Pioneering Ideas

A landmark first for the Archimedes model

At the very end of March, study findings were released in the online edition of The Lancet indicating that it is more effective from a cost and detection standpoint to begin screening for Type 2 diabetes in people between the ages of 30 and 45 — 15 years ahead of what established guidelines had been recommending.  Subsequent screenings should take place every three to five years thereafter.

While this is an important result for the medical community, the most significant piece of this story, in our opinion, was not covered in the news.  What really caught our attention was the fact that this was the first time The Lancet has ever published a peer-reviewed paper for which the research was based entirely on a simulated population and treatment options existing within a mathematical model – in this case, the Archimedes model of human physiology, diseases, interventions and health care systems.

For the study, the researchers simulated a population of 325,000 nondiabetic 30-year-olds.  According to Archimedes President and CEO John Beasley, “This paper presents the results of an international study that would never have been possible using an actual clinical trial. It would have required enrolling and following more than a million people for 45 years; the cost would have been astronomical.  The study examined the criteria for deciding when to screen for diabetes and Archimedes was the only model that could conduct a clinical trial simulation at this advanced level.”

We’re excited to see validation of the strength of the Archimedes methodology at this level.  Watch the blog for more updates soon on the status of the ARCHeS project, which will make it possible for public and health policy leaders to access the model to conduct their own virtual clinical trials from their desktops.  The vision is that a wide variety of key decisions will be informed by equally strong results from the model’s predictive analyses, and the sharing of findings powered by Archimedes will become common practice in peer-reviewed journals.

New Project HealthDesign Grantees Tackle ODL Challenges

Today, Pioneer and Project HealthDesign announced the five new grantee teams 
selected in the program’s second round of funding.  They’ll be breaking new ground in testing ways that patient-generated observations of daily living (ODLs) can be collected, integrated in clinical care processes and, ultimately, organized for action to drive smarter heath decisions by both patients and providers.  Congratulations to the grantees, who rose to the top of an applicant pool numbering nearly 150 with their innovative ideas and robust approaches:

• Carnegie Mellon University
• RTI International and Virginia Commonwealth University
• San Francisco State University
• University of California, Berkeley, in partnership with Healthy Communities Foundation and University of California, San Francisco
• University of California, Irvine and Charles Drew University
  

The teams will be working with patient populations that are managing two or more chronic conditions to collect and store various health observations that arise in the course of their day to day lives.  A later technical challenge will be to figure out best ways to share meaningful signals from these ODLs with providers and integrate that data in to clinical work flows.  National Program Director Patti Brennan writes more about this on the Project HealthDesign blog.

The patient groups are compelling, and you can see how making sense of ODLs and being able to act on them can have a tremendous outcome on their health.  Patients can use technologies like smartphones and biomonitors to harness information that better equips them to manage their conditions and make decisions that hopefully allow them to experience better outcomes, day in and day out.  Providers will get a far fuller picture of the way health plays out for their patients and be able to act on more meaningful information than that typically collected in a periodic office visit conversation. 

For example, parents of low birth weight babies will use a specially designed mobile device, "FitBaby," to record ODLs such as the baby’s temperament, exercise, feeding and sleeping schedules, as well as the caregivers’ stress levels and attitude swings. Providing nearly real-time data to clinicians will help alert them to early signs of health problems, which is crucial in treating low birth weight infants.  Another team will help young adults who suffer from Chron’s disease create visual narratives of their condition and treatment to provide concrete feedback to providers about how they feel from day to day. Patients will track ODLs of physical symptoms like diarrhea, bleeding, and profound weight loss, along with more complex social and emotional observations.

The path is not entirely clear, and lots of questions will be raised along the way.  Which is why the grantees will be sharing their learnings, experiences, road blocks, questions and successes along the way, largely via the Project HealthDesign blog and Web site.  We want their progress to be an open path along which you follow and help to guide.  We’ll be sharing updates and hope you’ll check in often as well.

Join Pioneer at TED 2010 – Health’s Future, Powered by You and Your Data

TED2010 – the Technology, Entertainment and Design conference – kicks off today and runs through the 13th in Long Beach, CA, with the Pioneer Portfolio resuming its role as an event sponsor.  There’s an amazing lineup of speakers, and we’re especially excited that two Pioneer grantees will take the main stage.  Nicholas Christakis of Harvard Medical School will be speaking on Thursday about the power of our social networks to influence the spread of health and social phenomena, including obesity, happiness and smoking cessation.  And Phil Howard, chair of Common Good and leading spokesperson for the work we have supported to test administrative health courts to overhaul our broken system of medical justice, will address the TED audience on Saturday.  

 

They’ll be among impressive company, joining speakers and performers including HIV vaccine researcher Seth Berkley, molecular technologist George Church, Bill Gates, musicians David Byrne and Sheryl Crow, behavioral economics founder Daniel Kahneman, game designer and Pioneer friend Jane McGonigal, chef Jamie Oliver and former CIA operative Valerie Plame Wilson, among many others. 

 

We’ll be leading two activities at TED – a luncheon on Thursday that will highlight the future of data-driven, patient-centered care.  We’re teeing up the following questions – in a world with abundant, accessible, actionable health data, how will our level of engagement in our health and health care change?  What expectations of doctors, nurses and other providers will we have, and what expectations will they have of us?  If we have and use our data – both those logged in our electronic medical records and those generated in the course of our everyday lives – how might our decisions change?  Behaviors?  Demands? 

 

It’s a fascinating conversation, and one that will feature Pioneer team director Paul Tarini as moderator WIRED executive editor Thomas Goetz and Beth Israel Deaconess primary care visionary and Open Notes grantee Tom Delbanco.  Thomas is releasing a book called The Decision Tree later this month that explores this new approach to health in which patients harness their data and use decision trees – essentially health-oriented flow charts – to engage more meaningfully in health decisions and manage their care more intentionally, leading ideally to better outcomes.  Tom will spotlight the role for providers to innovate in this space.  He’s leading the way in making health data for the patient – not just about the patient – by placing the information doctors enter in our medical records and clinical encounter notes,directly in our hands and revolutionizing our role in our health care.  We'll record the event and post it as a Podcast later in the week.
 
We’ll also be running an exhibit space all week, the centerpiece of which is a video drawn from interviews with a range of Pioneer staff, grantees and other experts on the leading edge of this data-driven, patient-centered vision.  A big shout out to our partners at DDB Issues and Advocacy, who turned hours of telephone interview transcipts in to a beautiful, dynamic and thought-provoking brief video that makes text – and these ideas – jump off the screen and challenge you.  I love this video and urge you to check it out and add your ideas and reactions on our YouTube page.

 

Pioneer will be live-tweeting from TED and we invite you to join us in the conversation on Twitter, where you can provide your answer to this: In a world rich with actionable health data, how will our relationship with doctors change?  Use the #pioneerdata hashtag and spread the conversation online.

 

Finally, we’ll be blogging the sights, sounds and stories of TED this week, so check back frequently.

 

CBS Sunday Morning to Feature Common Good, Health Courts

This weekend, tune in to CBS Sunday Morning for its lead story on Common Good, which, together with researchers at the Harvard School of Public Health, has been analyzing and testing the viability of a system of administrative health courts to more rationally handle medical injury claims.  The CBS piece will look broadly at legal fear in America, a key thread in Common Good Chair and Founder Philip Howard's new book, Life Without Lawyers.  Interviews touched on health courts and their potential to reduce errors, boost patient safety and improve the overall quality of care, in addition to producing a more functional and effective process for resolving medical liability disputes.  Click here to find out where and when to watch in your area.

