, what the world needs is a Dr. Spock for the whole family," and began to try to get the federal government to write a basic self-care book that they could give to every family in America.

That idea didn’t get very far in my two year tenure with the Public Health Service, but I held onto the idea, and a few years later landed in Boise, Idaho with a pretty open book on what I could do, and we started to develop that idea. And so Healthwise was formed in 1975. We published the first copy of the Healthwise Handbook through Doubleday in 1976. And we have been growing toward the same mission that we established right then, which was to help people make better health decisions.

So over the last 31 years, we have been continually looking for ways to enrich this mission of helping people make better health decisions by giving them books, giving them workshops, giving them good web based information, and now finding ways to prescribe information to meet their specific needs in every moment of care.

Do you want to know more?

Matthew: Sure. Let me ask you some more specific questions. Healthwise is founded as a non-profit, and I guess that perhaps the first time I ran into Healthwise was back in early ’90s. Somewhere around that time you convinced the folks at Kaiser Permanente to give that book to every member, I believe. Maybe that was just Northern California. The thing that I as a health care economist policy guy that I sort of sat up and took a notice, was that actually, they showed that emergency room visits declined dramatically amongst people who had these books.

So tell me a little bit about how that evolved, and how, apart from being sort of a worthy organization giving out information to people, Healthwise started evolving into being a place where the health care system realized it could start having a positive impact on savings, as well as outcomes.

In the early days we were grant funded. We had funding from the Kellogg
Foundation and a variety of other places, including the National Center
for Health Services Research. And we initially had workshops where we
would bring mostly women, mothers, family care-givers into workshops.
We’d give them a book and we’d give them, say, twenty hours of training
in how to do better care at home for their kids. And we had that
supported by grants.

And people really responded and said, "Boy
these are basic questions that we have, and learning these basic things
helps us do a better job, and helps us save money with the doctor." So
from that experience, we began to talk with some of the new managed
care plans that were evolving in the late ’80s and early ’90s to say,
"You know, this is in line with your mission of helping your members to
stay healthy and to avoid high costs. You should begin to do these
programs." And so we did quite a few of the workshop programs where we
trained trainers at health plans to present that information to their
members, but on a pretty small scale.

The first big breakthrough
we had was at Health Net, a Southern California based managed care
plan, who was planning to deliver some 20, 000 Healthwise Handbooks
through workshops to their members, but only to a small percentage of
their members. But only to a small percentage of their members. They
were going to do this through employers. And we went and talked with
them, and they came to realize that every member of their health plan
who did not have this book was at a disadvantage. So they said, "Well,
can we just give one to every family?" And of course we said, "Sure."
And that was the first I think 300, 000 book sale that we came across,
and many since.

Then Kaiser really came up next, where Kaiser
was doing some pilots of the program in Northern California. They were
very well received, and they rolled the program out across the country.
So I believe every Kaiser member in all of their regions, or at least
every Kaiser family, receives a Kaiser version of the Healthwise

I believe that there were some studies done within Kaiser demonstrating
that the initial roll-out, or maybe a test group (I don’t know how they
did it) was showing not only nice benefits for the members, but also
that it was reducing heath care costs for those members. Is that right?

That’s true. They’ve done those internal studies. I don’t know how many
have been actually published in the medical literature. There have been
other studies that have been done as well. For example, in 1996, with
funding from the Robert Wood Johnson Foundation, we delivered a
Healthwise Handbook to every family in a four county area in Idaho. And
incidentally we are in Idaho with our intergalactic headquarters here
in Boise. But we delivered those books, and then Blue Cross noted that
in the year following the distribution of the books, the per capita use
of emergency rooms went down I believe it was 16% during that first
year. And that’s the most dramatic response that we’ve seen.

the Kaiser point of view, all I can say is that they continue to buy
books for their members, so the results may have been positive for the
organization as well as [dog barking in background] for the individual.
Sounds like you’ve got a dog!

Matthew: That’s my dog barking. He hasn’t read his handbook about how to not bark during these [laughter] interviews.

I should say, Matthew, that our mission is to make people make better
health decisions. We don’t limit which people, but we haven’t gone to
animals yet.

