Pioneering Ideas

Open Notes and the Electronic Medical Record Podcast

"If you had the chance to look at what your physician wrote in your medical record about your last visit, would you take advantage of it?  Would this make your relationship with your doctor or primary care provider more collaborative? More effective?" These are just a few of the topics that host Madge Kaplan covered in yesterday's dynamic and engaging WIHI podcast on the Open Notes project and electronic medical records.

Guests included Dr. Tom DelBanco of Beth Israel Deaconess Medical Center and the Open Notes Project, as well as, Dr. Mary Merkel, a family practioner at Dartmouth-Hitchcock and Bob Desauiniers, Dr. Merkel's patient.

If you weren't able to catch yesterday's live broadcast, we encourage you to listen to the archived recording. You can also access additional information on the Open Notes project and the resources mentioned during program.

Gearing Up for the 2010 Games for Health Conference

The details have been announced for the sixth Games for Health Conference, the premiere annual event focusing on the role of digital interactive games in health and health care.

On May 25-27, 2010 at the Hyatt Harborside in Boston, health game developers, researchers, advocates and enthusiasts from all over will participate in specially developed learning and networking tracks: Active Gaming, Medical Training & Education, Physical Therapy & Rehab and Cognitive Gaming.  Have an idea for a session? Deadlines are fast approaching for the call for content so make sure to get your submissions in now.  

Every year, the Pioneer team shares highlights here on the blog and on our twitter account. While we will surely be sharing information before, during and after the event, we encourage you to experience the conference firsthand. Click here to register  and we hope to see you there!

Patient Safety and Medical Liability Reform Forum

This Thursday, Common Good, with support from Pioneer, will host an event in DC to discuss advancing patient safety and medical liability reform innovations. The forum’s topic is prompted by the September announcement from President Obama that the Department of Health and Human Services will launch a $25 million initiative to help states and health systems conduct innovative patient safety and medical liability demonstration projects. Health Courts could prove to be one of the key projects that states bring forward to the Agency of Healthcare Research and Quality (AHRQ) – administer of the grant – this coming January.

The event’s lineup includes some terrific panelists and is sure to generate interesting dialogue and ideas.

Common Good invites anyone who is interested in this issue to tune into the live webcast– feel free to share the link with other colleagues and contacts.  Here are specifics:

WHAT:  A forum on patient safety and medical liability reform.

WHO:

Dr. Lucien L. Leape, Chair, Lucian Leape Institute at the National Patient Safety Foundation

Michelle Mello, Professor of Law and Public Health, Harvard School of Public Health (and former Pioneer health courts grantee)

Nancy Foster, Vice President for Quality and Patient Safety Policy, American Hospital Association

Dr. Albert Stunk, Deputy Executive VP, the American College of Obstetricians and Gynecologists

Elaine Brightwater, Senior Project Coordinator, Center for Development & Disability, Uni. of New Mexico

Richard Boothman, Chief Risk Officer, University of Michigan Health system

Gordon Smith, Executive Vice President, Maine Medical Association

Dr. Alan Woodward, Former President, Massachusetts Medical Society

Martin Hatlie, President, Partnership for Patient Safety

David Oakley, Counsel, Healthcare, Manatt, Phelps & Phillips, LLP

Philip K. Howard, Chair, Common Good

WHEN:  Thursday, December 10, 8:30 a.m. – 2 p.m.

WHERE:  Via live webcast

Time for New Behavior Change Models and All Things Neuro

We had a really interesting meeting.  It was provocative and wide-ranging; I can’t begin to do it justice in the format of a blog.  Look for a more thoughtful and informative report in the weeks to come.  Also, we’ll work to set up an on-line space where people who are interested in these questions can come together.  In the meantime, here are just a few ideas and thoughts to come out of the meeting:

 

Do we need a next-generation model for behavior change?  The models we have for behavior change have enabled impressive gains and powerful programs, but they were largely developed 20 years ago when our ability to understand what is going on inside someone’s brain was much less developed.  Technology that didn’t exist 20 years ago provides a much more detailed picture of what influences decision and behavior, enough of a new picture that it may be time to re-evaluate our current models of behavior change.

 

Watch for increased use of the prefix “neuro.”  There’s neurotech, neuroplasticity, neuromodulation.  There’s neuroimaging, neuro-oncology, neurogenetics. and neurofeedback.  But when you seek to understand an experience at the neurological level—and you have the technology to do it—you can go anywhere: neuroaesthetics takes a scientific approach to understand perceptions of art and music.  At the other end, look for increased use of the suffix “ceuticals.”  We heard about the possibility of cognoceuticals that improve people’s capacity to learn (This has been happening for years, caffeine and nicotine, for example.  For five or six years now, there’s been the occasional story about use of Ritalin and Adderall as study aids.); emotoceuticals that could in a much more targeted way address emotional disorders or enhance certain emotional states; and, sense-ceuticals that could improve your sense of smell, touch, hearing.

