Pioneering Ideas

Pioneer Grantees Named to HealthLeaders Media’s 20 People Who Make Health Care Better

HealthLeaders Media identified 20 individuals to tell their stories of how they are changing health care for the better in its annual HealthLeaders 20 issue. Two grantees of the Pioneer Portfolio are included in this prestigious honor.

Clayton Christensen is often referred to as the father of disruptive innovation, the concept that new technologies have the potential to turn an industry upside down—but they may be difficult for established organizations to adopt. In 2011, Christensen and his team at Innosight Institute published a Pioneer-funded case study series on disruptive innovations within integrated health systems. In the summary report, researchers investigated how the seven integrated health systems think, act and innovate differently.

Nicholas A. Christakis is a well-established name in the science of human connectivity and social networks. In 2011, Christakis’ innovative Pioneer-funded research looked into how humans interact and coordinate in response to the behavior of one’s social partners in an article published in Science and in this profile.

We’re proud to call these innovating movers and shakers part of the Pioneer family. They, like all of us, are working to make a difference in health care. We encourage you to congratulate Christensen and Christakis (through his book Connected) on Twitter.

Gaining Perspectives on mHealth

In my recent blog post summarizing December’s mHealth Summit, I began by saying that the mHealth organizers must have been pleased with the conference, given its growth in attendance and engagement.

We were equally pleased with RWJF and Pioneer’s presence at the meeting – in fact, I’d say the meeting was a resounding success from our perspective.

Pioneer grantees Ben Sawyer and Debra Lieberman were both on panels featuring their work in health games and mobile technology. Deborah Estrin and Ida Sim announced the launch of Open mHealth, which is supported with funding from RWJF’s Pioneer Portfolio. And a session focused on this summer's mHealth Evidence meeting that was conceived of and co-sponsored by Pioneer.

Our Public Health Portfolio was also there looking for interesting perspectives on how mHealth could be deployed by public health departments to address a variety of health issues.

And finally, I was lucky enough to moderate a special session on a topic of keen interest to me and the portfolio.

“What I Really Need from mHealth: Five Perspectives on Value” featured a great cast of panelists including Robert Jarrin, senior director of Government Affairs for Qualcomm; Carol McCall, chief strategy officer at GNS Healthcare; Anmol Madan, founder of Ginger.io and visiting researcher at MIT Media Lab; and Richard Katz, director of cardiology at George Washington University Hospital.

Our session was structured around an imaginary mobile health application. The panelists discussed the value  of the application and how to demonstrate that value from the point of view of the individual, provider, various payers, regulators and researchers. This generated a fascinating conversation in which participants spoke from both a professional and personal perspective. Toward the end, we opened the discussion up to the attendees, which led to an informative and engaging discussion that will hopefully extend far beyond the session. The various perspectives are not completely aligned but yield something quite important when they do come together.

But wait, as they say on TV, there’s more! In addition to our panelists, we brought together about a dozen thought leaders, including representatives from organizations like NIH, Google, GNS Healthcare and the National Science Foundation, for a series of lively discussions about the future of mHealth and how to build value for all the players in the ecosystem. There was no lack of good ideas or strongly held opinions, and more questions were raised than answers offered. However, at the end of the night, we could all see light at the end of the tunnel. And that light came from a greater understanding of the value others saw in mHealth. From this newly fashioned broader vision, I’m hopeful we all left with a better sense of the way forward and with new ideas on how we could each play a role. 

I look forward to sharing more of what we learned and what this might mean for our investments in mHealth moving forward – and hearing your thoughts as well.

Why OpenNotes Will Open Minds

BY THOMAS FEELEY, MD, Vice President of Medical Operations, University of Texas MD Anderson Cancer Center, Houston, Tex.

Patients should know what’s going on with their health and health care. OpenNotes, which enables patients to see their doctors’ notes, is a simple idea that can help improve the patient experience and empower patients to become true partners in their care.

But OpenNotes has found that most doctors are wary of this intervention. Its survey of patients’ and doctors’ attitudes toward sharing electronic medical notes revealed doctors are worried about increased demands on their time and frightening or confusing patients.