Matthew: Well, he has his own health care issues, which [laughter] get dealt with by serious capitalists called vets.

talk a little bit about how Healthwise as an organization has evolved
and started working with different brands. I probably ran into
Healthwise as a business entity about seven or eight years ago when I
was working at a dot com. We were trying to sell a web based consumer
health record to a health plan. We were talking about how do we
integrate our web record with the information they’re providing, and it
turned out they were providing all their information over the web. But
it was your information. And there are also different places over the
web now that you’ll find Healthwise information not just in a book, but
also in monographs and consumer friendly forms all over the web. How
did that evolve?

The single beacon that we’ve been guided by is the mission: helping
people make better health decisions. How you reach those people… In
many cases that means aligning with organizations that have access to
those. So we really started with health plans. Health plans have huge
numbers of members, and they have a legitimate way to connect with
those members at a time that they’re having health problems. So it’s
been a good match for us, and I think if you took the top ten health
plans in the U.S., all ten are using our content. So we found a way to
ignore the competitive world related to health plans and to just say,
"Here is a basic resource that will help your members do a better job
of staying healthy and taking care of their problems. And we’ll market
it to you in a way that really makes a compelling case."

So I
think we just naturally found it. That’s been a good market for us and
a good avenue for our mission. As have things like the disease
management world, where many of the big disease management companies
now use Healthwise information for their nurses and for their members.
And also, of course, many of the big new health portals license our
information to deliver to people.

So wherever we can find a
channel for getting our information to a consumer at the time they’re
needing it to make a better health care decision, we want to follow
that channel.

Let’s think a little bit about the state of play. Because this is
where, I think, the information therapy movement is coming in.
Actually, before we get there, just tell me a bit about the Center for
Information Therapy and your role helping to start that, and why you
thought it was necessary to create an independent center, given that
Healthwise is already a non-profit—albeit one that’s competing with for
profit companies in the publishing and sort of content world.

Don: When Al Gore invented the Internet…

Matthew: Oh, a cruel hoax.

The Internet came about, we initially thought, "Boy, here’s Nirvana.
This is utopia for health information, because here now any time 24/7,
people can go and get good information about their health problems.
This is going to be great!" And then, as we watched it grow out, we saw
some problems. Number one, the information on the Internet wasn’t all
good. Two, people couldn’t always tell which information was good and
which was not. And three, even if they found great information, there
wasn’t a good way to use it within their doctor patient relationships,
because the docs didn’t have time to read it, and the docs didn’t
necessarily trust it. They didn’t know where it was coming from.

we kind of reached an assessment at one point saying, "Well of course
you’ve got to have good information on the Internet and help people
find it. That’s number one. But two, you need to find a way to
prescribe information to people so that they get it when they really
need it, they don’t have to go look for it, and what they get has been
vetted by their health plan or their doctor." That was kind of the
birth of the information therapy idea. Let’s prescribe information to
people, let’s call it therapy, information as therapy, because it’s
just as important as the test you get or the medication you get,
because it can improve your health in just the same way. So that was
kind of the birth of the concept.

And then we began to look
around and say, "Well, how do we infect the world with this idea of
prescribing information to people?" And we said, "Well, first, let’s
talk to some of the movers and shakers." So we talked to people like
Peggy O’Kane at the National Committee on Quality Assurance (NCQA). We
talked to the then CEO of Aetna, Jack Rowe. We talked to the head of
internal medicine at Mass General Hospital, Al Mulley. We talked to a
variety of people who really are smart and at the front of innovation
in health care. And they said, "This is a great idea! You need to find
a way to promote this to the world."

So we created the Center
for Information Therapy. Initially it was just a part of Healthwise.
Healthwise is non-profit, 501(c)(3) organization. Those people I
mentioned and others all came onto the board. At that time we called it
the Information Therapy Commission. And we began to set policy and
promote ideas around Information Therapy even while Healthwise as an
organization began to develop information therapy programs.

maybe a couple of years ago, we began to realize that some players in
health care, particularly people that provided information on their
own, were reluctant to join into the information therapy movement
because we had such a dominant role in that movement. And so we decided
that for the good of the country, for the good of the field, we would
back off from being the direct owner of this information therapy center
and make it an independent organization.

