Pioneering Ideas

Games for Health Conference Announces Opening Keynote and Initial Content

This post originally appeared on Gamesforhealth.org 

by BEN SAWYER on MARCH 28, 2011

Today the Games for Health Conference, now in its seventh year, announced its opening keynote will be Dr. Martin Seligman. Widely known as the founding father of Positive Psychology, Dr. Seligman will help Games for Health attendees understand the opportunities that positive psychology presents for games.

Drawing upon his latest findings concerning PERMA (five measurable elements that contribute to well-being: positive emotion, engagement, relationships, meaning, and accomplishment) and happiness Dr. Seligman will provide the basis for a conference long discussion and quest for how videogame developers and researchers can create “PERMA Power Ups” forged by a collaboration between the documented interventions of positive psychology and interactive entertainment. This presentation will also help attendees see beyond positive psychology to the possibility of a broader field of positive health.

His opening talk “Positive Psychology>Positive Computing>Positive Videogames” is one of over 60 talks planned for the three day event. Event organizers announced the initial schedule of talks is now online at its site:

http://bit.ly/gfh11sessions

 

“Games for Health as a field is moving past establishing itself as a worthy idea, to being a robust area of mass-market activity. Our seventh conference, with an opening keynote by Dr. Seligman, is an attempt to further realize the opportunity videogames and videogame technologies might have for health and healthcare on a large-scale,” said conference organizer Ben Sawyer.

Each year the Games for Health Conference, which is supported by the Pioneer Portfolio of the Robert Wood Johnson Foundation, brings together hundreds of researchers, health professionals, and game developers to look at a wide gamut of activity involving health and videogames. This year’s event continues with staple tracks of content on exercise, sensorimotor rehab, cognitive and emotional health, and features new talks on nutrition games, as well as excellent open track featured content on autism, HIV prevention, gamification of health, personal health records, sensor games, and global health.

Games for Health also features three excellent pre-conference events focusing on games accessibility, mobile games, and medical modeling and simulation with games.

“The breadth of material covered at games for health is one of its great strengths. As a sponsor of the conference and The Games for Health Project, we’re amazed at the continued expansion of where videogame innovation is showing possible efficacy in improving health and healthcare for all Americans,” said Paul Tarini, senior program officer for the Robert Wood Johnson Foundation's Pioneer Portfolio.

ABOUT GAMES FOR HEALTH
Founded in 2004, the Games for Health Project supports community, knowledge, and business development efforts to use cutting-edge games and game technologies to improve health and health care. The Pioneer Portfolio of the Robert Wood Johnson Foundation is the lead conference sponsor and a major supporter of the Games for Health Project. To date, the project has brought together researchers, medical professionals, and game developers to share information about the impact games and game technologies can have on health, health care, and policy.

A major effort of the Games for Health Project is the annual Games for Health Conference. Over three days, more than 400 attendees will participate in over 60 sessions provided by an international array of 80+ speakers, cutting across a wide range of activities in health and health care. Topics include exergaming, physical therapy, disease management, health behavior change, biofeedback, rehab, epidemiology, training, cognitive health, nutrition, and health education. The Games for Health Project is produced by the Serious Games Initiative, a Woodrow Wilson International Center for Scholars effort that applies cutting-edge games and game technologies to a range of public and private policy, leadership, and management issues.

ABOUT DR. MARTIN SELIGMAN
Dr. Martin Seligman is Zellerbach family professor of psychology, Director of the University of Pennsylvania Positive Psychology Center, and founder of Positive Psychology, a new branch of psychology which focuses on the empirical study of such things as positive emotions, strengths-based character, and healthy institutions. His research has demonstrated that it is possible to be happier — to feel more satisfied, to be more engaged with life, find more meaning, have higher hopes, and probably even laugh and smile more, regardless of one’s circumstances. Positive psychology interventions can also lastingly decrease depression symptoms. The research underlying these rigorously tested interventions is presented in Dr. Seligman’s new book, FLOURISH, published by Free Press in April 2011.

ABOUT THE ROBERT WOOD JOHNSON FOUNDATION AND THE PIONEER PORTFOLIO
The Robert Wood Johnson Foundation focuses on the pressing health and healthcare issues facing our country. As the nation’s largest philanthropy devoted exclusively to improving the health and healthcare of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. Projects in the Pioneer Portfolio are future-oriented and look beyond conventional thinking to explore solutions at the cutting edge of health and healthcare. For more information, visit our website at www.rwjf.org/pioneer.