Are questionable dosing practices fueling antibiotic resistance?

This post comes to us from Patricia Geli Rolfhamre over at Extending the Cure.  More in-depth conversation about antibiotic resistance and the future of our nation's supply of antibiotics is happening on the ETC blog.

Are there ways in which we can reduce the spread of antibiotic resistance by treating patients more strategically? The dosing and duration of antibiotic treatment have been shown to be critical determinants of the likelihood of curing an infection and of the emergence of resistance.   Adjusting these factors to a patient’s individual condition instead of treating every patient with the same antibiotic regimen may be an easy step toward fighting resistance.

Research reports from the American College of Emergency Physicians annual meeting in Boston earlier this week revealed that doctors who work in hospital emergency rooms rarely adjust antibiotic doses for obese patients. The consequences are an increased risk of treatment failure and resistance development. Yet it is unclear how much this will spur the growing resistance epidemic. Given the fact that more than a third of the US population is obese - this trend is worrying. But solving the obesity problem or adjusting the doses for obese patients is only a part of the answer. The other important parameter for successful treatment and for which a one-size-fits-all approach has generally been applied is the duration of treatment.

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.

The Need to Disrupt the Patient Gown: New Research, New Thinking

The efforts of Pioneer grantee North Carolina State University to redesign the current hospital gown are featured on the front page of today’s Wall Street Journal.  Congratulations to Blan Godfrey, Traci May Lamar and the NCSU team – it’s great to see prototype designs emerging from their comprehensive research to determine the needs, constraints and priorities of players up and down the hospital gown supply and demand chains.

 

The article takes a light touch with the subject matter.  True, most everyone hates the gown because it’s an unmitigated fashion disaster…ugly, flimsy, see-through, ill-fitting, inconvenient, hard to tie or fasten, and often thoroughly humiliating in its, er, exposure.  I’ve searched for who is buzzing about this story so far, and it’s been highlighted on the (presumably official, but who knows) Twitter stream of French fashion house Givenchy – I’m thinking this is an RWJF first.

 

But this project was always designed to go deeper, and there’s a real vision and potential for change in health and health care that motivated Pioneer’s decision to support this work.  Indeed, it’s interesting to think about it in the wake of Clay Christensen’s visit last week.  The current patient garment is a classic, ubiquitous example of a job that is not getting done for patients or, as the NCSU research shows, care providers either.

 

Between the survey research and focus group findings at the heart of this project, we’ve learned some interesting things about the gown, how people feel about it, and its impact on care.  The upshot is that it’s never been about just looks: 

• 87% of caregivers felt the current gown sometimes interferes w/ administering IVs, catheters, feeding tubes or other devices. 

• 88% responded that the gown sometimes or always affects the emotional wellbeing of patients.  66% thought it sometimes or always affected patients’ physical well-being.

• 74% of nurses are involved in the gowning process; patients are not comfortable with how to put the gown on when confronted with it, so that even if they’re not seriously ill or impaired, they typically ask nurses for help.

• Some patients confessed that they may limit their mobility becaused they are concerned about being overly exposed in areas outside of their hospital rooms – people don’t just lie in bed anymore to get well. 

• Patients tend to use a second gown as a robe to cover them from the back, which effectively doubles the cost and time of collecting, laundering and stocking gowns.

• There is the perception that nicer, more dignified gowns may help patients feel better emotionally and be more active, boosting their prospects for and pace of physical healing and recovery.  Patients are struck by their loss of dignity and control in the hospital experience..."If I have this gown, I’m really sick.”

It seems that there are certain things in medicine that we do because they’ve always been done that way; such is the case with the patient gown.  It’s become institutionalized as part of the status quo and has gone unchallenged for decades.  It seems so simple and obvious to change the gown and bring it in line with 21st-century care requirements and patient needs and preferences – however, if it were that simple, it would have happened.  As NCSU’s Traci May Lamar states in the article, "We thought that it would be a much easier problem to tackle."

Join Us for Games for Health 2009--Boston, June 11-12

The 5th Annual Games for Health Conference is coming to Boston on June 11-12 with a packed lineup of speakers from game development firms, health and medical institutions, academic and research institutions and elsewhere.  The conference has grown in to the premiere event for networking, identifying new opportunities and sharing learning in this dynamic space.  This year features three game expo spaces, special tracks on both exergaming and cognitive health, and 55 sessions covering the latest in:

• exergaming
• disease and health management
• skills and workforce training
• rehabitainment
• epidemiology
• virtual worlds and health

Here's a sampling of some of the sessions and speakers - click here for a full program schedule to date and to watch a video on upcoming event highlights:

• Jacob Vogelstein, Johns Hopkins Applied Physics Lab - Using Guitar Hero III to create a novel training and evaluation device for upper-extremity amputees
• Debra Lieberman, Univ. of California, Santa Barbara and Health Games Research national program - The Coming Age of Sensor-Based Health Games
• Paul Blair -- Capturing Wiimote & Accelerometer Data for Active Gaming Evaluation
• Ben Heckendorn, benheck.com - Modding and Hacking Game Hardware for Health: Ask and you might receive...
• Doris Rusch, MIT/Gambit - "Akrasia": Metaphorical Depiction of Addiction

Pre-conference workshops will also take place on June 10:  Games Accessibility Day features talks, networking and demos dedicated to making all games more accessible, and helping people with disabilities play their way to better health and wellness.  Virtual Worlds and Health Day looks more in depth at the potential of virtual worlds, which combine social systems with game-based interfaces and graphics to create entirely new spaces to train, practice and visualize. Such systems hold great promise for advancing health and health care through layering on of game play or enabling pure simulation or new forms of social interaction.

Click here to register -- a 15% registration discount is available by plugging in dmgfh09 to the registration code box.  Lodging and conference events are at Boston's Hyatt Harborside Hotel.  Please spread the word and hope to see you there!

RWJF's Expanding Social Media Presence

You can now follow new content from the Robert Wood Johnson Foundation via multiple social media platforms.  We've launched a new YouTube destination, where you'll find more than 30 video stories on the work of the Foundation and its grantees.  The featured story posted now is Pioneer's own Health Care Without Harm-- check out the ways in which Boston's Brigham & Women's Hospital is adopting more environmentally sustainable practices that have meaningful benefits in terms of worker and patient health and safety.  Lots more will be coming online from our Broadcast Health Series and other video efforts.

RWJF also has an active Twitter stream that just topped 600 followers - it issues near-daily updates on reports, announcements and new developments happening across the Foundation and its universe of grantees and interest areas.  Click here to sign up.

And, we're happy to announce that Pioneering Ideas now has a sibling with the launch of The User's Guide to the Health Reform Galaxy, RWJF's blog providing insights on key things driving today's reform debate.  The blog is part of a dedicated section of our Web site that goes in depth on issues that shape reform prospects: health care coverage, improving the quality of care, strengthening public health, etc.  Interesting posts have been published on health IT, the impact of the nursing shortage, social determinants of health and so on, and you'll hear from a range of staff and grantee voices.  Check it out and take us up on our sincere and open invitation to add your thoughts to the conversation. 