So beginning in January
of this year the center kind of went off on their own. And they are now
a 501(c)(3) completely independent of Healthwise, funded by a
membership program where there are some thirty or so organizational
members that fund the Ix Action Coalition. And they’re on their own. So
they’re now able to get grants themselves without having to say, "We’re
tied to a particular content provider." I think that was the main
reason it was better for them to be independent.

Now, some of
the people that are also developing content are sitting around the
table on the board of directors at the Center for Information Therapy
and trying to look at how does this idea impact the crises that are
going on in health care today.

If I was to talk about my sense, having been at a couple of the
conferences, that the Information Therapy Center, and the disease
management folks to a certain extent, and also probably many of the
technology folks (I’m thinking of people like the WebMDs of the world
and people like Cleveland Clinic Online and others who have been there
demonstrating their tools for getting information to patients, and to
physicians by the way) around that, the Information Therapy approach. I
think it seems to have done very well getting those folks on board.

I was to say where it looks like to me that there’s still a bridge to
be crossed, that there are clearly organizations that do better if they
have the ability to get better informed patients and lower health care
costs. And obviously Kaiser Permanente, Group Health of Puget Sound,
those names always come up when you’re having this discussion. Let me
add in, of course, that most health plans, although frankly they seem
to make more money when health care costs go up hither, but the concept
of being a health insurance company is that you are supposed to promote
health amongst your members and try to reduce overall costs, and if you
can create a better health care quality experience for your members at
the same time, that’s a great thing as well.

The challenge it
seems to me that Information Therapy is having, is how do you sort of
integrate the whole concept of Information Therapy into, if you like,
the great unwashed of American medicine, which is the 85% of physicians
and 80% of hospital systems where most of the care goes on, but really
are still in a fee for service world where–let’s be frank–the more
they do, the more they get, and most of their work is done on acute
interventions on sick people. You could argue that if you want people
to get healthier, they don’t get so much to do and they don’t get so
much money. That seems to be where the challenge remains. And if I was
to look around the room at the Ix conference, some of those folks are
the people that are somewhat missing. How do you think we’re doing in
that respect?

Well, I think the whole provider side of information therapy is just
beginning to show interest, just beginning to develop. And I think that
you’re right, that if you don’t develop the side you’ve really missed
the game in the long run.

We also know that it’s so darn tough
to change this sort of cottage industry delivery side of healthcare
that there are going to be some big gaps for a long time in the health
plans, and the disease management companies are able to help fill those
gaps until the provider world catches up.

But I think you’re
going to see some significant advances in the provider world. And I can
predict the way they’re going to come. They’re going to come through
the EMR plans, the EMR companies that offer electronic medical records
to clinics and hospitals that provide a platform for the easy
description of information to the patient.

Some of the people
you do see at the Information Therapy Conference straddle the worlds of
payer and provider. People like Kaiser; people like Group Health
of Puget Sound, where they have huge clinical systems that are going.
Where they have implemented information therapy, they have received
such incredible payoffs, both in terms of improved satisfaction of
their members, but also improved workflows and improved results, that
it will be impossible to compete with those kinds of plans unless the
fee for service system catches on and starts using those as well.

I think you’ll see, in the relatively near future, any clinic that
implements an EMR program, an Electronic Medical Record program, is
going to include information therapy in that implementation, so that
their patients get patient-facing advantage out of the technology. And
it’s going to reduce their costs in many ways. It’s going to allow them
to have more billings because they’re able to manage more difficult and
more complex patients in a shorter amount of time.

Let’s dig into that a little bit because I think we’re seeing a growth
of EMRs. Not as fast as some of us would like, but we are seeing the
growth of the EMRs across the nation. Most of the growth is in the
larger physician groups but clearly every physician’s organization of
whatever size is at least thinking of having the internal conversation.

in particular, if you look at some of the bigger provider groups who
are associated with plans or maybe not, but I’m picking here on Kaiser,
Group Health Cooperative Puget Sound and Cleveland Clinic, that have
active EMR’s from Epic. That particular company, they also have the
patient-facing view of that, which is, as you say, a venue where there
is a lot of information going on. Where people are actually being
prescribed: “Go read this piece of information”, or “Here’s a link to
somewhere interesting”.

