Provider-centric, face-to-face health intervention programs that help people quit smoking, lose weight and increase activity levels have been shown to work, but they are expensive, don’t scale, and inconvenient. By contrast, Internet-based programs with similar goals can be disseminated widely and inexpensively, and can be accessed by consumers at a convenient time and place.
Although many of the latter programs have been shown in clinical trial settings to be efficacious, attempts to commercialize them have been plagued by attrition. People stop using the programs because they lose motivation, can’t find the time, or become frustrated by clunky interfaces and data entry requirements.
In one study for example, only 26% of participants in a randomized trial of a free physical activity website dropped out of the study before it was completed, whereas 67% of registered open access users dropped out during the same course of time. The open access users also spent less time on the site.
The lower attrition rate in the trial was likely driven by the emotional, cognitive and logistic support provided by trial personnel. It follows that the commercial success of online health intervention programs hinges on their ability to support users in the same way as trained personnel do in clinical trial settings.
There’s no doubt that despite my thoughts that Obama wouldn’t (and shouldn’t) have pushed health reform in 2009, it was a very big year for health care. Death panels, public options et al—one hundred thousand visits to THCB in August don’t lie.
So what should you look for next?
The finish is the start: It looks like some version of the Senate bill will be a done deal by sometime late January. That means that there’s about two years of health care industry players figuring out what it all means. The biggest two questions are; what will the types of plan sold in the exchanges look like? (high deductible with some preventive care thrown in is most likely), and what will the cuts and changes in Medicare payment actually look like in practice? (More of the same or real re-alignment around some kind of bundling). All these changes need reactions from the incumbents to reorganize around the new revenue streams.
The Pew Internet/California HealthCare Foundation report, The Social Life of Health Information, is packed with new findings from a survey of 2,253 adults, including 502 cell-phone interviews, conducted in either English or Spanish.
We spent a bundle of money on making this a random sample of the U.S. population, but guess who got a call on his cell phone? None other than e-patient Dave! He had never talked with me about the survey questions or reviewed a draft, so I decided to keep his interview in the mix, but he surprised the heck out of the interviewer when he finished the sponsor identification for her at the end.Continue reading…
We do not live our lives alone. We live our lives in collaboration
with others.We communicate our needs and our goals, and together we
work to achieve them. This is exceptionally true for families and
individuals dealing with illness. Whether you’re dealing with
depression, or pain, or perhaps the fear and stigma of HIV, or the
impairment that comes from MS, Parkinson’s or ALS, what helps us the
most is when those around us reach out and share their support and
In the first and second parts of this series we talked about how and why there is no universal definition for the term “EHR.” Instead there is a legitimate, growing debate about the features and functions that “EHR technologies” should offer physicians seeking to qualify for HITECH incentive payments. We explored the layers of network technology, suggesting that federal regulators should “separate the data from the applications.”
We also argued that there is much to learn from development platforms, recently and in the distant past, that have used standards to open the aperture of innovation. The best of these standards have reflected the experience of what works rather than specifying how to make it work. Defining the standards for data, devices, and network technologies too restrictively could choke off innovation, rendering HITECH’s offerings whose expense and complexity are a barrier to, rather than an incentive for, adoption by physicians. Incoming National Coordinator for HIT David Blumenthal, MD seems to have been considering just this concern when he recently wrote:“… [M]any certified EHRs are neither user-friendly nor designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system. Tightening the certification process is a critical early challenge for ONCHIT.”
For too many years, I’ve witnessed the same thing. First, it was in the ACOR system. Then it occurred in many conferences about eHealth, e-Patients, and now Health 2.0 and the Connected Health symposium
at Harvard Medical School.
Why is an entire segment of the U.S.
population almost completely absent from the fast evolving world of
Health 2.0 and Participatory Medicine?
The uneasiness has consistently grown since 2004 when we ran our first large in-house survey and discovered
that over 98% of our users are Caucasians and less than 1 percent are African
Americans. It is too easy for all of us to forget about this disturbing
Nothing focuses the mind like an impending hanging. — Samuel Johnson
I’ve been preparing for tomorrow’s 3rd Health 2.0 conference in San Francisco, where I’ll join my pals Matthew, Indu Subaiya, Jane Sarasohn-Kahn and Michael Millenson amid a Who’s-Who cast of health industry luminaries. I spent part of Monday reviewing the attendee and sponsor lists, impressive indeed, testament to how seriously this topic is being taken throughout health care.
The meeting is sold out at 950 participants. It’s worth remembering that, before the first Health 2.0 conference 13 months ago, Matthew, who with Indu took enormous professional and personal financial risk to pull this off, told me he’d be surprised if 75 people showed up. There were almost 500, many of them with genuine influence.
If you don’t have an avatar, you may want to seriously think about creating one. I
am. I’ll admit it, at first I was skeptical, but the more I see the
benefits of virtual worlds, the greater the value and potential I can
see for health care.
An Avatar, as Wikipedia notes, is “a computer user’s representation
of himself/herself or alter ego.” (Hmmm, wonder what Joe the Plumber’s
avatar might look like)…
Second Life is the most well-known virtual world with more than 13
million registered users. It is primarily a social environment with a
strong creative component, since any user is allowed to create content
within the world. This highly-modifiable environment makes Second Life
uniquely suited to educational campaigns. For example, a space could be
created to simulate the everyday difficulties that people with mobility
challenges (i.e., people in wheelchairs), cataracts, or
diabetes-related eye illnesses face to help educate those without these
Whyville is an educational virtual world geared towards preteens and
children (ages 8 to 15) whose goal is to engage its 3 million users
across a broad array of subject areas, including healthy living, art,
history, and social issues. One could imagine an opportunity for
multi-generational education by creating “DiabetesTown” within Whyville
that would educate users about the importance of proper diet and
exercise, regular vision screening, and what life is like for friends
and relatives with diabetes.
Note: Amy Tenderich, who writes and maintains the wonderful Diabetes Mine,
just did this very illuminating interview with Google Health’s Missy
Krassner. As you’ll see, she doesn’t slow-pitch to Missy. This is a
sure-footed, tough-minded exchange about the real issues that are on
the table now in Health 2.0. – Brian Klepper
Slowly but surely, using the Internet for your health needs is
becoming as mainstream as shopping on the web: no longer futuristic,
but is it for everyone? And perhaps more importantly, are mainstream
commercial health platforms from companies like Google and Microsoft
really useful for people with specific chronic illnesses? I thought it
would be interesting to hear their side of the story.
So please welcome Missy Krasner, Product Marketing Manager for Google Health, whom I was lucky enough to catch up with for an interview last week.
Missy, shortly after Google Health launched last Spring, David Kibbe, former Director of Health IT for the AAFP, noted
that most of its services were “only mildly useful and sort of
‘toyish.’” How have these services evolved to be more useful to people
with health conditions?
Joshua Seidman is the president of of the Center for Information Therapy
that aims to provide the timely prescription and availability of
evidence-based health information to meet individuals’ specific needs
and support sound decision making.
There’s no doubt that they will get a lot of consumer traffic to their network of sites. One of the things that remains unclear for both Waterfront and WebMD is to what extent they will serve primarily as reference sources versus playing a greater role in consumers’ own health management. The answer may very well lie in the degree to which they provide information therapy (Ix), not just health information.
As 1.0 as it is, there’s certainly no shame in being a valuable reference tool. I’m a big fan of information democratization. But it’s impact on care management has limitations.