Nortin Hadler Lecture - Personal/Social/Policy Barriers to Wellness When it Comes to Low Back Pain

Next up, the Penn Positive Health Lecture Series features Dr. Nortin Hadler speaking on "Backbone: Personal, Social and Policy Consequences of Low Back Pain."  Nortin Hadler M.D., MACP, FACR, FACOEM, is professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill and attending rheumatologist at UNC Hospitals. Having analyzed the "illness of work incapacity," his most recent book is "Worried Sick: A Prescription for Health in an Overtreated America."  

The lecture will consider backache as a human predicament, a profound social problem, a medical issue, and a vexing public policy challenge.  Basing his critique on an analysis of the most current medical literature as well as his clinical experience, Hadler argues that regional back pain is overly medicalized by doctors, surgeons and alternative therapists who purvey various treatment regimens. Furthermore, the design of "health," workers' compensation, and disability insurance schemes thwarts getting well. For the past half-century, says Hadler, back pain and back pain-related disability have exacted a huge toll on modern societies, in terms of pain, suffering, and financial cost.

Here are details:

Date - Wed., April 22, 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

2nd-Round Project HealthDesign CFP Targets "Observations of Daily Living"

RWJF launched Project HealthDesign in 2006 to stimulate innovation in the development of personal health record (PHR) systems by transforming the concept of PHRs as data collection tools to PHRs as a foundation for action and improved health decision-making.

 

The first round of funding resulted in a range of applications that addressed self-management tasks ranging from a cell phone-enabled medication-management system to a personal digital assistant that collects and supports self-reported pain and activity data and provides a fuller picture of patients’ everyday chronic pain experiences.

 

In the second round, RWJF will award up to $2.4 million in grants to as many as five grantee teams for 24-month demonstration projects that will assess and test how “observations of daily living” — data on experiences such as meals, sleep, exercise, pain episodes and even moods — can be collected and interpreted such that patients can take action to better manage their health and clinicians can integrate new insights into clinical-care processes. 

 

Brief proposals are due on June 3.

 

Lygeia Ricciardi provides more details over on the Project HealthDesign blog.

Update: Positive Deviance & MRSA Reductions on NYT Lede Blog

Kevin Sack interviewed the CDC's John Jernigan about the effects of the Plexus Institute's positive deviance MRSA prevention partnership and wrote a post on the New York Times "Lede" blog.  Check it out and comment away, either there or on Pioneering Ideas.   

Positive Health Lecture Series Kicks Off With Sir Michael Marmot

In 2008, Pioneer funded Dr. Martin Seligman to extend his influential work in the area of positive psychology in to the realm of "positive health"--a new approach to improving well-being that emphasizes “health strengths” rather than the conventional mix of disease diagnosis, treatment and prevention.  Building on progress in the positive psychology field, which applies validated interventions to boost the strengths and virtues that help individuals thrive in daily life, Seligman and his team are exploring whether positive health may reveal a variety of potent, low-cost approaches that can serve as a buffer against physical and mental illness and, more importantly, enhance people’s overall health strengths.

The project is hosting a speaker series that kicks off next week at University of Pennsylvania's Medical School.  First up is Professor Sir Michael Marmot, chair of the World Health Organization Commission on Social Determinants of Health and director of the International Institute for Society and Health, University College London.  Marmot will address the Commission’s work to examine underlying social determinants of health and how it is transforming global and national policy debates to improve health.

Admission is free and open to the public, so feel free to spread the word among those in the NJ/PA/DE area.  Here are the details:

Date: Wednesday, March 4

Time: 12:00-1:00 pm

Location: Dunlop Auditorium in Stemmler Hall at the University of Pennsylvania School of Medicine, near 36th and Spruce Street in Philadelphia.

Need more specifics?  Click here.

Freakonomics Blog Sparks Debate On "Designing for Better Health" Competition

Major thanks to Steven Levitt of the New York Times Freakonomics blog (and co-author of the book by the same name) for publishing a post on the new Changemakers competition, "Designing for Better Health."  The competition, which seeks innovative "nudges" that can influence people to make healthier choices for themselves or others, has kicked off a really interesting string of comments among Freakonomics blog readers.  Add your perspectives, either there or on the Changemakers competition site.

Posting from TED: Health, Design and Game-Changers

Sorry for the lapse in TED posting…never have I seen an event program as packed as this.  It’s made getting back to the hotel a challenge, and throw in some tenuous wireless connections…well, you get the point.  But here’s a recap of RWJF’s luncheon at TED, held Thursday. 

We had a packed room of 60 TEDsters--including the creators of Del.icio.us and hotornot.com, heads of design schools, the president of user experience design firm Adaptive Path (developer of the Charmr, from an earlier Emily Culbertson post), execs from venture capital and game development firms, David Pogue (technology columnist for the New York Times and one of my favorite writers) and the founder of DNA Direct (a genetic testing and management company)—with about 30 who lined up to attend, but unfortunately we couldn’t accommodate due to space limitations.

Pam Omidyar, founder of HopeLab gave a great recap of the inspiration behind and clinical outcomes linked to Re-Mission, the video game developed for kids battling cancer.  There were cheers when she showed the results, which demonstrated that kids who played the game had higher levels of treatment adherence and more knowledge about their disease ,and were more empowered to fight back.  She showed amazing MRI imagery that showed players’ brains on Re-Mission.  Areas tied to emotional processing lit up, which was key to internalizing the lessons underlying the challenge and excitement of the first-person shooter game.  We were honored to have Taylor Carol and his dad, Jim, with us – Taylor is now in full remission from leukemia, played the game during his six months in the hospital, and is the star of our promise story on Re-Mission. 

John Maeda, president of RISD, outlined distinctions in mission and change vision between designers and artists, and called on more designers to apply their skills, thinking, creativity and ingenuity to save the world.  Having given some of the more popular TED Talks in years past, he provoked the group to think differently about the potential of this space.

The group then turned to the game jam, led by Ben Sawyer and game designers Noah Falstein and Larry Holland.  The crowd first decided to tackle the issues of chronic disease, and then refined the challenge further to focus on actions and behaviors.  Some of the ideas they proposed that seemed promising to the game developers included:

• Addressing metabolic syndrome, using a game approach to help navigate the different associated conditions and co-morbidities, trade-offs among treatments, and patients’ abilities to manage aspects of their condition.
• Developing a realistic, action-based approach to the immunization debate that can inform decisions around vaccine safety.
• A game focused on how to manage depression…when asked why that intrigued them, the developers replied, “Because it seems hard.”  
• Helping patients better navigate health care systems and services.

Noah and Larry continued to work through these possibilities in to the evening on Thursday and all day Friday.  The results of their concept development will be unveiled at our TED Lab exhibit space this morning.

We’re grateful to Pam, John, Ben, Larry and Noah for joining us and shining a spotlight on the potential for games to spark big change in health and health care.  I think people came away with a sense for that potential to touch people’s lives and help them pursue health goals and make informed decisions in uniquely powerful ways. 

Ben and his team are going to see where these ideas may go from here, so let us hear your input on how this exploration can lead to the next breakthrough health game.

Bringing our Game to TED – 6 Days and Counting

For the first time, RWJF and Pioneer are a sponsor of the annual Technology, Entertainment and Design conference, kicking off next week in Long Beach, Calif. 

In exploring the opportunity, we thought a range of issues and people supported by Pioneer might be interesting to TED – what we landed on was a look at of the games for health field, how it might transform health and where it’s going in the future.