Even just the simple things. Here’s, as
you know, as you’ve said many times, what’s discussed in front of the
patient or between the patient and the doctor tends to be forgotten as
soon as the people leave the room. That system provides a place where
that information can be captured so people remember the basics.

you having, either the center or Healthwise, or competitors of
Healthwise, having comparable conversations with the other major
technology vendors, the Cerners, and the McKessons and the GE IDX’s of
the world? Do you think everyone’s going that route or is it pretty
much Epic only at this stage?

No, I wouldn’t say it’s Epic only. We do have a lot of work with Epic
clients and we do have some conversations with Epic themselves, but
we’re certainly working with other players also. And I think it’s our
goal to be kind of agnostic related to that and to have our information
available to all the major EMR organizations.

We’re just getting
to the point where we have the products that are compelling for the
pure provider market. And what we have done with Kaiser and Group
Health has been great because they have a foot in each side. And even
then, some of the big clinics like Palo Alto Medical Foundation,
they’re able to use our knowledge-based content well.

But we
have new products that are much more geared toward the provider market
called patient instruction, which is a piece of paper or the electronic
paper that the doctor gives the patient following a visit or in a
visit. And that really is the core platform on which information
therapy will be built on the clinical side. It’s a little different
model than you would use with a health plan or a disease management
company. And our products have been a couple of years behind. So we’re
just now entering those markets and we think that it’s going to be
something that the clinical world takes note of.

That’s pretty interesting because we’re now discussing how do we
replace those pamphlets that you get given with all the discharge
instructions or whatever you get given and make sure that the patient
can read them and understand them and all the rest of that.

I think one of the takeaways that I’ve had from the various information
therapy meetings that I’ve been to in the conferences is that there are
many, many different paths to basically the same watering hole. This is
a marketing issue of how do you get patients to understand what they
should do and what works for the male in his sixties in Boise, Idaho
who has some kind of heart condition versus what works for the fifteen
year old diabetic living in south-central LA is incredibly different.
And just handing out a pamphlet that is not specific to those different
people doesn’t really work. And I think presumably that’s what you’re
talking about in terms of this…

There’s just so many ways to improve what we do now. Before every
clinic visit or before every one that’s not a walk-in, there’s at least
some encounter that sets the appointment. And that’s an opportunity to
send information to the patient so they can prep a little and also do a
little assessment so that when they get to the doctor’s office, they’ve
already done the base work of thinking about their symptoms, of
reporting what they’ve done at home etc, and the doctor can spend time
really helping them solve the problems.

So we heard from the guy
at the conference from Geisinger. I’m just blank on his name at the
moment but he was talking about why we need $100 an hour resource to do
$10 an hour tasks. Why can’t we let patients do the things they can do
themselves even better than the doctor and then save the doctor’s time
for things that can really make a difference, really monitoring their
co morbidities, for example.

So much of healthcare is around
chronic conditions and co morbidities of chronic conditions and yet
doctors are pretty much trained to just handle one condition at a time
in the visit because there is only time for one. With good information
therapy, when the patient comes in prepared and the information they
have been presented has been analyzed for the doc in advance, the
physician can handle more than one condition at once. So we’re moving
toward that kind of an intervention. It can really make a difference
not just in the cost crisis and the quality crisis, but also in the
manpower crisis that the healthcare system is facing.

Yeah, I think that’s certainly true. And I put there are two major
battles going in healthcare. One is how do you automate and improve the
ten-minute visit, what you’re referring to as the ten minute visit or
the fifteen-minute visit that the patient gets with the doctor. And the
other is how do you actually improve the however many weeks or months
it is between those visits, that the patients are basically maintaining

And that’s I think what you’re talking about is
information therapy is at the nexus of those two pieces. It’s how do
you make that visit more efficient by getting better information from
the patient filling in medical histories in advance or having questions
prompted or that kind of stuff versus having better information about
happened in the visit and what instructions given, how they should
follow up.