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Discovering the Pioneering Genome: A Few Final Thoughts From TED

My framework and perspective on measuring “pioneer-ness” has been radically altered by what I have seen and heard at TED.  What began as a traditional academic exercise of collecting data to examine a hypothesis and testing fit of predictions has evolved into a task of discovery – a quest to discover the “pioneering” genome.

Jim Hornthal gave a memorable talk in TED university (a series of short talks held in a smaller theater than the official “TED TALKS”) about the importance of pattern recognition, a quality another speaker said that only humans, not computers, possess.   

Pattern recognition can help us discover useful information we didn’t know we were looking for. Jim talked about several ways humans seek assistance when making a decision. 

• Rely on experts
• Rely on friends
• Check with crowds
• Use algorithms to understand complex data, such as what’s currently being done in genomics

We’ve used the first two to examine the Foundation’s Pioneer Portfolio.  We will embrace the third once open proposal is launched .It is the fourth that intrigued me…. a strategy that I encounter daily in my entertainment life, but had not considered in my work.

Similar to the iPod app Pandora, which predicts what kind of music an individual will like based on the fundamental properties of the songs they have indicated they liked in the past, I am intrigued by the challenge of discovering what it is about the Pioneer team’s projects that makes them pioneering, in order to predict projects and ideas that the team should seek to support.

To turn patterns into information, I’ll start by going through the notes I took at TED, the words my colleagues shared, and the characteristics the other meeting attendees supplied: infrastructure, unconventional, unpredictable.

I’ll also go through the two years of data we've collected in our quest to objectively score our portfolio's success at attracting and supporting successful pioneering ideas/projects.  Even our crudest measures, such as when we just ask our examiners, "Is this pioneering?" why?  What is pioneering to you?

Through all of this, I’ll look for clues to the building blocks of the pioneering genome, then see how we can use that information to gain knowledge.

 

Which way transparency Nirvana?

First the good news—many are pushing the envelope on public reporting of health care information these days. For instance, this week the HHS/Health 2.0 Developer Challenge awarded honors to a new mobile app—using Hospital Compare data in new and innovative ways—try it. This application maps and provides some quality information as well as immediate ER waiting times for nearby hospitals. The idea of this app challenge, as you know, is to unleash moribund federal information, such as that sitting in the creaky Hospital Compare—to innovative types who will take it and create new—and, ideally, useful ways to present the information.  That’s an exciting turn that makes altogether too much sense.

Then Wednesday, I had the good fortune to attend a very thoughtful AHRQ sponsored meeting on public reporting of care information for consumers.  The meeting included a good mix of consumers, employers, regional alliance leaders, health professionals, researchers and others.  Bill Roper provided a motivating keynote. The messages ranged from overt optimism about the important role of public reporting in the drive toward sustainable high value care—to the sober assessment that although public reporting has matured (some)—we may also be reaching limits.  As Steve Jencks commented—we’ve made progress—but let’s keep some perspective here—public reporting still needs some quick wins—it “isn’t quite covered in glory, just yet.”

Meredith Rosenthal, in her plenary presentation, observed that public reporting is essentially about to graduate from high school—sitting in the guidance counselor’s office trying to decide whether to go to college or trade school.  Bob Galvin, in the closing session, added—that while public reporting is indeed in the guidance counselor’s office—and it clearly has a bright future—it’s a pretty confused student.

The problem? There seems to be near unanimous sentiment—at least in this group—that public reporting of quality and cost information is critically important to drive sustainable health care quality and value. Still, after 25 years of trying it remains a hard slog. One line of thought is: stay the course!  We just need to keep trudging.  The holy land is right over the next hill—measures need a few more tweaks.  All we need now are those outcome measures that the real people actually want.  We definitely need a lot more engaged consumer activists and patients to help create those useful measures.  Everyone needs help getting to the right presentation of that information—presentation that will tip the scale, make the difference—and then accelerate our long, twilight march toward high value care.

Or maybe not.