The intersection of video and computer games and health and health care boils down to a pretty interesting question: what possibilities open up when you approach health as a design challenge?  It’s one we’ll be digging in to at TED, as our luncheon event features world-renowned designer, researcher, artist and thinker John Maeda, president of the Rhode Island School of Design.  Joining him is Pam Omidyar, co-founder of the Omidyar Network and of HopeLab, the group that launched the sophisticated, fun and effective kids’ cancer game, Re-Mission.  We’re really honored to have them with us.

John and Pam will hand it over to Ben Sawyer of Games for Health to lead TEDsters through a mini-game jam.  Ben will be joined by game designers Noah Falstein of The Inspiracy and Larry Holland of Totally Games…they’ll lead TEDsters through a structured brainstorm process that lets the audience throw out ideas for where a game solution might really push progress on a big health or health care challenge. Then, for the next day and a half, the game designers will feed that input in to their creative process, rapid-fire sketching out pathways to solutions until they emerge with a compelling health game concept by the last day of TED.  We’ll also have a “Lab” space with an exhibit designed by the super-talented team over at Daylight Design, which will guide TED attendees through the Now, Near and Next breakthroughs in the health games field. 

I’m really excited by all that I’ll hear that I know I can’t begin to expect…the unanticipated connections to the kind of social change that RWJF and Pioneer is after.  Nancy Barrand, Paul Tarini and I will be there and posting daily updates to the blog – we hope you’ll join along for our first TED and shoot us some comments and questions.

So simple...so stunning...such a struggle

Somebody sent me this image of a handprint featured in this week's New England Journal of Medicine.  So stunning.

 

Why?  The handprint was taken from an ungloved health care worker after performing an abdominal exam on a patient -- the pink area on the left represents MRSA colonies grown from the handprint.  Image B shows a second hand imprint obtained from the worker, after those same hands were treated with alcohol foam.  The resulting culture tested negative for MRSA.  So simple.

And still such a struggle for well-meaning care providers to take the necessary preventive steps.  Arghhh.  Innovations emerging from the Plexus Institute's positive deviance initiatives offer one promising path to a solution.  Last month, they were highlighted in the New York Times "Year in Ideas" for their success in changing processes that enable the right behaviors in hospitals' assault on MRSA infections.

Where might new innovations emerge to break through seemingly intractable problems like this?  Perhaps from the new idea competition  we launched yesterday with Ashoka's Changemakers to find those who are designing effective "nudges" that help people make better health decisions.  Paul Tarini will be writing more about the vision behind this competition, but if you're curious, check it out and join the search for simple but elegant breakthroughs that might prevent the next case of someone checking in to the hospital and winding up with a MRSA autograph stamped on his or her body.

"Happy Friday!" Takes On Added Significance with New BMJ Study

I'm happy today, which is likely to mean that my friends and family are happy, and their friends and family are feeling right with the world too.  So say grantees Nicholas Christakis of Harvard Medical School and James Fowler of UC-San Diego -- the latest study from their ongoing analysis of health effects in social networks finds that happiness, like smoking- and obesity-related behaviors, is a social contagion.  The article, "Dynamic Spread of Happiness in a Large Social Network," came out today in BMJ and has been getting a good deal of attention in the LA Times, Washington Post, NPR and elsewhere. 

As with earlier studies to come out of this line of research, Christakis and his colleagues used data from nearly 5,000 individuals enrolled in the Framingham Heart Study over a period of 20 years, and find a three-degree flow of influence when it comes to spreading the cheer. The graphic above shows the spread across the network.  Check out this finding from the release:

"...when an individual becomes happy, a friend living within a mile experiences a 25 percent increased chance of becoming happy. A co-resident spouse experiences an 8 percent increased chance, siblings living within one mile have a 14 percent increased chance, and for next door neighbors, 34 percent.  But the real surprise came with indirect relationships. Again, while an individual becoming happy increases his friend’s chances, a friend of that friend experiences a nearly 10 percent chance of increased happiness, and a friend of that friend has a 5.6 percent increased chance—a three-degree cascade."

Interestingly, the effect is not seen if you're unhappy -- that sentiment does not seem to spread the same way.  And it doesn't exist among co-workers.  Apparently, this may come in to play when we don't all exude joy in the same way as that dear colleague who just got the big promotion. 

Finally, Christakis and Fowler propose implications for health policy and health care:

"To the extent that clinical or policy manoeuvres increase the happiness of one person, they might have cascade effects on others, thereby enhancing the efficacy and cost effectiveness of the intervention...illness is a potential source of unhappiness for patients and also for those individuals surrounding the patient. Providing better care for those who are sick might not only improve their happiness but also the happiness of numerous others, thereby further vindicating the benefits of medical care or health promotion."

So, happy Friday, indeed -- here's hoping the feeling carries right through your weekend and to everyone in your networks.

Do you flu Yahoo!?

Google.org may have grabbed headlines last week with the announcement that search term activity on its engine may forecast real-life flu activity, but grantees Phil Polgreen and Forrest Nelson are releasing the first peer-reviewed journal article that documents this trend.  Together with partners at Yahoo! Research and Harvard, they published a study in Clinical Infectious Diseases that finds that frequency of Web searches on flu and influenza (excluding searches related to avian flu, vaccines and other outlier terms) predicted increases in cultures positive for influenza one to three weeks in advance.  Their study, and a quote from Phil, were cited in the New York Times cover story on the Google flu trends service.

Given the ultra-real-time nature of Web information, and the fact that 8 million people search for health information every day, it’s perhaps not surprising that this is a potentially rich avenue for exploring whether people’s hunt for information online signals their health concerns, experiences, conditions, behaviors, expectations and even outcomes.  This has sparked privacy concerns -- also not surprising.

Polgreen, Nelson and colleagues examined the relationship between influenza culture data and Yahoo! searches at the national level, breaking searches down in to 9 Census regions and tracking activity over time.  They reported a statistically significant relationship between intensity of flu-related queries and levels of flu cases and even deaths.  The methodology has some limitations due to the fact that data only go back four years and other reasons, but it’s another potentially valuable tool in public health professionals’ toolbox.  And given the reality that current CDC surveillance activities identify disease activity only as or after it occurs, any advance jump on an outbreak seems like a good thing. 

This is what drives Polgreen’s and Nelson’s other Pioneer-funded work to test the use of electronic prediction markets to forecast domestic and avian flu activity.  The premise being that more knowledge, gained more quickly, fuels wiser policy and resource allocation decisions, better prevention and treatment actions, and hopefully less incidence of disease with less harmful effects. 

Search term surveillance may yield trendspotting clues for public health officials fighting emerging and reemerging infectious diseases, changes in phenomena tied to chronic illnesses or trends in STD infections ahead of official reports of disease activity.  It’s fascinating to think of the potential that exists in mining aggregate data from the ways we digitally engage in the world in the course of our everyday lives, and how that collective information may be applied to improve public health and health care practices.  This is an area that Pioneer might explore more down the road – we’d like to hear what you think about this, and how it might be applied.

Live-blogging from Health 2.0 Conference

We weren't able to go to the Health 2.0 conference, which kicked off yesterday in San Francisco.  The agenda had some sessions that looked great, including ones on patient social networks, Health 2.0 platforms for patient-provider communication, how the field is moving ahead in Europe and Asia, and how the issues of privacy, confidentiality and security will shape consumer confidence in Health 2.0.

Luckily, Lygeia Ricciardi is blogging live from the event over at Project HealthDesign's blog.  Her first post is up and she'll be publishing a few more over the next day or two.