And I remember a couple of years back, it might have
been Paul Wallace or somebody else at the conference mentioned that
(you know these numbers much better than me) even though we know that
if you are discharged from the hospital you should be taking beta
blockers and an aspirin, in fact, nationally, we’re only at 55% or
whatever the number is of patients who are actually doing that because
somehow or another that information hasn’t been properly communicated
in the way it should be. That can be simple, there doesn’t necessarily
have to be an electronic tool to do that. But certainly that’s one
particular path to making that kind of intervention happen and be more

Right. And we like trying too, if it’s so easy to do that. You know we
usually think of patient instructions as being sort of the end of an
encounter. But what we know now is that you can have instructions
before the encounter starts, you can have instructions at the end but
then you have instructions that foul up because the day of the
discharge you have one set of issues. The next day has a different set,
and the following week and the following month there are other things.
With the beta blocker issue if you interview people six months later a
large number have stopped taking their beta blockers. If you ask them
why, they say "I didn’t think it was important." They forgot the reason
or the reason wasn’t explained well enough and nobody refreshed the
reason. So they just quit taking them. And boy, computers are great at
reminding people of those issues. They’re also good, well go ahead with
your question.

I was just going to say that it’s an obvious thing, that an any
educational situation you have to tell somebody four or five times the
same thing before they learn it in many different ways every time. And
at the moment you get one discharge sheet and one quick follow-up with
a doctor when you’ve got a number of other things on your mind and you
have to figure all that out. Six months later it’s not surprising,
although in some ways we know that those numbers of people taking beta
blockers should be way higher than they are, we shouldn’t be surprised
that they’re as low as they are because no one has figured out how to
get to them at the right time with that sort of follow up reminder.

Don: Right.

Matthew: I think that’s a lot of what we are talking about.

It is indeed. Of course we know that even though computers are so great
at doing this job there are still a lot of people who don’t have access
to broadband Internet use and so there are other methods that we have
to use as well. I think you probably saw at the conference this year
the number of health plans and the number of companies that are now
offering telephony phone based information therapy. Which are shorter
messages but do a good job of reminding people of things like its time
for your immunization or why don’t you schedule your mammogram.

Right. Now that leads us to an interesting sort of nexus because you’ve
got, if you like, an age spread. I don’t want to call this a digital
divide because that’s not what it is because there’s a lot of access
across income and class groups. There is certainly still for those over
65 much lower penetration of Internet use and for that matter much
lower penetration of mobile phone use other than straight talking over
the phone. So there are people developing SMS systems and instant
messaging things over the phone for these kind of reminders which are
working pretty well on young people in different parts of the world but
are not necessarily going to be the solution for the elderly.

I think the talk that you gave at the conference was looking at how you
get this type of information therapy across the spectrum. And we’ve got
that going on. What are the different techniques that you need? Does
the telephone work, does the mail work, does even pure person-to-person
communication work at conferences for pharmacists or whatever else.

on the other hand we’ve got this big development. It’s loosely been
called the health 2.0 movement or whatever you want to call it where
there’s a lot of peer to peer communication going on around the web and
if I was supposed to make not a criticism but sort of a statement about
information therapy at this point, it’s been an attempt to sort of
verify and put a mark of authority behind information that has been
delivered generally from the system to people.

But there’s also
all this communication going on between people both online and offline.
Now that’s beginning to become much easier with the advent of Google
and search engines and communication devices. Have you thought about
how the typical Healthwise monographs are going to fit into that world?

Well clearly you need both. You need good, vetted scientific
information that has a good base of medical research behind it and you
can track that research, you know it’s there. You need that in order to
go and work with your doctor so your doctor knows information you’re
using is vetted. You also need to know what’s worked for other
patients. The two work together really quite nicely and that’s why in
our content we always include references to the self-help groups that
are relevant to your particular disease.

There’s a national
self-help clearinghouse that has hundreds of these self-help groups
that allow self-helpers to get in and say "I was in your shoes and this
is what you have to watch out for and this is how I did it." That just
gives you the context to use the more evidence-based information to
your benefit. So I think the two don’t fight against each other at all,
they really work hand in hand. You really need both in order to do the
best job.

Yeah, and I would speculate that maybe Healthwise itself there are sort
of two things going on. One is the issue of things that we know we
ought to do but don’t do. How do we get the patients after they’re
discharged to take their beta blockers? How do we get the diabetics to
check their blood sugar and regulate their insulin levels? Then there
are the sort of things that we know how to do it but we don’t know how
to get everyone to do it.

Don: Yeah.

