Pioneering Ideas

An OpenNotes Annoucement

A couple of weeks ago, Steve Downs discussed the Boston Globe coverage of the OpenNotes© study at the Beth Israel Deaconess Medical Center (BIDMC). Last week, BIDMC announced the details of the OpenNotes© demonstration project, which is funded by a grant from Pioneer.

One hundred primary care physicians and 25,000 patients will participate in the 12-month study at three sites – BIMDC in Boston, Geisinger Health Systems in Pennsylvania and Harborview Medical Center in Seattle. The study – the focus of a July 6 article in American Medical News – is looking at what happens when patients are given full, real-time access to the notes from their doctors' visits.

This project could affect behavior in both patients and physicians, perhaps even creating more openness and engagement. That said, as Steve notes, it is “a controversial idea that needs to be tested.” Or, as one internist quoted in the AMA news article put it, "I want to be a part of this even though I'm not sure I'm going to like it." We look forward to your questions and the many that are sure to follow as this project moves forward. 

Can a Reduction in Hospital Acquired Infections Cut Health Care Costs?

There is no denying that hospital acquired infections (HAIs) are an expensive drain on the system and impact the lives of an estimated 1.7 million hospital patients a year – killing nearly 99,000 annually. Is it possible that simply instituting best practices in infection control can substantially reduce these infections and save the nation’s healthcare system billions of dollars a year?  Yes, according to an article in last week’s Roll Call by Ramanan Laxminarayan of the Extending the Cure initiative, a Pioneer grantee, and Ed Septimus from HCA Healthcare System.  Laxminarayan and Septimus propose several ideas and incentives, which they believe will reduce the rate of resistant HAIs and control the rise of antibiotic resistance. 

Are hospital acquired infections really the low hanging fruit that will benefit patients and cut health care costs?  Check out the article and then come back here and let us know what you think.   

 

Using Games to Support Children's Healthy Development: Opportunities & Challenges

We welcome Ann My Thai to our guest blogger series.

Ann My Thai is the Assistant Director of the Joan Ganz Cooney Center at Sesame Workshop and the co-author of Game Changer: Investing in Digital Play to Advance Children’s Learning and Health. Ann leads the Center's strategic partnership efforts with high tech and gaming industries, and oversees organizational growth and strategy. Before joining the Center, she served as a consultant for Education for Development, Vietnam, a nonprofit organization that develops informal educational programming for disadvantaged children in Ho Chi Minh City, Vietnam. Thai received her bachelor's degree in Political Science from Yale University and a master's degree in Business Administration from the Ross School of Business at the University of Michigan.

Readers of the Joan Ganz Cooney Center’s latest report, Game Changer: Investing in Digital Play to Advance Children's Learning and Health might be asking why we chose to discuss how digital games could advance both children’s learning and health in the same paper. Named for its founder, the Center’s roots lie in Sesame Street’s “whole child” approach, which encourages learning that supports many different aspects of a child’s healthy development—from literacy skills, to social and emotional development, to practicing healthy habits.  A solid base of research tells us that children who eat healthfully and are more physically active are also able to learn more easily.  It also tells us that children who suffer from health threats such as obesity do worse in school and are less successful later in life.  Given the inextricable ties between learning and health, and the parallel efforts in each field to harness the power of games, we wanted to address the potential role they might play in health and education reform together.

The idea that digital games might actually help improve children's learning and health is, in some quarters, a radical one, but for authors of the report, it is also a pragmatic one. The medium has a high penetration, with 97% of American teens playing computer or video games.  Furthermore, digital games are reaching children at younger and younger ages for longer periods of time.  The average child begins playing games at age 6, down from 8 years old a few years ago, and the amount of time a child plays on average more than doubles between age 6 and 9.  This level of play shows that it is no longer a question of whether we should enlist games in our learning and health efforts but how we may do so.  Game Changer aims to spark a productive dialogue about the opportunities and challenges of using games to support children’s healthy development.

To kick off this dialogue, we unveiled the report on Tuesday with the Woodrow Wilson Center for International Scholars at an event in Washington, DC.  It featured a panel of experts from industry, research, and policy and hosted nearly 100 participants and a web audience from these key sectors. 

A key insight raised at the event was the lack of training available to health researchers to engage in the type of multi-disciplinary game R&D requires. Dr. David Abrams, Executive Director of the Schroeder Institute at the American Legacy Foundation, which focuses on accelerating the reduction in tobacco use, especially for young people in the U.S. population, said that the health care sector has “not looked beyond itself” to consider the whole child in advancing children’s health. The current generation of health researchers is too often isolated from the broader perspectives or tangible incentives to engage in a multi-disciplinary approach.  