What if, instead, we already have a large chunk of the public actively engaging with health care information, such that it is—on HealthGrades, WebMD, Consumer Reports, Aligning Forces for Quality sites, Hospital Compare?  Bob Galvin in his comments estimated, say, 10 to 15 million people already.  What if we’re not actually going to get many more?  What if we’re not going to see an enormous marginal return in new numbers as we struggle to improve publicly reported measurement incrementally?  What if more and more of the public are not going to wake up one day and jump online to sort through ever more complicated information to make decisions?  Certainly, our currently motivated “mavens” need better, more usable information. But these mavens also may be the actual, ultimate consumer audience—when it’s all said and done.

There is another point—perhaps we should accept that sometimes people simply act on price—just price. Price can, in fact, be a very strong information signal—and extremely user-friendly—especially when people are first dollar sensitive.  Certainly, that’s not always the case—many people will avoid the cheapest care at all costs—because, for instance, they may be terrified of getting “cheap bad” care.  But still—no arguing about it—in the right circumstances price can move markets.

In his closing comments on Wednesday, Galvin provocatively suggested some nuance here.  Perhaps we should recognize that those important mavens out there will be mavens—and then work hard to get them the best measures and tools they need to make good recommendations and decisions.  And maybe we should also accept that for some things—some procedures, images, prescriptions—individual people will be, well, deal searching consumers—and will shop avidly, as we want them to do, for the best bargain—in those limited instances.  If that’s the case, let’s help them.  In addition to developing better, publicly reported quality and cost information for mavens, we should accelerate work significantly to identify those price sensitive activities for everybody else and rapidly develop (no easy task) that price information.  But really—and not to be too flippant—why not slap some useable, accurate prices on those items pronto—and let the bargain hunting begin?

 

 

Focus on the Pig: The Making It Better Symposium at RISD

Aidan Petrie of Ximedica said it bluntly. In acknowledging that it is often tough for designers to break into health care institutions and play a significant role, Petrie, an industrial designer, gives this advice to designers: "remember, it’s not about putting lipstick on a pig – it’s about the pig." Exactly. In that stark phrase Petrie captured much of my thinking as I sat through the day-and-a-half long “symposium on art, design and the future of health care” at the Rhode Island School of Design (RISD), sponsored by RWJF’s Pioneer Portfolio. The intersection of art, design and health should not be about prettying up a lousy system—it should be about designing a better system to begin with.

The symposium was the brainchild of RISD president John Maeda, who wanted to connect the talents of RISD students and faculty with the urgent problems of health and health care. And there were many references to the strange bedfellows nature of the gathering. This awkwardness was most pronounced among the participants who came from the health care and public health side of the aisle. The artists and designers who spoke generally seemed quite comfortable with the notion that health does not exist independent of a broader life but is deeply intertwined, and as such, it is a natural subject for art and design.

So we saw Damon Rich apply a designer’s approach to understanding how to boost public participation in the decision-making processes that affect public spaces; the wonderful artist Mel Chin bring his passion and vision to the tragedy of lead poisoning in inner cities; and Amale Andraos’ brilliant visions of greener, healthier urban landscapes and buildings. But, by and large (there were exceptions), participants from the health sector looked at this question of how art and design could intersect with health with a slight puzzlement before defaulting to… communication. As one put it, we need great designers to help us communicate the complexity of health care in ways that people will understand. With all due respect to health communication, which is a vital field, health in the United States has even more fundamental challenges that demand the talents and skills of the design and artistic communities. Let’s get them to focus on the pig.

Within a couple of generations we have managed to engineer movement out of our work days, cooking out of our homes and play out of our children’s lives. We have designed communities and pioneered lifestyles whose only logical consequence is poor health. We have designed a health care system that has brought us the 7-minute office visit, the dreaded emergency room wait, the explanation of benefits statement, 50 million people without coverage and – oh yeah – a crushing federal deficit. I won’t be naïve and say that a few designers will turn this all around – these are deep-rooted problems – but I do believe strongly that we need the creativity and the perspective that they bring. We need people who look at these problems differently. Who are, as John Maeda put it, naturally curious. Whose views are not so deeply ingrained that they cannot ask “why not?” Who, like the delightfully unexpected Kelly Dobson, ask questions that stop us in our tracks, make us uncomfortable and make us remember that we’re human.

