Today
I’m at the HealthCare Unbound conference in San Francisco, where
I’m on a panel on PHRs at the end of the day. Tomorrow morning
I’m presenting at the Silverlink/HealthWise session on Information
Therapy in Boston. You do the math and figure out where I’m spending
the night! Funnily enough as I type I’m sitting next to Josh Seidman,
the President of the Center for Information Therapy, who’s on a panel
here later today. Tomorrow I’ll be seeing his colleague Dorothy
Jeffress. At least those two have figured out the divide and
conquer thing.

First
up was Vince Kuratis. He told us the DM world was
ending (otherwise known as Medicare Health Support crapping
out).

Liz
Boehm, Forrester was looking at tech adoption among
seniors and trying to do it by same store growth versus new growth in
tech use by seniors as they age over time. Most growth in familiar
technologies; (e.g. replacement technologies like cell phones, DVD,
etc) was dominated by real growth BUT going online regularly and having a
computer at home are primarily from people aging in (new growth rather than
same store growth). And that means the adoption will take much longer.

Why
is this adoption rate so slow? Seniors have trouble seeing. Seriously. She
showed a cool slide that showed problems with vision that more seniors have
(focus, seeing at night, etc, etc). And hearing, and using the mouse and
interacting with websites, etc, etc, etc. And there are problems with cognition
(as you age your short term memory falls apart, as we all know!). Liz tried to
get the crowd to follow some basic instructions like standing up, sitting down,
hopping up on one foot; she said that most seniors have trouble
following those instructions quickly. I noticed that most people were too lazy
to get up and follow along (Josh and I did of course). So motivation is a
problem too (after all if a good looking blonde woman can’t persuade
a room full of geeky men to do anything, what hope do the rest of us have!).
Liz then gave a whole list of things that companies targeting them should do to
change behavior. Looks like Forrester is having trouble get its clients to
figure this out, and is having to go back to real basics on the whole matter.
To me that’s not particularly good news, as if they have to be
helping them with that. Here’s the data from Forrester.

Mike
Barrat, Critical Mass Consulting who thought up the
Healthcare Unbound moniker (and corrected me when I once wrote that Liz did
it!), has figured out why we won’t manage our health, and why he won’t
stand on a scale, given that he’s no longer at quite his high school
weight. Why not? We hate setbacks more than we like gains. (Experience losses
at double the emotional impact that we appreciate gains). So we avoid all kinds
of bad news (based on the heuristic issues around loss aversion that ended up
in Nobel prize being awarded in 2002). Ignorance is thus a physiological state
as people don’t want to hear bad news and would rather be unaware. He put up a
Mark Twain quote "all you need in life is ignorance
and confidence and then success is assured." And claimed
that he wasn’t referring to the current President. Plus
even if we let patients into decisions (a la Wennberg) we have to take these
decision biases into account.

How
to get over this? a) information, b) Notice that the decisions will be
resulting in feedback ASAP, and c) help people in planning and to overcome poor
impulsive desires (need tools to incorporate that), and d) technology that does
that (such as an automotated device like an alarm clock!).

David
Kibbe, AAFP gave a great talk about Health2.0 (and
apparently wasn’t too upset that only one in three members of the audience had
heard of the CCR which he was behind). He used the concept of data
coming from multiple places; data being liberated by the
technology as the future definition of the movement. And gave a view of
the technology developments and the standards that are conduits for
those standards which he called the MP3 for the
industry. And he noted that Health2.0 is not inevitable, as it was not
just the transistor radio, but it was the transistor radio and KMart together
which made the big change; as the appliance stores made money on
repairing vacuum tube radios and were interested in replacing
them.  (MH note: This reminds me of the need for MP3. plus the iPod,
plus iTunes for that market to really take off).

Jeremy
Nobel was great — but you all already know about him and
his mum.

Gordon Norman,
CMO, Allere. Was at Pacificare, and sometime THCB
contributor. His presentation rapid-fire and fabulous. I’ll link to it soon, and grab him for an interview if I
can.