Finally, monitoring your brain’s wellness could become a new responsibility for primary care providers.

Darwin Labarthe Lecture: Cardiovascular Disease Prevention

Next up from the Penn Positive Health Lecture Series is a talk by Dr. Darwin Labarthe on cardiovascular disease prevention. As part of his lecture, Dr. Labarthe will explore the contributions that new prevention strategies, social determinants of health and positive health may play in cardiovascular disease prevention.

Dr. Labarthe is the Director of the Division for Heart Disease and Stroke Prevention in the National Center for Chronic Disease Prevention and Health Promotion at the CDC. The second edition of is text, Epidemiology and Prevention of Cardiovascular Diseases: A Global Challenge, will be released in March 2010.

The lecture series is part of the Positive Health project which is funded by the Pioneer Portfolio and led by Dr. Martin Seligman of the Positive Psychology Center at the University of Pennsylvania.

If you have the opportunity to attend we'd love for you to share your thoughts.

Here are the details

Date - Wednesday, November 11, 2009

Time - 12:00 - 1:00 p.m.

Location - Dunlop Auditorium, which is in Stemmler Hall at the University of Pennsylvania School of Medicine, Philadelphia

Free and Open to the Public

Health IT: What’s the Future?

I’ve just come back from the "Discovery and Innovation in Health IT" workshop. You can find more on the workshop’s web site.  You can also follow the twitter stream by using the #dihit hash tag.  This workshop pulled together about 100 people – mostly researchers from academia, government and corporate labs – to lay out the key health IT research challenges going forward.  I’ve attempted to summarize some of the key themes and points that were raised, but I’ve by no means captured it comprehensively and I’m certain that I’ve taken a lot of license in my interpretation – so please add your voices – I’d love to get other perspectives.

The workshop started with some tone-setting presentations that illustrated the gap between the potential of health IT and where we are now.  Zak Kohane, in a brief introduction, noted that back when he was a grad student (more than a few years ago), clinical decision support was said to be right around the corner and while it’s still not reached its promise, Apple’s managed to generate 86,000 apps in its app store, many of which focus on health, in less than a year.  “Why?” he asked.  Bill Stead, recapping the work he led for the National Research Council’s report on Computational Technology for Effective Health Care, laid out the challenge starkly, saying (and I’m paraphrasing) that the path we’re on with health IT will not solve the problems in our system and could even make them worse.  Most hospitals have implemented IT in ways that rate a 5 on a scale of 100, where 100 is ideal and the best are at 15-20, he went on.  Today’s health IT systems “chain us” to the realm of transactions not decisions and often focus on post-hoc documentation.  “Would you ever get into an airplane where the pilots go through the checklist after they’ve taken off?” he quipped.  He focused a lot on the need for cognitive support, showing a hockey stick graph of the number of facts that will be relevant to a given clinical decision over time (this theme reappeared several times over the two days).  The number is expected to reach 1000 by 2020, while the number of facts that a human can contemplate while making a decision remains stuck at um, five.

 

Other presentations, notably from Dietrich Stephan of Navigenics and Craig Feied from Microsoft, extrapolated from recent progress in genomics, proteomics and systems biology to sketch out a future of increasing precision in our understanding of diseases (hence the hockey stick of medical knowledge).  In these visions, the increasingly ability to subclassify diseases at the molecular level, to understand the biological processes that cause them and to design laser-like therapies to target them, leads to precision diagnoses, early detection and better understanding of which therapies will work and which won’t.

TEDMED 2009 = Innovation, Technology & Inspiring Stories

I really liked TEDMED. There was lots of wiz-bang new technology stuff – genetics, organ regeneration, ways to slow the aging process, wearable sensors that can monitor and wirelessly transmit data that traditionally required a person to be in a controlled environment with leads connected to multiple body locations. It’s really exciting to see what may be possible in a few short years. Of course, no one really talks about how long it will take, how real people will be able to use these gadgets and how they’ll be paid for.

 

There are also great stories of human accomplishments – either overcoming tremendous adversities to triumph or innovative and caring ways to help others. Every one of the presentations is worthy of commentary. In addition, it’s amazing to realize the number of incredibly smart people that were there. Not only are they smart but each has accomplished more than one might expect, even given their brain power. And many of them are truly nice and approachable.