Interesting things, here and there...

Thanks to Jerry Michalski of Sociate for telling us about a massively multiplayer online game hosted by Institute for the Future called Superstruct.  The folks who do IFTF's 10-year forecasts put together a game in which anyone and everyone can figure out what life might be like in 2019, and help invent the future of society as it relates to 5 different scenarios.  One is directly about health -- the QUARANTINE category states that outbreaks have become a common element of our existence.  It focuses on a respiratory infectious disease called ReDS and challenges players to consider all the implications and figure out how to respond.

The other game scenarios have important implications for health as well, as they immerse you in envisioning a world in which we're:

• RAVENOUS - the food chain is broken and we have to reinvent ways to feed ourselves
• in a POWER STRUGGLE - the world is caught up in "Alternative Fuel" wars over what will take the place of oil
• facing GENERATION EXILE - our neighbors have become climate and economic disaster refugees in search of new places to live, or
• an OUTLAW PLANET -- In 2019, the mobile internet and sensor networks we rely on to hold our societies together are being hacked, griefed, and gamed.

The site today reports that there are 4,905 players with a collective score of 4,911.  What this means is that the current survival horizon, based on all of these superthreats and how we deal with them, is through 2047.  The game started on Oct. 6 and runs for 6 weeks -- check it out and sign up to play.

Another item worth reading is eFuturist Douglas Goldstein's take on the future of video games and health, posted today on The Health Care Blog.  He has this to say:

"It may be surprising to some that the health care industry has been among the first to recognize the ‘game-changing’ potential of games in business and other environments.  Leaders in the health care sector are now embracing video games as an integral part of a digitally enabled health culture."

He also points to an October 2008 market report from iConecto that identifies health games as a growing field.  Right now, they estimate that the health games market stands "at approximately $7 billion during the next 12 months including the markets for brain fitness ($267M), exergaming ($6.4B+) and other Health eGames on the consumer and professional side ($250M+).  An expanded executive summary of the report can be obtained here.

Project HealthDesign Webcast now available

Click here for a complete Webcast from last week's Project HealthDesign forum on the future of personal health records.  The Webcast is broken down by sessions so you can check out as much or as little of the day as you like.  I also encourage you to check out a set of short videos that drive home what it might be like for patients to use next-gen PHR tools and applications in the future -- you can access them by clicking on the links to each grantee's summary. 

We hope you'll continue to give us your reactions to the day's discussions, whether you saw them live or on the Web. 

Blog talk post-Project HealthDesign event

More than 200 guests joined us for Wednesday's event, "New Frontiers in Personal Health Records: A 'Report-Out' from Project HealthDesign and Forum on Next-Generation PHRs." It was an exciting day -- the grantee teams rolled out their diverse PHR application prototypes and talked candidly about the themes that tied them together: focusing not just on the records but the actions you can take given the information; the power of looking beyond medical data to incorporate observations of daily living; and moving past PC-based access to practical, on-the-go IT tools that fit in your daily routines.  And we heard some provocative panels talk about common platform solutions to support a vibrant marketplace of such tools, key policy considerations, how health systems are harnessing the future of PHRs, and directions that industry leaders may take to meet consumers', employers' and others' needs.

Steve Downs will have more to write on Pioneering Ideas about his thoughts on the event, and where we go from here.  But in the meantime, bloggers at the event captured some interesting insights:

• Keynote speaker Amy Tenderich of DiabetesMine summarizes many of the key themes that RWJF President Risa Lavizzo-Mourey presented at the start of the day, and which carried through the whole event.  Amy's great talk at lunch reminded us with urgency, and yet much hope and humor, that the health, IT and design communities should sit up and pay attention to the fact that devices should fit people's habits, preferences and styles in addition to the particulars of their health conditions. 
• Lygeia Ricciardi live-blogged a couple of posts during the day on the Project HealthDesign blog.  She first commented on the morning grantee panels -- a key point that rang through all of their work was that illness happens to the whole person, not just a body part or system.  Designing tools through patients' eyes enabled very different breakthroughs as a result.  She later drove home a point that U. Rochester grantee George Ferguson stated -- that the field should be moving toward delivering a seamless ecosystem of PHR tools and technologies for consumers, not a plethora of stand-alone gadgets.
• Vince Kuraitis of Better Health Technologies and the e-CareManagement blog moderated an afternoon panel with executives from Google, Dossia and Microsoft to tease out where the industry may be heading.  He writes on the evolution from PHRs to comprehensive PHR systems, and why this transition may take hold among patients more easily than providers.
• Family physicial and patient empowerment champion Ted Eytan posted live from the opening session and shared a great set of photos from the event.
• It was interesting to read why an attendee from the Center for Student Health and Life thought students might be the quickest adopters of PHR applications like the ones presented on Wednesday.  They think it's due to student's pervasive reliance on social networking tools and the promise that PHR technologies hold for wellness promotion. 
• Federal Telemedicine News posted a range of points made by many of the grantees throughout the morning. 

Thanks to everyone who participated in the event.  Look for a link to a complete Web cast of the day on Monday.

FasterCures, Innocentive Crowd-Source Solutions for Biomarker Research

I mentioned in my post on FasterCures' Mid-Year Top 10 Watch List that they were working on an Innocentive competition to discover breakthroughs in disease research. Yesterday, that competition went live -- FasterCures will award a guaranteed payout of $10,000 for the two most promising ideas that encourage companies to invest and collaborate more in biomarker research and qualification.

Biomarkers are used by medical professionals to determine proper diagnosis, prognosis and the optimal course of treatment for a patient. Widely viewed as a critical technology to personalizing treatment choices and maximizing the impact of medical treatments, biomarkers are key to the biomedical research process and can shave years and millions of dollars from the research and development process.

According to FasterCures President Greg Simon, health care industries have "...little incentive to invest in biomarker research and development and keep the results of their investment in the public domain, where it can do the most good."  Hence the move to crowd-source solutions from the open scientific community that competes in Innocentive's online challenges. Their hope is to eliminate that "first-mover disadvantage" by throwing the search for solutions wide open -- Innocentive's network reaches 160,000 "Solvers" based in 175 countries and cutting across 60+ industry disciplines.

The biomarker challenge is posted in InnoCentive’s Global Health Pavilion, home to competitions that focus on solving some of the world’s biggest health challenges. The entry deadline is November 15, 2008. We'll be interested to see how this approach to discovering breakthrough ideas works for FasterCures.

FasterCures' Mid-Year Top 10 Watchlist

FasterCures gives us a mid-year blog check-in on its Top 10 trends to watch regarding breakthroughs in medical research.  Their number one slot talks about how donors can maximize "return on philanthropy," referencing the FasterCures Philanthropy Advisory Service that will launch this fall.  Pioneer supported this, along with Gates, to provide an investment-grade information marketplace that can guide the efficiency and productivity of (a) donors and (b) nonprofit disease research groups that rely on their support in the search for cures.

Other things to watch?  The need for more cutting-edge translational research to move findings on new therapies and approaches from the lab to the clinic more quickly.  Science 2.0, and crowd-sourcing new discoveries.  I was interested to learn that FasterCures will be posting an "ideation challenge" this fall through InnoCentive.  Comparative effective analysis.  EHRs and the "healthcare information superhighway.  And, new paths to breakthroughs that look beyond the standard clinical trial approach.  They give a nod to Archimedes and our support of ARCHeS, stating that, rather than depart from the gold standard of clinical trials, predictive models could "radically streamline the[ir] design and simulation".