Some of the biggest challenges of the day—such as childhood obesity or the fourth grade reading slump—are too broad and complex to be addressed by the expertise of any one discipline.   These are problems couched in layers of social, economic and other environmental factors, as well as developmental factors distinct to each child.  Responding to these issues from a whole child perspective will demand greater investment toward funding and collaboration models and infrastructure that support multi-disciplinary collaboration.  Such investment is essential if we are to tap into the digital media that surrounds today’s children in a purposeful way.  

Fun, Kids & Evidence-Based R&D = Games for Health Success?

We continue our guest blogger series with Richard Tate of HopeLab.

Richard Tate is the Director of Communications and Marketing at HopeLab and a blogger on Sticky Notes, HopeLab’s official blog. 

HopeLab, maker of the groundbreaking Re-Mission videogame for teens with cancer, is an innovative nonprofit harnessing the power and appeal of technology to improve the health of young people. Their evidence-based, customer-focused development process delivers fun, effective products that measurably improve the health and quality of life of adolescents and young adults.

More than 30 years ago, Joan Ganz Cooney began to build the evidence base for entertainment technology as a tool for good in the lives of young people. From Cooney’s work, the groundbreaking program Sesame Street emerged, and the show quickly demonstrated the incredible power of harnessing the appeal of TV technology to achieve specific goals in children’s educational, behavioral and social development. The approach worked, and TV producers, critics and generations of viewers were persuaded.

Can we do the same for digital games? Most definitely. What will it take to get there? The Sesame Workshop’s Joan Ganz Cooney Center released a new report offering a roadmap forward. Based on my work at HopeLab with our Re-Mission video game for cancer and my own experience as a kid watching Grover and Big Bird after school, three things come to mind as essential components: fun, kids’ input and evidence-based R&D.

Focus on Fun: There’s a reason 97% of American teens play computer or video games (hint: it’s not because they’re looking for educational opportunities). It’s because games are fun. And “fun” doesn’t have to mean “pointless”. Quite the contrary. The creative freedom afforded by today’s game technology gives us an opportunity to produce content that’s immersive, highly entertaining AND targeted at specific outcomes in the “real” world. But if games aren’t fun, kids won’t play. And if kids won’t play, we can’t achieve the outcomes we’re after. That’s where many “serious game” projects seem to stumble. Looking back, I didn’t watch Sesame Street because I wanted to learn the alphabet. I just had a blast singing “C Is for Cookie” with Cookie Monster.

Kids First: How do we know what’s fun for kids? We don’t – unless we ask them. Too often, the fun factor – the essential ingredient for games – is forgotten when adults begin to layer education and learning opportunities into entertainment media based solely on academic research. The best, most reliable way to gauge what’s truly engaging and fun for kids is to engage them directly. In our experience at HopeLab, kids are great at generating ideas and honest with their opinions when given an opportunity to contribute. It’s why we invite them into our development process and incorporate their feedback every step of the way. Talking to kids is the best way for us all to ensure we’re on track to deliver games that are fun and effective in improving kids’ lives.

Evidence-Based R&D: Commercial video games for entertainment are largely developed based on the creative vision of industry experts. Games that aim to do more than entertain require both creative vision and evidence to inform objectives and validate outcomes. Data – scientific evidence that games work – has been the critical missing piece in catalyzing broad, systemic and sustained engagement in digital games development for health and education. For example, demonstrating through research that games can enable patients to better manage their health and reduce healthcare costs is essential to engaging the healthcare industry in creating games as tools for consumers.

Research also provides insights to the field on how to create games that work to achieved desired benefits.  Advances in health games research and development have largely been driven by the commitment and financial resources of major foundations like the Robert Wood Johnson Foundation, and individual philanthropists, like HopeLab founder and board chair Pam Omidyar. The government also has funded development of leading-edge, game-based virtual technology for training soldiers. HopeLab has generated compelling data on Re-Mission and how it works to improve kids’ health, but more needs to be done in the field. RWJF’s Health Games Research Project aims to do just that. It would be great to see others come forward in the public and private sectors to support more evidence-based development of health and education games in the coming years.

Games are a tremendously powerful part of our kids’ lives, and it’s within our control to make them tools for good. The new Cooney Center report is a timely assessment of how digital games might advance our efforts to improve the health and learning of young people. Wouldn’t it be great to look back on this time as the point at which digital games, like television, became a medium that both entertained us and improved our lives?

Guest Blogger Series: Views on Increasing the Use of Digital Games for Health

We started June off with a look at games for health in preparation for the 2009 Games for Health Conference. We attended, we tweeted, and we shared updates on some of the incredible developments that took place this year. Now we’d like to end the month by looking at the opportunities that games have in creating positive health outcomes among children.

