Future of Consumer Healthcare

1. Future of Consumer Healthcare Lisa Gualtieri, PhD, ScM, Course Director Tufts University School of Medicine July 20, 2012

2. “The internet saved my life”

3. It isn’t easy to find pictures of bat’s teeth

4. “Armed” with information, Diana educated the people who treated her

5. e-patient Dave • “Nothing beats a smart partner who listens to you and wants you to do well.”

6. Janice Adams: “I asked our doctor if I should look something up on the Internet and he said, ‘No. Come and ask me; it’s too frightening if you read the wrong things.’ And we do.”

7. Volker Wulf: “My sister is a doctor.”

8. Scott Bateman and Adrian Reetz

9. Scott’s feet

10. AnjaHabas-Korbar: “It was easier to get information from the Internet than from doctors… being in pain is motivating.”

11. Lynda’s story • Lynda has vertigo • “I go online all the time” • My specialists don’t talk to each other • Ear, nose, and throat doesn’t talk to allergist • My specialists have blinders • Impact of seasonal allergies • I’m not alone - others have it worse

12. Nancy Flournoi: “I looked up side effects for my husband’s medication and one was ‘stops breathing’. The doctor didn’t bother to tell him that.”

13. Ron Perkins: “I don’t find credible sources. Maybe they’re all sponsored by the drug companies?”

14. What is typical health information seeking behavior? • Is it Diana? • Is it Dave? • Is it Janice? • Is it Scott? • Is it Anja? • Is it Lynda? • Is it Nancy? • Is it Ron?

15. People’s use of the online health information for themselves or others • Triggers • Different reasons • Different contexts • People use • Obsessively to rarely or never • People bring • Different skills • Different needs • Different health literacy skills

16. Some commonalities • People generally look on their own • Common triggers • Pain • Economic • Immediacy • Determine if doctor needed • Learn what doctor didn’t say • Learn what others have done

17. Healthcare is changing • Potential to fundamentally change healthcare • Concierge medicine • Shared medical (or group) appointments • Walk-in clinics • Telehealth • Home visits • Use of the internet for healthcare directly impacts far more people today than EHRs • But that’s where $$$ are spent

18. Easy to have eye contact with a barista

19. Technology can get in the way

20. Idealistic scenario Patients Physicians Technology

21. Technology can be a partner

22. Patient centeredness - AHRQ • Patient centeredness • Healthcare that establishes a partnership among practitioners, patients, and their families • To ensure that decisions respect patients' wants, needs, and preferences • Patients have the education and support they need to make decisions and participate fully • Patient-centered care • Encourages patients to comply with treatment regimens • Can reduce the chance of misdiagnosis due to poor communication • Has been shown to reduce underuse/overuse of medical services • Can reduce the strain on system resources and save money by reducing the number of diagnostic tests and referrals • Can sometimes increases providers' costs, especially in the short run

23. Take a historical perspective • Pre-internet…

24. Marcus Welby brought medicine into our homes

25. Democratization of medical information

26. Incredible opportunities!!!

27. And many pitfalls

28. Pitfalls include • People going online instead of going to a doctor • People using poor quality or deceptive information – the barriers have dropped • People misusing or misunderstanding information • People obsessively searching • People who are scared to death • People confronting their doctors or not telling their doctor about their “Dr. Google diagnosis”

29. “Don’t ask, don’t tell” culture • Doctors don’t ask and patients don’t tell • Yet patients are increasing relying on technology especially with social media and mobile • Technology becomes a cognitive prosthetic device for many • Are patients less likely to ask their doctor questions because they plan to look it up?

30. Interventions can avoid “don’t ask, don’t tell”

31. How can the pitfalls be avoided Patients Physicians Technology

32. Better health literacy skillsBetter training of healthcare professionalsBetter design

33. Better health literacy skills • How to search • What to look for – dates, authors, seals • How to communicate with a physician • What to believe and when and how to be skeptical

34. Better training of healthcare professionals • What and when to ask patients • What and when to recommend • Which to recommend • How to increase health literacy skills

35. Better design of health sites, social media, and apps • Test on real users with mixed health literacy skills in context • Conduct formative evaluations from the start • Have clear health goals and measure success at achieving them • Use better imagery • Clear branding and accreditation

36. Accreditation • Works when • Accreditation exists • Processes are transparent • Processes are not criticized • Healthcare consumers know to look • Happens in other domains • Is there a better way in healthcare?

37. Which resources have you used to obtain information on a health-related question?

38. Introduce intermediaries Patients Intermediaries Physicians Technology

39. Who are intermediaries?

40. Who are intermediaries? Patients Intermediaries: Medical librarians, Pharmacists, Health coaches, Patient navigators, etc. Physicians Technology

41. Intermediaries help patients • How to search and what to search for • How to detect the quality of expert-generated content • How to use user-generated content • When to contribute user-generated content • How to communicate with physicians about online activities

42. Intermediaries help physicians • What their patients are doing online • What resources their patients need • How to communicate with patients about online activities

43. Toward a better future for consumer healthcare Patients Intermediaries: Medical librarians, Pharmacists, Health coaches, Patient navigators, etc. Physicians Technology