These fears are overreactions. At the University of Texas MD Anderson Cancer Center we have been giving patients access to their electronic medical records—including their doctors’ notes—since May 2009. While initially doctors complained that they had to explain more to their patients about what was written in their records, the doctors soon came to realize the benefit of having patients who are more informed about their care plan and lab results.

Today, 84 percent of our patients have obtained access to their electronic medical records, including their doctor visit notes, via a secure Web-portal. Patients have actually become avid readers of their medical notes. 

This has been a particularly important intervention at a cancer center like ours. Our patients are treated on an outpatient basis and in one visit often travel from the lab to the doctor’s office and then to get chemo. Having their medical information as they move from location to location makes a huge difference to our doctors. And it has made a huge difference to our patients and their caregivers. Cancer is a family event. It’s rare that a patient is not accompanied by a family member when they come to our clinic.  We know they are sharing their records and doctors’ notes with their family and we think it helps them and their family members get a better understanding of what’s going on with them.  

Our experience at MD Anderson helps build the case for why this kind of transparency is a good step for patients and doctors. But what we don’t have yet is the scientific evidence and rigorous research to show that opening medical notes does not significantly impact doctors’ time and work flow, or make patients more confused or anxious. 

That’s why the OpenNotes demonstration results will be so important to mapping out the future.  Because it has been tested for 12 months in three very different sites around the country with very different sets of patients, it can provide important answers to questions and help guide future efforts to make sure this model works effectively.

Rather than spending so much time fretting about the implications of sharing information, we should be looking to projects like OpenNotes to show us how we can make it work for both patients and physicians to improve care and improve lives.

@Choo: Can Twitter Track The Flu?

Now that flu season is upon us, more and more Americans will be tweeting about aches and pains and other symptoms that could signal the onset of the flu.

Pioneer grantee Philip Polgreen and his colleagues at the University of Iowa in Iowa City suggests that social media tools such as Twitter and Foursquare could one day be used to track flu activity—and give public health officials a heads up if activity takes a turn for the worse.

Polgreen and his colleagues published a study last May in the scientific journal PLoS One that tracked millions of tweets during the 2009 swine flu pandemic. They discovered that many Americans used Twitter to express concerns about the flu or talk about early symptoms such as a fever. The researchers collected tweets that used the words “flu,” “fever,” and  other related terms and analyzed them—finding that Twitter data could be used to estimate the incidence of the flu in real time.

Currently, the system the CDC uses to track reported cases of influenza has a time lag of several weeks, giving the flu a chance to spread. Polgreen and his colleagues believe that Twitter might help speed up that process by alerting public health officials about an increase in flu symptoms in real time. The early warning might provide officials the time they need to curtail the spread of the flu or to urge more people to line up for flu shots.

And what about getting a head start on information about where the flu is spreading? The Iowa team recently analyzed data from FourSquare, a social media application that permits users to “check in” and record their current location in exchange for incentives, like coupons.

The information could also be used, the team says, to track the location of individuals infected with the flu or some other contagious disease—and then send alerts to public health officials trying to contain an emerging disease threat.

The team presented the early findings from the study at the International Society for Disease Surveillance meeting held in Atlanta on December 7-8.

Polgreen also says that the Twitter stream might be used to look for public misinformation about the flu—like the mistaken belief that antibiotics can combat it. Twitter reveals all kinds of fears, concerns and behaviors and might give public health officials insight into the myths they should address in public education campaigns.

Such real-time information could also inform the CDC about overuse of antibiotics. On November 14, the CDC launched an annual campaign to curtail the unnecessary use of antibiotics given the estimate that about 50 percent of all antibiotic use is unnecessary. Furthermore, research by Polgreen and colleagues published last July in Infection Control and Hospital Epidemiology suggests that antibiotic use goes way up during flu season.

Antibiotics, however, do nothing to combat the flu or other viral infections. Think about that—or better yet tweet about it—the next time you get an ache or pain that signals the flu.

Let us know what you think: When you feel sick this flu season, will you tweet about your experience?

You can also vote for "The Use of Twitter to Track Levels of Disease Activity and Public Concern in the U.S. During the Influenza A H1N1 Pandemic," published in PLoS ONE in May, as one of RWJF's Most Influential Research Articles of 2011.