We'll keep you posted on the launch of the Philanthropy Advisory Service.  In the meantime, anything else you'd add to their watchlist? 

Forge New PHR Frontiers with Project HealthDesign at 9/17 Forum

We hope you can join us September 17th in Washington, DC for "New Frontiers in Personal Health Records: A Report-Out from Project HealthDesign and Forum on Next-Generation PHRs."  Project HealthDesign and its grantees have been pushing the potential for personal health records (PHRs) and related technologies to help consumers take charge of their health like never before.  This free, one-day event will feature the grantee design teams, who will showcase the prototype PHR applications they have been developing over the past 18 months, along with experts discussing key issues in this space, including:

• ways that new PHR designs can enhance how people manage their health and coordinate their care in the course of their everyday lives;
• the most important policy questions that will shape this dynamic field;
• where health system and tech industry leaders see this field heading, and its potential for empowering consumers;
• the innovative possibilities that emerge when you involve end users in the design and development process from the start;
• functional requirements and common platform components developed by Project HealthDesign, and how they could have broad application across the PHR field;
• ethical, legal and social implications presented by next-generation PHRs, and more.

Speakers confirmed thus far in the lineup include:

• Colin Evans, President and CEO, Dossia
• Risa Lavizzo-Mourey, President and CEO, Robert Wood Johnson Foundation
• Keith Toussaint, Senior Program Manager, Microsoft HealthVault
• Amy Tenderich, DiabetesMine blogger
• Carol Diamond, Managing Director of the Health Program, Markle Foundation
• Karen Bell, National Health Information Technology Coordinator, Office of the National Coordinator for Health Information Technology

The event is being held at the Westin Washington, D.C. City Center -- please e-mail Erica Garland or call 202-745-5119 to register.  We hope to see you there for what looks to be a day of fascinating discussion and exploration.

Save the Date - New Frontiers in Personal Health Records

Mark your calendar now -- we're pleased to announce that details have been set for "New Frontiers in Personal Health Records: A Report Out from Project HealthDesign and Forum on Next-Generation PHRs."  Here's the logistical info:

Date: September 17, 2008

Time: 8:00-5:00

Location: Westin Washington, DC City Center

RSVP: Erica Garland, GYMR Public Relations

We hope you can join us to explore the vast potential for personal health records (PHRs) and related technologies to help consumers take charge of their health like never before. The event also provides the opportunity to showcase the array of next-generation, user-centered PHR applications developed by grantees of Pioneer's Project HealthDesign program.

Project HealthDesign grantees have pushed PHRs far beyond just providing consumers with access to their health information...these PHR tools are designed to meet people's varied and specific health needs, interpreting their health data and delivering customized feedback that can guide their daily health decisions. In addition to highlighting what Project HealthDesign has learned in the process of developing these tools, the Showcase will feature panels and discussions with leading health IT pioneers, policy makers and industry experts. At the event, you will have the opportunity to:

* Participate in an open dialogue about the prototypes and the future of PHRs, including lessons learned from user-centered design and policy directions to support continued growth and innovation in the PHR arena.
 
*  Engage in discussions with key experts on a variety of topics, including future directions that key industry players may take in this arena.

* Hear lessons coming out of Project HealthDesign and how they might influence emerging PHR services.

* See the prototypes that Project HealthDesign innovators developed to demonstrate the practical applications of PHRs to improve people's daily health.

* Learn about the functional requirements and common platform components developed by Project HealthDesign and explore how they could have broad application across the PHR field.

Please spread the word to others that may have interest in this event - we'll be posting back regularly with updates on the agenda and speakers.  We hope to see you in September!

Tomorrow's New Vital Signs, PHR-delivered

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

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

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

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

Largest-ever CleanMed Conference Wraps Up in Pittsburgh

Stacy Malkan from Health Care Without Harm (HCWH) sent us an update from CleanMed 2008, which wrapped up this week in Pittsburgh.  More than 600 people participants came together to galvanize action to green the health care system.  Teresa Heinz and grantee Gary Cohen of HCWH gave welcoming remarks and Ron Davis, president of the AMA, followed with a keynote address, showing that this issue has grabbed the attention of some of the most influential leaders in health care.

Theresa Kanter attended and will provide a first-person blog report, but for now, here are a few links to more conference and green health developments:

• The Wall Street Journal blog covered the meeting -- reporter Laura Landro took a closer look at a proposed plan to introduce health care's first electronic energy auction service.  The goal is to use the substantial purchasing power of hospitals to move the health market toward more sustainable product development and resource consumption;
• CleanMed conference blog, for summaries of discussions on clean energy purchasing, the future of sustainability in the health care sector, etc.; and
• The newly launched Web site for the Global Health and Safety Initiaitve, which HCHW is helping to spearhead.  Nearly 20 founding health care systems have banded together thus far to transform the way that health care designs, builds and operates its facilities, along with the products used within those facilities.

Game Drives Open-Source Biochemical Discoveries

On Day 1 of the Games for Health conference, Zoran Popovic of the University of Washington gave a demo of his Fold It! game project.  This unique effort, produced in partnership with Electronic Arts and others, is a massive multiplayer game that challenges thousands of players to work in competition and collaboratively to answer unknowns about the stucture and design of proteins.  I don't know a whole lot about proteins, beyond the fact that they play a big part in many diseases and also can contribute to cures, which is intriguing scientists like Zoran.  Ultimately, the answers uncovered through the game play contribute to the search for vaccines and cures related to HIV/AIDS, cancer, Alzheimers, etc.

    Here's a screen shot of Fold It!

The "Second Life" of NY Times Magazine Cover Feature, CeaseFire

This weekend's New York Times Magazine cover story profiles CeaseFire, a violence prevention program built on a public health model that attacks the spread of violence much like epidemiologists attack the spread of infectious diseases.  The charge it issues in its ads and print materials is clear-cut:  Stop. Shooting. People.  CeaseFire is supported by RWJF's Vulnerable Populations portfolio, and its innovative "violence interruption" strategies are making a real difference on the streets of Chicago and increasingly, as the article notes, in other urban centers plagued by gun crimes and deaths. 

Among RWJF programs, CeaseFire also has been out in front in testing virtual world tools and techniques to enhance its real world impact.  In 2006, CeaseFire Deputy Director Candice Kane and her partners at the University of Illinois at Chicago's Center for the Advancement of Distance Education (CADE) attended a Games for Health West Coast meet-up in LA.  Since then, they have developed two islands in Second Life as part of their training protocol for violence interrupters and community outreach staff, helping them learn how to diffuse situations that otherwise might escalate in to violent attacks or acts of retribution. 

CeaseFire Island avatars and streetscapes are closely modeled on real-life Chicago staff and neighborhoods...right down to the graffiti and cigarette ads plastered on the buildings.  A slide deck from CADE provides some great screenshots -- if you read the Times story, you'll recognize Janell, Tio, and others and see what their avatars look like.

Coming up, we'll get the chance to talk to Candice about CeaseFire's experience in using Second Life to complement its offline training efforts, though we might have to wait for their phones to stop ringing off the hook, given the interest the Times article might spark.  Stay tuned...

P.S.  The slide presentation also highlights other ways in which CADE is using virtual worlds to improve pandemic flu and bioterror-related disaster preparedness.  Find out more at www.virtualpublichealth.com.