There’s a lot around there, which is true. The other is what’s
increasingly starting to be called the long tail, which has been
borrowed, from this book by the guy from Wired magazine, Chris
Anderson. The concept is there’s a lot of information, that there’s
always new information being developed in health care and there’s stuff
that we don’t know clearly what the answer is. If we generate more and
more information online we have the capacity to search that information
more and more and we can start judging that and evaluating that.

a couple of interesting physician based websites that just opened
starting to do that work where physicians are asking each other
questions and putting in queries about new things they are seeing.
Sermo is one, MyMedNetworks is another. I think you are going to start
seeing an explosion of this on the patient side.

I think there’s
a role for the Center for Information Therapy or other sort of bodies
is to start helping with the process of validating, either on the
physician’s side or on the patient’s side, again, what’s good
information and what’s not good information and who are the people you
can trust. I think it’s not just anymore the American Diabetes
Association or whatever but who are the patients that are useful people
to add to this discussion and who are the people who are selling
Alfalfa beans from Mexican clinics as a cure for cancer.

gone referring people to the peer-to-peer discussions as self help. Are
you thinking of getting involved in the validation of that side?

I think that kind of defeats the purpose. I think you need to know
where to go to get the good evidence based information. We’ve tried to
establish ourselves as a source for that. Then you need to be able to
take other people’s opinions and make your own judgment about whether
that’s going to be particularly useful and helpful. For so much of
health problems the medical piece is not the only piece that you’ve got
to solve. It’s the family piece, it’s the social piece, it’s what do I
do at work or what do I do at school or what do I do with my child not
related to the medicine and tests they are getting but related to how
do I nurture them through this episode? There’s not a good way to
validate that. I think that you’ve got to give people at least one good
source of evidence-based information and let them rely on that. And you
need to let them open up to whatever sources peer-to-peer might, they
might find valuable. It’s kind of like you can get the ratings, you can
go to the movies and get a rating for whether a movie is PG or R-rated,
or whatever, and you can also read the reviews of the experts and see
whether this is a good movie, or see who wins the Academy Award, but
you also often want to ask your buddy well, what did you think of the
movie? And that’s what makes up your mind whether you go or not. The
combination of all these things, what we’re committed to doing is
giving people at least a source or the evidence base, vetted
information, written in a form they can understand and presented in a
way that’s truly structured around the decisions they have to make. We
think that is one of the pieces they need, and they need other pieces
as well.

That makes a lot of sense. I think that the wave of the person asking
their buddy what happened in the movie, whether they liked the movie,
the word-of-mouth piece is actually going to become much bigger in
health care, especially in the next five years. I think that’s going to
be an interesting contrast. But I think the obvious thing as people
become more aware of this stuff, they’re going to be using all kinds
of, all that as a source, but also you’ll see an explosion in the
trusted sources like the Healthwise and other content providers like

One of the kings of health care blogging but I suppose they’re now I
don’t know if there’s a 100, 000 health blogs or if they’re more than
that but,..

Actually, probably the most interesting stuff is not the blogs like
mine on changes and trends in the health care system, but actually the
ones written directly by patients.

Don: That’s right, that’s what I was referring…

Matthew: There are some, especially in the diabetes world, I’m thinking about Diabetes Mine,
Amy Tenderich’s blog, which is really got an extraordinary information
about somebody going through life as a diabetic, and now people are
sending her new diabetes blood-glucose measuring tools and pumps and
talking about her experiences, and there are a lot of people writing
about that experience, and there’s a huge amount of information sort of
coming peer-to-peer, as that develops. And you’re going to see, like in
any kind of social market, knowledge and opinion leaders emerge and she
clearly is one in that very specific area. And I think that how that
plays out is going to be interesting, but it’s going to be there.
Certainly much more information is better, so long as there is some

So let me ask you, two quick final questions, Don.
The first one is, you talked about the evolution of the next ground of
information therapy being very connected to the development of
electronic medical records, we’ve seen in a couple of countries I’m
thinking the UK, Norway, New Zealand, actually pretty widespread use of
primary-care electronic records at this stage. Has there been much
impact that you’ve seen internationally of information therapy.