Reflections from mHealth Summit 2011

I'm sure that the organizers of this year's mHealth Summit were more than pleased. There were more than 3,600 people in attendance, up 1,200 from last year. The exhibit floor was larger and more complex, rivaling some trade shows. There were tracks for business, research, policy and technology along with a slew of special sessions and keynotes from Secretary of Health & Human Services Kathleen Sebelius and Surgeon General Regina Benjamin, among others. Some presentations soared with whiz-bang demos and promises of how technology will change the world; others bemoaned the complexity of interoperability, the "silo-ization" and the lack of demonstrated value.

While there is no question that mHealth is on the rise, some, including myself, are wondering if we’re heading toward a bubble of inflated expectations. As with all bubbles—dot com, housing etc.—the question isn’t whether there is significant underlying value (there is), but instead “how do we invest in the value that can be realized without buying into overinflated hype?” In the context of the ‘90s’ dot-com bubble, “How do we place our bets on Google and not on pets.com?”

The answer isn’t going to be found in the next jazzy consumer-oriented gadget, but by connecting great ideas that will help us lead happier, healthier lives over the long haul – connecting business, research, technology, and policy interests to find shared value.

I came away from the 2011 mHealth Summit optimistic in the overall potential of mHealth, but a little skeptical about the direction it seems to be heading in. Introducing multiple new and evolving health innovations is inherently complex, as is the perversity of our current health infrastructure. Yet one can’t help but notice that there are some very smart people working on developing the promise mHealth can offer to address some of our most pressing health challenges.

A central question will be how willing those from the “m” will be to ensure that the “health” is improved? And how open will the folks from “health” be in fulfilling the promise of “m” technology?

This will require us all to see value from others’ perspectives in this growing ecosystem. I’ll explore this more in my next blog post, so stay tuned.

In the meantime, take a moment to peruse RWJF’s coverage of the Summit on NewPublic Health.org, which tapped into some of the conversations, new collaborations and innovations in mobile health that might feasibly be applied to public health, and started a conversation about the potential for mobile technologies to help the public health field connect with hard-to-reach populations and bridge disparities.  Read what they learned in interviews with Susannah Fox of the Pew Internet and American Life Project about advances in mHealth, with Yvonne Hunt of the National Cancer Institute about the potential for mHealth in public health, and with Robert Kaplan, director of the Office of Behavioral and Social Sciences at the National Institutes of Health about the rigorous research still needed to support the field. We’d love to know what you think, so don’t forget to comment on each post or below to share your insights.

The False Dichotomy of Nature Versus Nurture

We all attribute certain traits to nurture and others to nature. “I’m stubborn. I get that from my dad’s side. My ambition and leadership skills? I learned those.” But Pioneer grantee Nicholas A. Christakis says more of the traits we typically attribute to culture have evolutionary roots, including who we choose as friends and whether or not we practice healthy behaviors.

In this week’s TIME magazine, Christakis argues that a new synthesis of biological and social science – biosocial science –can unearth solutions to some of the world’s most vexing public health problems. He writes that we can use our understanding of biology and behavior to address problems like how to get medications or tools to remote villages, control the behavior of dangerous crowds, or predict an epidemic before it happens. Christakis, a Pioneer grantee and a professor of sociology and medicine at Harvard, contributed this essay as one in a series by TIME’s most influential people in the world.

You can also learn about Christakis’ innovative research into how humans interact and coordinate in response to the behavior of one’s social partners in a recent Pioneer-funded article published in Science and in this profile.

Read the TIME essay, review Christakis’ work on patterns of human coordination and defection, tweet your thoughts about the nature versus nurture argument, or comment below. We’d love to hear what you think.