Three things I Know to be True (TED edition)

TED presentor Sarah Kay, an amazing 22 year old spoken word poet (check out her TED talk when it gets posted), asks her students to list what they believe to be true to help them tell their stories.  It’s great advice.  I was stuck all week trying to figure out what to write about, but it was fairly easy to come up with just three things I think are true about TED. 

1)      TED can be very intimidating.  Attendees include world renowned scientists and researchers, successful entrepreneurs and venture capitalists, celebrated designers and artists, and famous actors and actresses.  And, it seemed like they all knew each other really well. It was easy to feel small, unaccomplished and left out.  But over the course of the week, you meet lots of people and realize that there are many attendees who have similar feelings and that most people don’t know each other.

2)      Meaningful conversations do happen at TED.  Once you get over the intimidation factor and can strike up a meaningful conversation, you find out about some great projects.  I talked to an acclaimed industrial designer, Yves Behar, who designed the Jawbone headset and the $100 laptops for One Laptop per Child.  He’s also designed high-quality, free or low-cost, fun eye glasses for kids in Mexico with hopes to bring these glasses to students in the US. 

3)      Optimism pervades TED.  A major theme at TED is the use of cutting edge technology and its role in solving big problems.  For example, Dr. Anthony Antala gave a presentation on “printing” organs to solve the organ donation shortage.  But there were other speakers and attendees who spoke less about how they’re using technology, and more about their desire to make the world a better place.  I met Shantanu Sinha, who gave up his prestigious consulting job to join his best friend, Salman Khan, on a non-profit venture called Khan Academy.  Khan Academy is attempting to fix our broken education system by “providing a world-class education to anyone anywhere."  They’ve posted thousands of videos on math and science, and they’re just beginning to branch into other subjects.  These free videos are intended to help students learn at their own pace at home- they can watch the videos over and over again until they understand the concepts while getting more targeted interventions at school.  After Sal Khan gave his talk, there was a collective sense of optimism that prevailed for the rest of the conference. This optimism has re-inspired me to think positively, differently and creatively to solve some of our most challenging and pressing issues in health and health care.

 

Future of Nursing Campaign Upends Old Ideas on Health Care

By Sheila Burke, Chair for the Advisory Committee of the Future of Nursing: Campaign for Action

Last week’s TED conference drew big crowds with big themes. Consider just a few: “Might you live a great deal longer?” “Not business as usual.” “Medicine without borders.” And “The rise of collaboration.” These are just a few of the topics that echo the newly formed Future of Nursing: Campaign for Action, led by the Robert Wood Johnson Foundation to help transform not just today’s American health care system but also the culture of health care overall.

In its effort to ensure that all Americans have access to high-quality, patient-centered care and that all health care professionals are better prepared and able to practice to the fullest extent of their education and training. Campaign for Action focuses on the vital role played by the largest segment of that workforce – the nation’s 3 million nurses – and the actions that will enhance their ability to contribute as essential partners in the delivery of services.

Building from a 2010 Institute of Medicine report on nursing, Campaign for Action has several immediate objectives that will impact nurses’ knowledge, skills and experience, yet each objective is set within the broader context of creating a health care environment that is truly coordinated, integrated and equitable for everyone.

The primary goals of the Campaign for Action are to advance interprofessional collaboration throughout health care settings; strengthen nurse education and training to ensure an adequate supply of highly competent and professional nurses; expand leadership ranks to ensure that nurses have a voice on management teams, in boardrooms and during policy debates; and enable all health professional to practice to full level of education and training. These goals can only be realized successfully if we focus on quality – how to improve it, sustain it and expand it.

Realizing this goal depends greatly on our commitment to taking care of people not just in hospitals but in their homes, clinics – whatever setting they choose, or need to receive care in. To do that we need to make sure our workforce is of a sufficient size and has the knowledge necessary to provide the quantity and quality of care that will be necessary. Delivering care that is truly patient-centered will require a workforce that is able to collaborate with providers across care disciplines and practice to the full level of their education and training. Only then can we hope to meet the goals stated in the IOM report.

We must apply what we know about quality in our effort to transform the health care system. We have to make sure people get the care they need in the setting that is most accessible, practical and helpful to them, from the provider that is uniquely qualified to treat them. Nurses are a critical element of the health care system we envision for the future.

