Pioneering Ideas

Personal Health Records on the Hill

Last week, I joined the Project HealthDesign grantees in DC as they shared their projects on Capitol Hill. It was an opportunity for the grantees to brief members of Congress and their staff about personal health records (PHRs) and the importance of engaging patients in the design and functionality of PHRs. We've talked about Project HealthDesign before on this blog, so you may remember that Project HealthDesign focuses on the patient or end user. (Conversely, most PHRs available today respond to the needs of healthcare systems or providers.) I loved hearing from the research and design teams how the patients, through their testing of the applications, ultimately shaped the design and functionality. The patients gave feedback on icons, font sizes, and whether or not they would use specific functions. All of the researchers agreed that their feedback made for a better application.

But, back to the Hill where the nine project teams took their ideas to their Representatives, to their Senators and their staffs. A number of the research teams were joined by patients who spoke about the value of the research. While the intent of the visits was to brief those on the Hill about Project HealthDesign, we also got a briefing of our own. We learned that the staffers knew quite a bit about PHRs, including who the major providers are. One of staffers we met has her own PHR, and many of the staffers used a simple PHR application to track their physical activity: a pedometer! Recently, Blue Cross/Blue Shield gave out pedometers and launched a challenge to track steps. It was no surprise for me to learn that some of the congressional offices have a challenge within the challenge for the top step-getter in the office. During our visit, the staffers and members also raised questions about privacy, security, and how the applications would interace with existing Electronic Medical Records.

Since we've taken the pulse of PHR awareness on the Hill, I'd like to take the pulse of PHR awareness among our readers. Do you have a PHR? Are you doing something tracking your health on a daily (or just regular) basis?

EHR Adoption - Waiting for the Magic

Without having read much of Arthur C. Clarke’s science fiction, I am still going to quote his Third Law of Prediction, which states that “any sufficiently advanced technology is indistinguishable from magic.”

There are many technological advances in medicine that would appear magical to the doctors from the last century. In the past, people suffered through highly invasive surgeries with grueling recoveries; now, surgeons can make tiny incisions and see their way inside and around the human body. Here’s a simpler example: I’ve worn glasses or contacts since the third grade, and my prescription got to the point where I was almost legally blind, yet last year, a laser operation that lasted just under a minute gave me 20/20 vision without any corrective lenses. Does that seem magical? Absolutely.

However, most of what we understand to be health care - care received by a patient in a multiplicity of settings and involving numerous transactions such as doctor visits and lab tests and hospital stays - has not yet been magically transformed by technology. Doctors and nurses still keep paper charts. Transferring medical records from one doctor to another is still a ginormous pain in the neck.

The Robert Wood Johnson Foundation is gearing up to release the second full report that examines where this country stands in terms of adopting health information technology. This second report, in particular, focuses on electronic health records, which are the most commonly understood example of health information technology, and are usually seen as information systems designed for the provider side—for the people who give the care.

So what are the headlines from the report? One, while it’s increasing, the rate of adoption is still snails-pace slow—4% overall when using the definition of a “fully functional” EHR, and 13% overall for a basic one. On the bright side, though, it seems that those who have adopted electronic health records like them. Physicians report that EHRs can help improve the quality of their clinical decision-making, helps them avoid making errors, and streamlines procedures like prescribing and communicating with other clinicians.

What, then, are the big stumbling blocks that are bogging down the rate of adoption?

Extending the Cure Update

It has been a busy spring for Pioneer grantee, Extending the Cure and we thought we’d take a minute to let folks know what they have been up to. In April, ETC brought together a group of 30 health care and infection control experts to discuss hospital infection control practices and policies – and I had the good fortune of joining the meeting. It was two days of lively discussion – surely a result of bringing together such a diverse group of physicians, health care administrators, policy-makers, academics and international infection control professionals. The discussion was focused around four core questions: What works to stop the spread of infections in hospitals? How can incentive-based policies be used to appeal to economic decision-making and encourage hospitals to improve infection control? How can the data that is being collected from hospitals around the country be analyzed and used effectively? And finally, what policies might work to reduce hospital infections?

While these questions are not new, the discussions raised interesting ideas and new perspectives on tackling hospital-acquired infections. Extending the Cure captured the highlights of the two-day meeting in a summary posted on their website. Take a look and let us know what you think about these approaches to tackling MRSA and other hospital-acquired infections.