There has been a little. Not a whole lot, but Molly Mettler and I wrote
a white paper in which we, we wrote it for the Department of Health in
the UK, about this time last year. Some of the elements of that, of our
paper, showed up in their big white paper, which was called "Our
Health, Our Care, Our Say," I believe. It was signed by Tony Blair and
released at the end of January last year, and in just this month there
has been an announcement of some I think they called them information
prescription pilots, in the UK, using Cancer Backup, which is one of
the nonprofits there that does a lot of cancer education and a few
other organizations. So, it’s being picked up in the UK. Of course they
have the National Health Service, so they have more of a organized way
of getting across the whole system I guess. But they also are
struggling with their EMR side, so it’s there’s still a long way to go
there. And there has been interesting in information therapy really
across Europe, so others and I have done presentations on information
therapy in Luxembourg, in Prague, in the Hague, in the Netherlands. And
everywhere there is an acceptance that this has got to be the way it’s
done in the future. It takes a while, so they’re having to pull their
infrastructure together and of course in many cases they don’t have the
consumer health information that we have in order to deliver the
content within the information prescription.

Well, in some ways that’s good, that’s a whole new market, right? But
what you’re saying is that even though they have a lot of primary care
EMR used in some of these countries, they haven’t mastered the
information therapy to the extent that some of the more advanced places
here that have got primary care EMR, even though they may be

I think that’s right. I think in some ways they may be ahead. I think
they’re ahead in infrastructure, not necessarily in the delivery of
content. Partly because the culture isn’t quite there yet in many of
these countries. There is a good book called The European Patient of
the Future by Angela Colter, who interviewed patients and doctors in I
think eight different EU countries and you can just see from one to the
next to the next the variance in the cultural readiness for empowering
patients. It’s nothing you’d want to try in Spain right now, for
example. Theirs is a very paternalistic system, not ready to empower
the patient. But in some of the countries you mentioned there’s a much
greater openness.

That’s pretty interesting. And finally the last question is what are
you most excited about — maybe you were already asked it — in terms of
the adoption of the technology behind information therapy. Where do you
think the biggest movement in the next two to the three to four years
will be around the whole information therapy movement?

The thing I’m most excited about in that period of time is what health
plans will be able to do for their members with chronic conditions.
These are people generally that have multiple chronic conditions. The
RAND study showed that about half of them don’t really get the care
that they should be getting. There’s a big gap between what we know we
should and what we do. And information therapy campaigns that can be
easy for patients are that are identified by their health plan and sent
to each person on a periodic basis can give a very personalized guide,
sort of their own personal care management plan that will in a very
exciting way help them get better health outcomes, help them avoid
emergency room visits, help them avoid hospitalization, help them get
more money’s worth for the drug money, for the drugs they spend, for
the drugs they buy. And I think that’s the most exciting thing right
now is these campaigns for chronic disease that for really the first
time give a patient a sense of mastery over their condition or over
their multiple conditions.

Matthew: That’s great. Because I
wrote an article a while back called "The Yin and the Yang of Health
Insurance Plans," and there are plenty of things health insurers are
doing that many of us find pretty uncomfortable and pretty
discouraging. But, on the other hand, there are those beavering away
within these medical management groups within the health plans who
really have been trying to figure out how to do disease management
better and it’s great that they’re now getting to promote some of these
programs, both with health coaching, and also with advocacy programs
but also with these disease-management programs which communicate
better how to use these disease-management tools and techniques and
companies or whatever, to the chronically ill. I think you’re right.
The patient is a scarce resource, but also the organizations that are
reaching out to the patients have to figure out how it is that they can
make the best of that resource because self-management is a great
thing, but if people aren’t informed how to do it, it won’t happen,
so…I’m with you on that.

So with that I want to say thank you very much, Don, it’s been great
chatting with you and I’ll looking forward to seeing you at the next
information therapy conference or the next time I end up in Boise,
Idaho, whichever is sooner, and thanks very much for being a guest on
The Health Care Blog podcast today!

Don: It was my pleasure, Matthew. Thank you!


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  1. Al Gore never said he invented the internet. That is right-wing propoganda, and repeating it only serves to discredit one as being a reactionary “free-marketer,” intentionally blind to facts and deaf to the cry that dire economic circumstances leave one with freedom of choice, but nothing to choose from.
    Mr. Gore WAS responsible for legislation privatising the internet – that’s right, turning it FROM a government service TO a private one. That IS what he said.
    Again. Right-wing propoganda would assume he wanted only to tax and spend. Surprise.

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