Given the aging patient population, the aging provider population and the influx of millions more into the health care system, we need to ensure that we expand access to ensure that people get care when and where they need it, and at lowered cost. To do this we need to remove all barriers preventing nurses from practicing to the full degree permitted based on their education and training that could delay or prevent patients from getting the care they need. But it doesn’t stop with nurses. In making the recommendations of the report a reality, we have to make the system more collaborative with all health professionals working together in a coordinated and seamless way to benefit patients wherever they live, work or play. 

TED is about using the power of ideas to change attitudes, lives and ultimately, the world. The Campaign for Action is committed to doing just that, and with the support of all health professionals, it will succeed.

 

Control Freaks

Who’s driving in this relationship anyway—us or them? 

I distinctly remember my 1970’s fourth grade summer Weekly Reader (showing my age) that described a not too distant future when self-driving electric pod cars would transport human passengers, attaching on and off highways of magnetic strips. They’d be safe, clean and efficient—because the people of the future would value those attributes.  That vision, of course, hasn’t materialized. (Yet?).  

Last week, though, at TED2011 with Google’s self-driving cars we got a glimpse of a new emerging potential reality. That potential is definitely more tangible and recognizable than my Weekly Reader vision—better in some ways—certainly more prosaic and believable. In fact, I can attest that it is indeed right here, right now.  This just might be where things get pretty interesting—and disconcerting.

At TED, steady lines of politely waiting, very curious “blue jean-eratti” piled into a souped up Toyota Prius to go-kart around a parking lot for a few minutes.  Those human pioneers eagerly turned over the driving controls completely to the car computer—putting their safety and lives in its hands.  No big deal, right?  I took some Droid video during my test—see what you think. 

 

 

 

When our turn came, three of us along with a Google engineer jumped into the banal, familiar interior environment of a Prius.  The Google driver pulled around to the starting point, then announced that he was turning over control to the car and released the steering wheel.  That’s when the familiar turned, well, alien.  The car, who (and I mean who) had been patiently waiting its turn, expertly took the reins—and literally peeled out across the lot, weaving through and around the orange cone course.  We all laughed and yelled spontaneously with delight and, admittedly, some nervousness—watching the wheel turn by itself—listening to the tires screech, feeling the acceleration and braking—all without human intervention.  Our anxiety was both for our immediate safety—wanting to believe that the computer knew what it was doing—could see its way around the course.  But there was something else too.  This new experience may have very big implications—at least that seemed to be the consensus of the folks who waited in line with me.  It now seems almost inevitable—just a matter of time.  How long will it actually be before we begin to mostly or even entirely turn over the driving task to the machines?  Five years?  Ten?  Sooner?

But there’s more.  Last weekend in her New York Times column, Maureen Dowd ("Have You Driven a Smartphone Lately?" ) turned her critical wit on the new 2011 Ford bells and whistles computer dashboard.  She asserted that the automaker was irresponsibly creating essentially a public menacing, driver distracting smartphone on wheels.  At TED this week, Bill Ford got to present a different view.  He described a disastrous, pending, perpetual global traffic gridlock—as the sheer number of cars grows exponentially across a rapidly developing world—unless we design our way out of that particular scenario. Ford’s design focus is based on a car oriented future, obviously.  Some criticized that view.  He also seemed to imply that the new powerful onboard computer dashboards are easing drivers toward a time when those pervasive computers not only entertain but also pilot—freeing the driver and passengers to work and play while traveling.  The smart cars will also soon communicate with other cars and devise the smartest, safest, fastest routes to and from destinations—and, importantly, avoid pedestrians and cyclists along the way.  Obviously, Dowd’s safety points resonate.  Distracted driving hurts and kills thousands annually—it’s an immediate and terrifying public health challenge.  Technology that potentially promotes distraction is dangerous.  Ideally, our advances would build toward the future emphasizing safety first—before entertainment and convenience.  If only. 

In any event, if there was any doubt about the rapidly proliferating power and real world potential of self driving technology, the Google demo just completely snuffed that.  And, to my initial point, that’s more than a little disconcerting.  Like many of you no doubt, I’m a horrible back seat driver.  I did, luckily, survive my brief test drive—er, ride—into the future.  Before last week, as much as I love my Droid and other gadgets (and I do), there’s likely no way I’d have said we’re ready to turn over the wheel to those gadgets.  Now, honestly, I’m not so sure.  In fact, that transfer may come soon—very soon, ready or not.