In early June, Extending the Cure released Examining the Antibiotic Pipeline, a new policy brief that examines the history and development of antibiotics in the U.S. The brief starts with Alexander Fleming’s discovery of penicillin and wraps up with a look at antibiotics currently available in the U.S. and those in late-stage development. The brief underscores that antibiotic development has slowed over the past three decades and that new antibiotics are declining in diversity – trends that are concerning to physicians and public health folks who are seeing an increase in antibiotic-resistance. But developing new antibiotics is a challenging task, and a new Extending the Cure profile on Pfizer scientists Paul Miller and Michael Dunne details those challenges and explores what is really needed to bring new antibiotics to market.

Extending the Cure will continue to explore the issue of antibiotic development and their next policy brief, due out next month, will highlight recommendations for how we can encourage antibiotic development while rethinking how we, as a society, use antibiotics. We'll be sure to let you know when the brief is released.

Tomorrow's New Vital Signs, PHR-delivered

06/23 - Quick update: Jane Sarasohn-Kahn posted a nice commentary on Health Populi, in which she discusses this latest e-primer and the potential for PHRs to meaningfully track observations in daily living.  Thanks, Jane!

Project HealthDesign has released a new e-primer that explores the importance of observations of daily living (ODL) in moving toward next-generation personal health records and health management.  PHRs enable consumers and providers to incorporate routine health observations that go well beyond what data are captured at clinical visits.  Some are more obvious than others – blood glucose readings for diabetics, did I take the right pills at the right time today – but others may play an equally important role in pursuing health goals and managing chronic health conditions. 

Things like:  Does my chronic pain spike when the temperature dips below a certain threshold?  What effects might a particularly stressful month, with long hours at work and marginal sleep, have on my eating and activity behaviors, and hence my diabetes?  Can the fact that a 17-year-old with a chronic illness is regularly self-reporting his or her mood to be bad or sad play a role in the self-management of his or her disease?  And, if today’s pollen counts are really high, can my PHR device send me an alert in the morning to remember my inhaler, and then delete that point-in-time data capture because it may not be useful if conditions change tomorrow?

The ability to seamlessly capture such observations and show trends over time could add immense value for patients, who are looking to make the smartest decisions that will enable them to feel and function their best on a day-to-day basis.  And it might reveal important patterns to their health care providers, who rarely get a glimpse in to the potential impact that poor sleep, high stress or signs of depression can have on health outcomes over time. 

Checking in with Stacy Cho

This spring Susan Promislo introduced us to Stacy Cho, the winner of Hope Lab’s Ruckus Nation competition to get kids moving. Stacy, a middle school teacher in Seattle, Washington won for Dancing Craze, her idea for an interactive dance game with wearable motion sensors that make the player’s virtual character come alive as they dance. It lets the user pick the music, record their moves and share their virtual dance video online.

Stacy attests that Dancing Craze grew out of her ongoing efforts to find new and innovative ways to motivate her students. As someone who knows firsthand the challenges of getting kids to be active, we thought we’d ask Stacy to share some of her thoughts about the competition, physical activity, creativity and games. She graciously agreed to let us post her responses here on the blog.

Obviously your students were part of the inspiration behind your winning idea, Dancing Craze – how did they respond to the news you had won the Ruckus Nation competition?

My students were so excited when I came back and told them I was the grand prize winner!They spent the whole class period talking about how I should spend my winnings. Some of them wanted me to buy them laptops or take them on a trip. We agreed that if they could come up with a field trip that involved some kind of physical activity that I would consider the outing. All of the students are working on their proposals right now!

Has the competition or idea of Dancing Craze inspired you to think about your role as a teacher differently? Has it changed the way you think about health and physical activity?

It’s rewarding for the students and staff to see that their ideas really can start a movement. Our students are so creative and have the best ideas -- this experience has shown them that their ideas can turn into reality. Ruckus Nation has brought a focus to the topic of obesity in a fun and creative way. Our school has adopted a wellness policy where we have changed the food served in the lunchroom to ensure that it is healthy and eliminated the pop machines. However, the role of physical activity still needs to be addressed. Movement can be incorporated into every class and kids will participate in those activities if we make them fun.  I know Dancing Craze will inspire kids to start moving. My entire school can’t wait to try it out!