RWJF's Wii Workout

Following on Theresa's post...

Though we might not be as edgy as the Game Developers Conference (yet), RWJF is making strides (and swings, punches, serves, strikes and spares).  We thought you might like to check out a few photos from the recent "getting to know Wii" sessions that the Foundation held for staff.  Thanks to all who graciously gave us the OK to share these (and who pull it off with such style in their business-gamer attire).

	Linda and Lois duke it out in the boxing ring.
	Jasmine and James have the crowd on their feet.
	And Wilson shows off his left hook as Jasmine plans her next move.

There's even talk that they may break out the Wii for our trustees to play during their upcoming board meeting.  In a few weeks I'll check in with Kristine Nasto, who oversees our facilities including the fitness center, to see whether and how the games are influencing people's workout preferences.

Ruckus Nation Celebration!

Ruckus Nation announced its grand prize winner today -- congratulations to Stacy Cho, a Seattle middle school teacher, for rising to the top of 429 entries with her "Dancing Craze" game idea and landing the top prize of $50,000! 

“Dancing Craze” is an interactive game with wearable motion sensors that make your virtual character come alive as you show off your real-world dance moves. It lets you pick your music, record your moves and share your virtual dance video online. With “Dancing Craze,” you can also create group dances or test your skills by mimicking videos from other players, and log on to the “Dancing Craze” website to see whose moves are voted number one.

Moments after finding out she won, Stacy said:  "I wake up every day and look for ways to motivate kids. I looked around at the games kids were playing and realized that the piece that was missing was physical activity. My idea is all about movement and music and fun to get kids moving." 

When she learned about Ruckus Nation, she encouraged her students at Island Middle School to enter, and then got inspired to enter herself.  The idea came to her in the middle of the night.  "You always think of the best things when you’re sleeping, right?  Kids are obsessed right now with games, with Dance Dance Revolution and Guitar Hero. We even have Rock Band at our house. I just started trying to think of what else I wish they had, and I thought, ‘Why can’t a game respond to my movements or actions?’"

HopeLab founder and board chair Pam Omidyar had this to say about the competition to find ingenious ideas to get kids more physically active -- "We learned from our experience with Re-Mission that if you lead with fun, health will follow...Ruckus Nation continues that tradition. HopeLab’s commitment to quality research and innovation will ensure that the creative thinking put forward in Ruckus Nation is put to great use to help kids.”  Indeed, the next step is for HopeLab to test the winning idea for its viability as a product that could be prototyped and brought to market.

The awards ceremony took place at the de Young Museum in Golden Gate Park, and our own Paul Tarini was on hand to help judge finalist entries and speak at the ceremony.  Congratulations to the winners and to HopeLab -- it was exciting to see the creativity from so many teams around the world.  Ruckus Nation always challenged people to believe that "Your idea could start a movement."  Hopefully, the ideas it generated will help sustain a movement to direct innovation toward helping kids lead healthier lives.

Who'll Make the Biggest Ruckus? Stay Tuned.

Ruckus Nation, the international online idea competition we sponsored with HopeLab to get kids moving, announced its semifinalists today.  Of the 429 entries from 37 countries, 56 teams won $250 semifinalist prizes.  Check out some of the ideas behind "Artillery Dodgeball," "Txt It!," "The Poof Suit," "Pulse Force," "QuikChange Inline," "Snag Tag" and all the other winning concepts on the Ruckus Nation site. 

This is all leading up to next Monday's announcement of the 10 finalists across the competition's four age categories (middle school kids, high school, college/university, and all others) and the grand prize winner.  Finalist teams will receive $25,000 and the grand prize-winning team will receive $75,000 for coming up with the most innovative product idea that will inject a healthy and cool dose of physical activity in to kids' lives.

Paul Tarini will be at the grand prize event at the de Young Museum in SF's Golden Gate Park on Monday, and we'll post the final competition results as soon as we learn them.  In the meantime, congrats to the  semifinalists!

Sports4Kids -- Winning Through Play

We've written a lot about competitions that RWJF has sponsored with Ashoka's Changemakers, but here's a great piece of news coming out of a  competition that was not tied to us.  Yesterday, Sports4Kids, a Bay Area-based program supported by RWJF's Vulnerable Populations Portfolio, was voted by the Changemakers online community to be one of  three winners in the "Sports for a Better World" competition, sponsored by Nike. 

I've lucked out by getting to work with Sports4Kids in the past, and their model is revolutionizing recess and reintroducing play in to the lives of low-income kids.  Founder and Ashoka Fellow Jill Vialet is a dynamic force in bringing the power of play to change kids' lives, improve school environments, and build family and community engagement.  Check out the video to get a sense of the program's impact and why it's exciting to see this program gain wider recognition. 

Congrats to Sports4Kids, and to Changemakers for another successful competition that has elevated the efforts of leading social entrepreneurs throughout the world.

Wii are excited...

Every Tuesday morning, RWJF program staff gather for a meeting to review proposed grants, policies and other foundation matters.  There's usually a few minutes at the start when announcements, staff birthdays, etc. flash on the screen at the front of the room.  Today we found out that RWJF's fitness center is adding the Nintendo Wii to the array of fitness services that are available to staff and guests. 

I was surprised at first that they made the move, but think it's great that the facility is so forward-thinking in its approach to fitness.  It may be the trick to get me in there one more day a week, which I've been pledging to do for ages now, but with no real conviction. 

I'll try to follow up with our fitness center staff to see whether and how staff incorporate the Wii in to their workouts, and report back to the blog.  In the meantime, have you heard of other workplaces that are trying this out?

Project HealthDesign Releases Core Technical Requirements for PHRs

Today, Project HealthDesign released an advance set of core functional requirements for personal health record (PHR) applications of diverse types. What we’ve learned as the grantee teams have progressed is that, despite the differences in PHRs designed for, say, adults managing chronic pain, caretakers of children with cystic fibrosis or sedentary adults wanting to increase their activity, there are numerous functions they have in common. Things like wanting PHR tools that track observations of people’s illness experiences, or incorporate calendaring and reminder systems that prompt users to take medications or schedule appointments.

With support from our funding partner, the California HealthCare Foundation, Project HealthDesign enlisted the expertise of Walter Sujansky and his team at Sujansky & Associates to work closely with the grantees to develop basic functional building blocks that are useful to many, if not all, of their projects. Four target components—medication list management, calendaring, observations captured in the course of daily living and identity management—were identified as representing important building blocks for many PHR applications.

Given the diversity of the grantees’ PHR applications, we expect that this set of open-source functional requirements should be useful to the broader field. They can inform the providers of PHR platforms of potential services they can offer to enable more third-party application development. This will hopefully add something valuable to what the Microsofts and Googles will provide in the PHR space. The requirements also provide an opportunity for PHR application developers to join the discussion and add their perspective on what core services are needed to support their applications.

The “joining the discussion” piece is especially important to us. The Project HealthDesign team invites you to review the functional requirements and provide comments on how you think they might work. You’ll find more information on the requirements and the ongoing work of Project HealthDesign and Sujansky & Associates on the project's site, and a longer description of this new effort on the Project HealthDesign blog.