What if Superman’s a YouTube Hero?

Picture this—a 51 year old on a recent transcontinental flight with nose poked into an iPod Touch watching a documentary—tears streaming.  My co-passengers almost certainly noticed—not clear what they thought.  I have no idea why I downloaded “Waiting for Superman” the day before my flight to this week’s TED2011 in Long Beach.  I had intended to watch that movie for months—but just hadn’t found the time.  Whatever the reason, the last minutes of that film hit me hard.  It’s ironic because just a few days prior, I posted on Facebook about a different movie: “127 Hours”.  My Facebook post gamely highlighted that movie’s disturbing intensity as an intrepid, solo hiker finds himself literally swallowed and held by a desert canyon—with his right arm essentially and permanently trapped by a fallen boulder.  The character played by James Franco is forced to make a horrific life or death decision—no one was coming to rescue—ultimately he chooses life and saves himself.  My post pointed out that “127 Hours” wasn’t for the squeamish—and I wasn’t squeamish. 

 Given that bravado, it’s curious that just days later I would go to pieces when those “Superman” kids and their families in spite of their best desperate efforts, couldn’t find a way out of their own entrapment.  The kids don’t even get a real choice—they’re just stuck.  I get that the topic is hard, complicated, controversial—but for me, that failed school tragedy is not about “the teachers” or “the unions” or silver bullet solutions like “charter schools”.  Nope, my tears weren’t about the adults at all; rather, they were for those kids (and all the kids) trapped in failed and mediocre schools without choices or options and what that entrapment means for their lives.  Obviously, we can and must do better—we can’t leave them stuck in deep failed school canyons; they need our help. 

On the plane earlier this week all I could do was weep ineffectually.  You can imagine my surprise when upon arriving at TED I found a “Waiting for Superman” DVD in the pre-meeting materials. (Cue Twilight Zone music…).  That might have been that—just serendipity—a coincidence to ponder—except yesterday afternoon during a session called “Knowledge Revolution” curated by Bill Gates, enter Salman Khan with his well-received TED presentation. (See mention in great Day Two Summary)  It seems Mr. Khan left his hedge fund job a while back because he’s passionate about teaching kids.  In fact he’s so passionate about it that he did something amazing—creating, so far, over 2,000 YouTube video lectures on a range of topics now posted  here.  All these video lectures are free and available to anyone—they’re also wonderful.  Khan says kids can watch the lectures at home and do practical homework tasks together in the classroom—reversing the current teaching mindset.  His site includes sophisticated tracking capabilities for teachers—so teachers will know who’s mastered what topics and who needs targeted help.  Also, kids who have mastered certain areas can serve as mentors for peers who haven’t.  In fact, with these powerful tools, the learning environment is not contained to the actual classroom.  There’s no reason, he says, that a student in Calcutta couldn’t help a child in Kansas City—and vice versa.  Khan, in fact, envisions a global, one world classroom.  Yesterday, that inspiring vision brought the TED crowd to their feet with loud, joyful cheers.  Maybe there is hope.  Maybe we, the adults, need to solve this intractable entrapment by thinking, collaborating and acting in a multitude of radically different yet reinforcing, out of the box, ways—and do it quickly—for our stuck kids.

Visualizing the Threat Posed by Antibiotic Resistance

Reposted on 3/3/2011 from The Health Care Blog

By JOHN LUMPKIN AND RAMANAN LAXMINARAYAN

How reimagining data – and reframing a problem – can help avert a looming public health crisis

 For the first time, researchers and policymakers can visually track the rise in “superbug” infections over time and identify regions of the country with rapidly spreading rates of resistance.

Researchers at Extending the Cure, a nonprofit project funded by the Robert Wood Johnson Foundation’s Pioneer Portfolio, have developedResistanceMap—an online tool that tracks changes in resistance levels. These maps show us how the problem of antibiotic resistance has gotten worse–with some regions of the country experiencing a significant and worrying increase in drug- resistant microbes.

Infections like those caused by MRSA (methicillin-resistant Staphylococcus aureus) kill an estimated 100,000 people in the United States each year. Progress toward solving this emerging public health crisis has been slow, an important reason why the Robert Wood Johnson Foundation has funded this research through its Pioneer Portfolio. We share a common view that the best way to prevent an epidemic from occurring may lie in dramatically reframing how we approach the problem.