 

For me the highlight of the event was Jamie Heywood talking about the Patients Like Me site. The reason for this is less that they are using some pretty impressive analyses but more that you have a platform where ordinary people can record their experiences with their conditions and treatments in a way that contributes to a shared and actionable understanding, without expert clinical intervention. The reality is that right now this helps each participant deal with her or his condition. In addition, it is beginning to yield data that can expand clinical knowledge faster and more broadly than traditional methods. Whether the scientific community can learn how to make use of that data seems to me a question of how open the professionals are to exploring nontraditional sources. I certainly hope they are.

Connecting Revolutions in Neuroscience with Health and Health Care

As a national leader in health and health care, the Robert Wood Johnson Foundation is continually searching for opportunities to generate greater impact. One of the charges of the Pioneer team, the most explicitly future-oriented of RWJF’s program areas, is to identify and investigate areas where transformative breakthroughs feel most possible.

In line with this charge, working with the Monitor Institute, we’ve invited a provocative group of academics, researchers, physicians and industry leaders in neurotechnology, neuroscience and behavioral health to step to the ledge of current innovations in these fertile and promising fields – and then step beyond it – begin to anticipate what near-term and distant innovations in these fields could mean for health and health care.  

On November 11-12, this group, along with staff from the Foundation and Monitor, will engage in a series of highly iterative, forward-looking discussions that will culminate in a wrap-up that integrates the thinking across all three disciplines and outlines connections and implications for the future of health and health care.

This event is a new approach for Pioneer. It is not connected with any prospective funding initiative. Rather, we play the role of convener, focused on bringing together the experts who hold the key to identifying and advancing the next generation of innovations in this space.

I, for one, can’t wait to see what everyone has to say. If you would like to follow the conversation about the Forum on Twitter — leading up to, during and following the event — please use the #rwjfneuro hash tag.

Interested in more information?

Pre-read

Participants

This Is a Brainstorm

There is no such thing as a blank check — particularly in this economic climate. Resources are not endless; parameters exist. But the Pioneer Portfolio is dedicated to powering ideas that have the ability to truly transform health and health care and — to do so — we need to encourage people to THINK BIG.

From October 27-30, members of the Pioneer team will be in San Diego to participate in TEDMED2009. While we are there, we will ask other participants — if someone was to hand them a blank check — what they would do to transform the future of health and health care? What kind of problems do they see as being “stuck” and that, if solved, could bring about significant improvements 5, 10, 15 or more years down the road?  Where are the breakthrough opportunities?

But we don’t want to limit the conversation to the group at TEDMED; we want to take the conversation to Twitter and ask a broader audience for their ideas. Like you.
 
There is no blank check.
 
This is not a call for proposals.
 
This is a brainstorm.
 
We want to hear your ideas because they inspire us and because we hope you might inspire each other.
 
If you would like to participate in the conversation and let us know how you would transform the future of health and health care, please tag your “tweets” with the #blankcheck hashtag. We’ll “retweet” them to share with those who follow Pioneer on Twitter and we’ll share them with everyone at TED MED through a live feed we’ll have playing throughout the event. If you don’t want to share your own ideas, but want to see what other people are thinking, you can follow the conversation here. And please consider telling others about the #blankcheck conversation.

Positive Emotions, Diverse Social Networks and Social Status = Positive Health?

We’re pleased to announce what is sure to be another engaging program from the Penn Positive Health Lecture Series. On June 24^th, Dr. Sheldon Cohen, Ph.D., will lead a talk on the roles that positive emotion, diverse social networks and perceptions of social status play in morbidity and mortality.  

Dr. Cohen, who is the Robert E. Doherty Professor of Psychology at Carnegie Mellon University, has published work on the roles that stress and social networks can play in physical and mental health.  As part of his lecture he will discuss his experimental work where mental and biological predictors are assessed in healthy people before their exposure to the common cold virus.

The lecture series is part of the Positive Health project which is funded by the Pioneer Portfolio and led by Dr. Martin Seligman of the Positive Psychology Center at the University of Pennsylvania. 

If you have the opportunity to attend we’d love for you to share your thoughts.

Here are details:

Emphasizing the Positive: Positive Emotions, Diverse Social Networks, and Social Status Contribute to Lower Morbidity and Mortality

Date - Wednesday, June 24, 2009
Time - 12:00-1:00 p.m.
Location - Dunlop Auditorium, which is in Stemmler Hall at the University of Pennsylvania School of Medicine, Philadelphia
Free and Open to the Public