What do you see as the biggest challenges to get kids moving?

Time is the biggest challenge. Our kids are so overscheduled and stressed out that some just don’t have the time to get moving. There is such a focus on test scores and academics. After school, our students are spending time with their tutors or go to after school enrichment programs. They may have a musical instrument lesson that requires a lot of practice time. And while some students are involved in after school team sports, they may not get much play time or physical activity if they are not one of the better players on the team.

I have found that when students finally get home from school and after school activities, they just want to decompress and relax –- they sit on the couch and watch TV. Once they eat dinner and do their homework, it’s time for bed and then they repeat the process all over again the next day. We need to incorporate physical activity into the daily structure that kids already have in place. What are they doing now, and how can we make that more active?If they are already playing video games, how can we incorporate movement into that video game?

What role do you think games have in the classroom? And what role can games play in making kids more active?

Games are so important in the classroom. It’s a fun and interactive way to have students show their mastery of the standards. If I have a set of problems that I want my students to complete on a given day, they are so much more engaged when I turn those questions into a game rather than giving them a worksheet to do at their desks. Games keep us engaged and add an element of competition that always tends to motivate learners. Everyone wants to be a winner, and quite simply everyone wants to succeed because it makes you feel good. Ruckus Nation and Dancing Craze show that this applies to physical activity as well – I think games are great way to get kids moving!

And if you want to hear more from Stacy, check out her description of Dancing Craze on You Tube.

CleanMed 2008

As Susan mentioned in her earlier post, I recently attended the CleanMed 2008 conference in Pittsburgh, a city which exemplifies how environmental improvements can lead to improved health.  The CleanMed conference is about shifting hospital buildings and health care practices towards environmentally-friendly solutions.  The Pioneer Portfolio is interested in these types of innovative environmental solutions that also improve the health of workers and patients.  I’m a bit of a tree-hugger, so I can easily embrace this topic.  For those who still need convincing, the Research and Education Workgroup of the Global Health and Safety Initiative is in the midst of several research projects.  Check out their website for new content and findings.

I thought I might share here some of the “greener health care” solutions that piqued my interest in Pittsburgh.  The solutions range from a spark of the imagination to validated programs.

·       Porous Cement.  This is a neat example of a green solution with unintended health benefits.  One of the health systems reported using porous cement in the driveway/parking lot outside of its lobby.  Porous cement (or pervious concrete) is green because it allows water to go through the cement, which minimizes run-off and provides water quality treatment.  The unintended health benefit is that because the driveway was not as wet when it rained, less water was coming into the lobby, and the number of slips and falls, well, fell.  The installation of the porous cement and the reduction of the slips and falls in the lobby have not been statistically correlated yet, but the anecdotal evidence is promising.

·       Green Hospital Loan Fund. This is another spark of the imagination, but was inspired by the successful Green Campus Loan Fund (GCLF) at Harvard.  The GCLF supports projects ranging from physical improvements to behavior change campaigns that reduce environmental impact in 10 years or less.  In 2007, the fund included in its achievements a reduction of 33,227 metric tons of eCO2, saving over 15 billion gallons of water, and a reduction of 200,000 pounds of waste.  Also, the return on investment for the fund was 27%.  Pretty respectable.  The question is, could this model be applied to health care systems?  Could something that's successful on a campus scale up to success in a region, or even a country?

·       Video Games to Model Energy/Health Impact. I promise I did not bring this up!  At a discussion of how to make the case for greener healthier solutions to the C-suite, someone suggested a video game that models the impact of products and services.  SimCity models urban planning decisions; SimHealth simulates the impact of national health policies; Health Advisor simulates health advice on the impact of the business of health care.  I can’t think of a game that yet combines the environmental impact, the health impact and the business impact in a compelling format.  If I was the CFO of a hospital, I would play if it had cool avatars and compelling story lines (like fighting the sludge monster that has syringe fingers).

Lastly, one of the exhibitors at CleanMed asked, "what have you done that is cleaner, smarter, safer, greener?"  The answers were collected on sticky notes stuck to an oil drum tower.  So, I'm turning the question over to you - what have you done?  Let us know, using your comments to this post.