This is exactly what Extending the Cure has done with ResistanceMap, a web tool that presents scientific data in a user-friendly way, allowing policymakers and researchers to quickly identify regions in urgent need of better infection control, enhanced surveillance, more vigilant antibiotic stewardship, and comprehensive methods to curtail the spread of resistant microbes.

At the core of these maps are data on more than 5 million individual patient samples tested for resistance, or the ability to survive a treatment course with an antibiotic. The resulting maps show that resistance has risen sharply during the first decade of the 21^st century.

They also highlight additional significant trends. Each year, tens of thousands of people are killed by Acinetobacter baumannii, which causes pneumonia and other health problems. This microbe now has the ability to evade a last-resort class of antibiotics called carbapenems. The map shows resistance rates in the U.S. have risen from under 5 percent in 2000 to nearly 40 percent in 2009, an eight-fold increase. In some cases, infections caused by this superbug are unstoppable.

That’s why tackling a superbug like Acinetobacter requires new thinking on an old problem. The Extending the Cure project started with a 2008 report that examined antibiotic resistance in a fundamentally different light. By approaching the problem as a natural resources economist might, the report argued that we could help turn the tide on superbugs by optimizing the effectiveness of a scarce societal good (antibiotics).  Taking such a perspective leads researchers to look upstream from the point of antibiotic use and consider issues related to the development, production, regulation and management of these drugs.  This is a dramatic break from usual approaches to drug resistance which emphasize infection control and greater government investment in new antibiotics to replace older, ineffective ones without altering incentives for how antibiotics are utilized.

At the time, this concept was well outside the established research paradigm. And, in fact, the concept emerged from a completely different field of study. However, through its Pioneer Portfolio, the Robert Wood Johnson Foundation serves as an incubator for ideas – like ResistanceMap — that have the ability to drive lasting change in health and health care.

With the launch of ResistanceMap, we have the ability not just to study the past but to peer into the future of resistance, accelerating our progress against superbugs—a crucial step if we are to stave off a major public health crisis.

John Lumpkin, M.D., M.P.H., is senior vice president and director of the Health Care Group at the Robert Wood Johnson Foundation in Princeton, N.J.

Ramanan Laxminarayan, Ph.D., is the director of Extending the Cure, a project that studies the growing problem of antibiotic resistance. Extending the Cure is funded in part by the Robert Wood Johnson Foundation’s Pioneer Portfolio.

 

Spread.

What is an idea worth spreading?  I almost fell out of my chair here in Long Beach, California yesterday at TED2011—a couple of times, actually. (Here’s a great overview of Day 1)  In addition, though, to the big tent main sessions—spectacles you might even say—the week long event includes some slightly lower key, somewhat intimate venues that highlight wonderful talks by various folks with great ideas.  One of those was yesterday morning by Charles Roberts from the Royal Institute about addressing climate change.  Of course interesting—yet it could have been more of the same—until he started linking to some pretty universal truths.  Roberts lamented that many current efforts to address carbon reduction struggle because of market dysfunction or in many cases occur in settings that completely lack market forces that might prompt carbon efficiency.  He then ticked through the things that might help generate some market functionality—things that could prompt companies, like for instance airlines, to step up and address their carbon issues.  Those tools include…wait for it…consumer engagement, widely available information, incentives.  He suggested a system to rate companies based on how those businesses address their carbon footprint.  It would, he noted, be quite important to report those measures publicly.  He described some matrix roll up scores that summarize past, present and future possible carbon efforts.  His system would rely on competition with financial incentives in which customers sought out companies with better scores—and rewarded those companies for decreasing their footprint.  One reason his points resonated—we designed our very own RWJF Aligning Forces for Quality based on many of the same tenets.  Of course, Aligning Forces is an effort to address a different, but arguably similarly intransigent complex adaptive system problem—stubbornly persistent mediocre health care quality and value.  Nevertheless, in Aligning Forces what tools did we and our experts land on?  You guessed it: consumer engagement, measuring and reporting, improvement resources, changing payment to reward better, more efficient care outcomes—all to correct a fundamentally dysfunctional marketplace. Sometimes a new idea, I guess, can also mean taking what we know and applying it, spreading it even, to new hard problems in different ways. 