Yesterday, the Sesame Workshop’s Joan Ganz Cooney Center released a new report on the power that video games can have in addressing some of the most pressing health challenges facing America’s children. The report outlines some strong evidence that games can make a positive impact on the health of our children – a great step. However, we also recognize that there is still work that needs to be done to increase the use of digital games for health.

With that challenge in mind, we posed a question to a panel of guest bloggers and invited them to share their point of view:

“There is a growing consensus that digital games can be deployed to support learning and behavior change for positive health outcomes among children. What do you think needs to be done to increase the use of digital games for this purpose?”

Over the next week, they’ll be posting their thoughts right here – we encourage you to leave your comments and take part in the conversation. 

Opening Physicians' Notes to Patients

Today’s Boston Globe ran a story (page one, no less!) announcing our grant to Beth Israel Deaconess Medical Center run a three-site demonstration of opening up physicians’ notes to patients.  That’s not just making labs, drugs, allergies, etc. available to patients – it’s giving them access to the actual notes that the physician records about a visit.  Now these notes are technically available now – under HIPAA each of us has a right to our full medical records (of which physician notes are a part), but the processing for obtaining them is often slow, cumbersome and even expensive in some cases.  Under this project, called Open Notes, patients will receive a secure email after the note has been completed and they can see it right away.  They’ll also be prompted to review the note prior to their next visit.  So instead of limiting access to the very determined, access will be easy for anyone who’s mildly interested.

Why would we fund this?  Several reasons, really.  First, is that at the Pioneer Portfolio, we’re very interested in patient-centered innovation.  Let’s face it:  virtually every trend suggests that people are going to have to become much more engaged in their care and in taking care of themselves.  And, as the pioneers of shared decisionmaking, patient centeredness, patient activation, online support groups and the health 2.0 community have shown us, real benefits come from this engagement.  So much of the energy and excitement in health care today is coming from the patient/consumer side of the equation.  So it’s a space where we believe we will find many innovations that can ultimately transform health.

Second, it’s an elegant system tweak that could really affect behavior.  It’s just a hypothesis at this point, but think about how the knowledge that a patient will read a note will affect how the physician writes the note.  Of course the effect will vary by individual, but this little tweak – with a very small marginal cost – takes a task that physicians do dozens of times a day and reframes it.  As my colleague Paul Tarini has pointed out, it says that this note is for the patient more so than about the patient.  Subtle but important.  My own bet is that this change could do more for influencing how physicians see their relationship with their patients than years of training on how to be more patient centered.  Of course I could be wrong!

And that brings me to the third reason.  This is a controversial idea that needs to be tested.  As we – and Tom Delbanco, the principal investigator on the grant – talked to people, we found strong opinions on both sides of the issue.  There are many people with a patient advocacy perspective who think this is so obvious, such a right and there should be no question about it.  And there are many physicians who think – for very plausible reasons – that this is a terrible idea.  As I said in the Globe article, there’s a bit of a religious character to the debate – you either believe one thing or the other and you believe it strongly.  But there’s been precious little evidence to inform that debate.  That’s why it’s important to do the study and do it on a large scale.

So we’re all excited about this project.  It’s a simple but powerful idea that deserves a real test.  And we hope it sparks enough discussion to raise some interesting and fundamental questions.

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 

Let the Gaming Begin!

Today the 5^th annual Games for Health conference kicks-off in Boston, MA.  The conference has sold out and for good reason: the schedule is packed with a dynamic lineup of speakers and sessions.  Pioneer has been a major sponsor of the conference since 2004 and we’re excited that it has grown to be the premiere health gaming event.   

Several of Pioneer’s grantees will feature their work during the conference:

• Debra Lieberman, national program director of Health Games Research, University of California at Santa Barbara, will be presenting on the “Age of Sensors,’ along with Marientina Gotsis, University of Southern California and Kevin Stanley, University of Saskatchawan, today at 2:00 PM.  A couple of Health Games Research grantees are presenting as well – Ann Maloney of Maine Medical Center will talk about social and psychological factors linked to exergaming play today at 4:30 PM and a team from Cornell University will update attendees on progress with their Mindless Eating Challenge game study tomorrow at 3:00 PM.  
• David Lowenstein from The Joan Ganz Cooney Center, will be moderating a discussion on ‘Games for Health and Education: A Policy Report’ also today at 2:00PM.  Look for news on an upcoming DC event on this report, to be held June 23.
• Ben Sawyer, President of Digitalmill and Games for Health Founder, will be leading two presentations during the conference. ‘Games for Health Potpurri: 10 Things We Might Have Overlooked until Now’ and ‘Health in Games: An Update’. Both sessions are tomorrow, June 12, beginning at 2:50PM

If you are at the conference you should stop by and listen to their sessions. 