Vote for the Most Influential Articles of the Year

It’s time for RWJF’s annual research poll! David C. Colby, vice president of Research and Evaluation, announced the 20 nominees for RWJF’s Most Influential Research Articles of 2011. We are honored that three Pioneer grantees made the list:

• Positive Health – Heart Health When Life is Satisfying: Evidence from the Whitehall II Cohort Study, published in May’s  European Heart Journal, found that satisfaction in four life domains—job, family life, sex life and self—were independently associated with a 12 percent reduced risk of total coronary heart disease. The research supports Positive Health, a new field of inquiry into whether there are assets that help people achieve and maintain good health and recover more quickly when they are sick. Vote for Article 12 or learn more about this project.
• Flu Prediction Market – The Use of Twitter to Track Levels of Disease Activity and Public Concern in the U.S. During the Influenza A H1N1 Pandemic, published in May’s PLoS ONE, followed researchers who used Twitter to effectively track public concerns about H1N1 and follow real-time disease activity. Tweets related to hygiene coincided with public health messages about the outbreak, and there was a distinct association between twitter data and the actual progression of H1N1. Vote for Article 11 and learn more about this project.
• Project ECHO – Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers, published in June’s New England Journal of Medicine, demonstrated that primary care providers can be trained via video communications technology to manage complex chronic conditions formerly outside their expertise, thus expanding their ability to bring better care to more people in their own communities. By putting the best available medical knowledge into the hands of everyday clinical practitioners, Project ECHO exponentially expands the capacity of the health care workforce to provide high-quality care in local communities. Vote for Article 17 or learn more about this project.

Vote for your top 5 Most Influential Research articles of 2011 now and use #Final_5 on Twitter, Facebook, and LinkedIn to follow the conversation and let others know which articles you think should make the top five for 2011. Voting ends on midnight of December 23 so act fast! This year’s winners will be announced in the next issue of Evidence Matters to be released in early 2012.

Pioneer Grantees Named to Forbes’ Top 30 Social Entrepreneurs List

BY BRIAN QUINN, team director of RWJF’s Pioneer Portfolio

Forbes is known for its lists – America’s richest people, most expensive zip codes, most promising companies and more. This year, for the first time in its 94-year history, Forbes released a new list – the top 30 social entrepreneurs. We’re proud to announce that Pioneer grantees made the list – twice!

Jay Coen Gilbert, Bart Houlahan and Andrew Kassoy made the list for B Lab, a nonprofit that certifies businesses as “B Corporations”—companies that adopt a legal structure requiring them to create value for a broad set of stakeholders—employees, communities and the environment–not just their shareholders.  Their hope is that certified “B Corps” will flourish by attracting consumers who are looking to support businesses that align with their values and helping investors to drive capital to higher-impact investments with greater social responsibility, as well as financial returns.  To be certified, companies must adopt the legal structure and pass an annual B Impact Assessment. Under their Pioneer-funded grant, B Lab will develop the first set of criteria to assess a corporation’s performance in areas of employee and community health and safety to be included in the annual assessment.

Sara Horowitz is listed for founding Freelancers Union, which provides affordable health insurance to freelancers, consultants and temps who don’t have access to employer coverage. Her grant from Pioneer enables the Freelancer's Union to expand its group purchasing health-benefits program from New York into New Jersey and Georgia.  A previous grant established the for-profit Freelancers Insurance Company to design a health plan model for freelancers in New York state that combines catastrophic insurance coverage with coverage for prevention and wellness services.

RWJF’s Vulnerable Populations Portfolio is also excited to see two grantees on the list. Jill Vialet made the list for founding Playworks, which improves the health and well-being of children by increasing opportunities for physical activity and safe, meaningful play. Playworks sends trained, full-time coaches to low-income, urban schools, where they transform recess and play into a positive experience that helps kids and teachers get the most out of every learning opportunity throughout the school day. Rebecca Onie is included for co-founding Health Leads, which mobilizes undergraduate volunteers to help patients fill “prescriptions” shared during provider visits for basic resources needed to be healthy, like food, heating assistance, child care or housing. Health Leads is one of many promising models addressing social needs through the health care system.

As team director of the Pioneer Portfolio, I’m thrilled to see our grantees singled out as innovative entrepreneurs. These innovators represent the kind of leadership and ingenuity that can help us tackle the tough health and health care problems we face in the U.S. Check out the story and don’t forget to congratulate Jill Vialet (@jillvialet), Rebecca Onie (@rebeccaonie), Sara (@Sara_Horowitz) and the B Lab crew (@BCorporation) on Twitter using the #Impact30 hashtag.