TED Update: Day 1

With the first full day of TED 2011 presentations wrapping up yesterday, we wanted to provide a few highlights of what the RWJF team has been seeing on the ground at the conference. Here’s a quick look at their thoughts, as expressed on Twitter:

@lorimelichar (Lori Melichar): Lori’s on the hunt for innovative ideas at this year’s conference, and has taken it upon herself to devise a system of objectively comparing a concept’s “pioneering” value (read yesterday’s post for more on this).

• Whitacre gave me chills and brought me to my feet but was it pioneering? In think I have to land on innovative. #ted #Rwjf
• cantu was truly mind blowing #ted #Rwjf paper tastes like maki roll, a tablet makes a lemon taste like lemonade. COB, r u listening?

@PaintMD (Michael Painter): Mike was busy retweeting and summarizing content yesterday from each of the major (and some of the lesser-known) speeches. Thanks to his efforts, Mike received some nice kudos from other conference goers.

• @paintmd is also doing a fantastic job of live tweeting #TED updates #rwjf (via @mindofandre)
• #TED yesterday was about humans relentlessly connecting-today so far it's about: who are we? are we alone? how will we know?

@alshar (Al Shar): Aside from sharing his insights from yesterday’s discussions, Al also took on the role of RWJF’s photographer (see the lead in shot on today’s post for just one example of Al’s submissions).

• Another #TED shot from @alshar from #RWJF http://yfrog.com/hsf4rtwj (via @pioneerrwjf)
• Smilers live longer-Ron Gutman #ted2011#RWJF

You can tune into the conversation by viewing our real-time Twitter aggregator. Or, join the discussion by using both the #RWJF and #TED hashtags.

 

 

Measuring “Pioneer-ness” at TED

I'm thrilled to attend TED this week. In addition to being open to new ideas that might morph into fundable projects for RWJF, I’ll be expanding and refining my thoughts about measuring “pioneer-ness.” This means trying to distill a core definition of "pioneering" and validating this definition – seeking, in the end, a scale and/or indicators rwjf staff and others can use to objectively score the ideas we support.

I plan to collect data by having each RWJF program officer here rate presentations as "pioneering, innovative, interesting, or not that interesting" and by interviewing fellow attendees about how they make determinations about the ideas they're hearing.

As the week goes on, I may find I have a checklist I can use to score each idea.

 I may not.

If I had to answer the question today of "what is pioneering”—and how you measure it – I'd say, without taking credit for the language: 

“Pioneering ideas have potential for breakthrough solutions to emerging or persistent problems."

If I had to answer the question today, how do you make decisions about pioneering (vs merely innovative) ideas, I'd say:

“RWJF pioneer team members seem to know it when they see it.”

If I had to answer the question today of  "how do you measure ‘pioneeringness,"  I’d say:  

“I don't yet have good indicators, but a scale to measure "pioneer-ness" would surely include elements of newness, unexpectedness, risk (carefully defined),and  the potential for a leap in progress. These projects also have the potential to transform health care with out-of-the-box solutions.”

I'm not sure if I would include the elements of elegant or simple, but I'm expecting to be most blown away by ideas that I understand but never would have come to me.

I hope a few new ideas will come to me as well.

Update to original post: I’ve been asking each of my colleagues (and TED attendees I’ve interviewed) to rate the ideas presented as Pioneering/innovative/interesting.

I found that scale limiting, and have expanded to: Pioneering/innovative/important/interesting. Though something can be innovative, but not important technically, so I’m going to work with this scale until it breaks down.

Here are some words and concepts that are being associated with the concept of pioneering:

• (un)Predictability: However, it’s not always clear what’s better in terms of impact. Julie Taymor talks about the value of not knowing where you are going to end up, so I think that having a project that allows for unpredictable outcomes will have  more pioneering potential.
• Simplicity
• Understandable
• Done before?
• Tried before: This is a real challenge. I’ve started with a score of pioneering for more than one idea, until speaking with others and finding out that someone else has done this before.
• Redefine rules?
• Suggest an infrastructure?: This is likely to result in lasting social change (no need to define the type of change..maybe that’s unpredictable)
• Hypothesis driven?
• About discovery?

I’ll continue to hone this scale throughout the remainder of TED and will let you know how things shape-up after the conference.