These are just a few examples of the packed lineup that features the latest in exergaming, disease and health management, skills and workforce training, rehabitainment, epidemiology, and virtual worlds and health.  If you’re attending we’d love to know about which sessions or speakers you are excited to hear.

Also, we’re excited to see that HopeLab, with whom we partnered on Ruckus Nation, announced that they are collaborating with Virtual Heroes to create the next version of their amazing game, ReMission!, which helps kids fight cancer.  Funding partners include Vivendi, the Annenberg Foundation and the Lance Armstrong Foundation. 

As a reminder, Pioneer Portfolio will be tweeting throughout the event @pioneerrwjf and you can follow all live twitter feed from the conference here and here.  If you plan to tweet from Games for Health make sure to include the conference hash tag #gamesforhealth or #g4h09.  

Mix of things to check out

A bunch of things caught my eye today that may be of interest.  First, given that the Games for Health conference kicks off today and I have to sit it out this year, I was especially glad to see this article in the Syracuse Post-Standard.  It profiles one of our Health Games Research grantees, Cornell University, which has given middle-schoolers iPhones loaded with a game designed to encourage healthier eating choices.  The way they do it is pretty clever, though...the kids take care of their own virtual pet and snap photos of their food selections, which are sent to the Cornell research team.  When indicated, the virtual pet will prompt the kids to consider, say, trading in their chips for a yogurt next time.  It's more of a fun interaction than preaching, as the article points out, and it goes wherever the kids go.  I like that it shows how health is playing out apart from health care settings and encounters, and how games and game technologies may provide ways to deliver health messages to kids in ways that are so much more up their alley, and potentially so much more effective.

Second, Steve Downs and John Lumpkin blogged on June 1 on "Catalyzing an App Store for EHRs," which our friends at the Health Care Blog were kind enough to re-post.  A great conversation has kicked up around this - read the comments and add your own thoughts.

Finally, Project HealthDesign received 145 new proposals last week in response to its Round 2 CFP. National Program Director Patti Brennan talks about the breadth of ideas and wide range of observations of daily living that teams proposed - they'll be working together with patients managing multiple chronic diseases to capture and analyze health data generated in the course of daily life and test how it can be integrated in to clinical care workflows.

Wanting the Computer to Know Who I, the Patient, Am

The post below comes from our grantee Jan Walker. She and Tom Delbanco, of Beth Israel Deaconess Medical Center, ran a series of focus groups funded by Pioneer to get at the heart of people's preferences for their health information needs, and what they would be open to considering when it came to using health information technologies to engage in managing their health. These focus groups were designed to help inform our Project HealthDesign work, but the insights they yield extend far beyond that program. The findings are shared in the June 2009 issue of the Journal of General Internal Medicine.

I recently read the posts by/about Sandy Pentland and Clayton Christensen describing futuristic applications of IT to health care. Then, two weeks ago, I heard Dr. Robert Brook address a plenary session of the Society for General Internal Medicine annual meeting suggesting that the presidential election in four years could well hinge on the state of health care. Among other things, he urged us to personally assume responsibility for disrupting the mess we are in.

Consumers are also ready for a sea change. My colleagues and I had a fascinating experience talking with consumers from many different walks of life in four parts of the country. To a remarkable degree, they believe computers should be personal partners that help them manage garden variety health issues, freeing clinicians to manage serious problems and chronic illness. They want full access to their medical records and expect computers to coach them about health behaviors by integrating information from their records with their personal preferences and data derived from monitoring devices. They appear willing to accept advice from algorithms and faceless online clinicians and to trade guaranteed privacy for guaranteed access to their information in an emergency.

I was struck by how much these consumers understood about the predicament of their personal physicians, from paperwork hassles to productivity pressures. And they seemed genuinely sympathetic, wanting to use technology to contribute to solutions. “I get the same antibiotic for the same sinus infection every winter; why do I need to go see my overwhelmed doctor for that?” “Why can’t I get an automated reminder for my annual mammogram with options about where to get it, instead of having to get an order from my doctor, who may not remember to do it?”

Peoples’ long term financial health used to be largely in the hands of pension programs, but much of this responsibility has lately been transferred to us as individuals. Now many of us make our own decisions about savings and investment, we manage our own retirement portfolios, and financial companies compete for our business by offering services that enable us to do it. Could the same thing happen in health care? Health is also a long-term investment – could consumers rather than their personal physicians assume responsibility for “investments,” such as routine preventive care? What if providers and health companies competed for patients not just on quality and cost, but also on services that enable people to manage their own health and minor illness? What if consumers could shop for disease-specific applications that plug into their PHRs, just as they shop for applications for their mobile phones?

These possibilities are barely glimmers on the horizon. They could help us to create a truly patient-centered health care system and get beyond what is often empty rhetoric.