On Not Being Boxed In By Common Sense

Over lunch, I was reading this week's e-mail digest from the Skoll Foundation's Social Edge community, a great source for the latest on social entrepreneurship.  Today's lead feature is a string of first-person blog entries from Bill Strickland, who over time has built up the Manchester Bidwell organizations to provide wonderfully effective arts, education and career training opportunities for disadvantaged youth and adults.  A MacArthur Genius Award recipient, Strickland has become a force for economic revitalization and social change in his home city of Pittsburgh, and his model is spreading to other cities.  I was struck by what Strickland had to say about the change that he has led:

"That didn’t happen by magic. It happened because I refused to be limited by what conventional wisdom, or other people, or the cautious little voice we all have in our heads told me I couldn’t do. I haven’t accomplished everything I set out to do, but I’ve accomplished a whole lot more than I would have if I’d let myself be boxed in by common sense and “sensible” expectations."

To solve the health care problems of today and tomorrow, we need visionaries with that same persistence, ingenuity and ability to fend off the pressures and constraints of conventional thinking.  They are who Pioneer seeks to connect with and support. 

Which leads me to ask:  do you know where the Bill Stricklands of the world are working within the health sector?  We also want to connect with unique thinkers and change-leaders outside of health that can bring fresh perspectives and decidedly not boxed-in solutions to challenges in health and health care.  If particular folks come to mind, tell us, either via the blog or by e-mail.  Thanks.

"Project Runway" Meets Health Care

I had always assumed that shopping for Italian fashion was bad for me for any number of reasons...cruel combination of sticker shock and the fact that clothes in Italy seem to be sufficiently tight on me that they cut off blood flow to vital organs.  A recent post on WIRED's blog may lead me to think differently.

Smartex, an "e-textiles" company based outside of Pisa, is designing functional clothing that not only looks good but also captures key health data.  They've created a system called "WEALTHY," (for, "wearable health care system") that uses sensor-equipped textile interfaces to continuously monitor vital signs, wirelessly relay EKG and other data and contribute to intelligent decision-support systems for patients and caregivers.  Despite its built-in electrodes, temperature sensors and conductive leads, the company's tank top (shown here) feels completely normal and even looks halfway decent.

(...fortuitously, our wonderful blog coordinator, Kate Garrett, has temporarily relocated to Pisa this spring, and may be able to follow up with an investigative site visit to Smartex headquarters.)

I know at least several Project HealthDesign teams that have considered how biosensing fabrics and materials might help people track valuable health info. in the course of their daily lives and transmit that data to their PHRs, providers, etc. Or how introducing biosensors in to people's homes -- say, in mattresses to measure sleep patterns or whether a patient actually gets up on a given morning -- can supply valuable point-in-time and trend data that provides a richer, more useful picture of how a person managing a chronic disease is really doing.  The University of Rochester's Center for Future Health has done some leading work with smart bandage technology, as well as how to empower patients to better manage their health by building off of appliances and technologies already found in the home.

So it appears that, someday, "retail therapy" may pay off physically as well as emotionally. How broad are the potential applications, I wonder? And what might be the barriers to their widespread use?

Health 2.0's Spring Fling: Connecting Consumers & Providers

Emily Culbertson attended and blogged about last fall's inaugural Health 2.0 conference, led by Matthew Holt of The Health Care Blog and Indu Subaiya of Etude Scientific.  Their next meeting is coming up March 3-4 in San Diego, and they'll keep this dynamic conversation going with sessions featuring:

• Doug Solomon of IDEO talking about the optimal user experience for Health 2.0 destinations
• M.D.s outlining ways patients should consider communicating with their doctors
• CEOs of firms that are out in front when it comes to using the web and automated mobile and voice solutions to keep consumers healthy and engaged

To find out more and register, check out the Health 2.0 conference site.

Next-generation PHRs surface new questions on privacy and ethics

Thanks to Lygeia Ricciardi for the following...

"Many of the posts on the Project HealthDesign blog directly or indirectly address the topic of privacy, which is of course a core issue concerning PHRs specifically and the electronic exchange of health information generally. If you haven’t already seen it, take a look at the Project HealthDesign E-primer, The Need to Know: Addressing Concerns about Privacy and Personal Health Records. It gives a good overview of the privacy landscape in this context, touching on topics including pending legislation and ethical issues.

Regarding ethics, Ken Goodman (who heads up Project HealthDesign's efforts to better understand the ethical, legal and social implications of future PHR directions) explores the implications of defining privacy as a “human right”—if our society does so, we free ourselves from a great deal of debate about protecting it. But where would the boundaries of such a right lie? The E-primer poses some difficult policy questions, such as whether health information collected by a patient in a PHR should be treated differently from medical record information under current regulations."

This E-primer asks how consumers may regard issues of privacy, security and control of their health data in an age of smarter PHR systems, and how policies and norms may shift as a result.  Will people be willing to share personal health information in order to gain greater efficiencies in their everyday lives?  We do it all the time now with personal banking and finance info.  Another question - how will the Myspace and Facebook generation treat the disclosure of personal health specifics in this era of all-about-me online identity? 

Thoughts?

Regarding ethics, Ken Goodman (who heads up Project HealthDesign's efforts to better understand the ethical, legal and social implications of future PHR directions) explores the implications of defining privacy as a “human right”—if our society does so, we free ourselves from a great deal of debate about protecting it. But where would the boundaries of such a right lie? The E-primer poses some difficult policy questions, such as whether health information collected by a patient in a PHR should be treated differently from medical record information under current regulations."

This E-primer asks how consumers may regard issues of privacy, security and control of their health data in an age of smarter PHR systems, and how policies and norms may shift as a result.  Will people be willing to share personal health information in order to gain greater efficiencies in their everyday lives?  We do it all the time now with personal banking and finance info.  Another question - how will the Myspace and Facebook generation treat the disclosure of personal health specifics in this era of all-about-me online identity? 

Thoughts?

Pioneer Invites 11 "Disruptive Innovations" Entrants to Apply

The competition on Disruptive Innovations in Health and Health Care was the first time that we intentionally used the Changemakers open-source competition model to scan the field for ideas that the Pioneer Portfolio might wish to invest in directly. Not knowing how the challenge of disruptive innovation would play out using this type of competition model, we were astounded by the response — more than 300 entries — and really impressed by the creativity and quality represented in the mix of innovations proposed.

We're happy to announce that Pioneer staff have completed their review of the full set of entries. We had some spirited discussions about the ideas that flowed through these entries — they stand to really shake up established ways of doing things in health and health care and trigger big gains for consumers. So, while it's taken us some time, we're happy to announce that we have invited 11 entrants to compete for grant funding, if they so choose. Many you will recognize as finalists and winners, while others were included because we were excited about the pioneering approaches they presented.

These entrants will be asked to demonstrate how RWJF funding could be used to further the development of the work represented in their respective Changemakers entries — either through demonstration, scale and/or replication. The total amount of grants made under this phase will not exceed $5 million.

All of us at RWJF continue to be inspired by the ideas and energy contributed to this competition, and we're grateful for the participation of the global community of entrepreneurs who entered, commented or spread the word about it. We'll keep you posted on future funding decisions stemming from the Disruptive Innovations competition.

The 11 entrants invited to compete for RWJF funding are:

Business Week: Better Care Through Design

Business Week has an interesting article on "Designing the 'Care" in to Health Care."  The writer points to a coming age of user-centered mobilization:  "What lies ahead is an opportunity to design a health-care experience that reflects our nation's desire to help itself be healthy. Let's call it the 'Age of Empowerment,' when we innovate to create healthful experiences that can save money, support better clinical outcomes, and improve patient quality of life. Design thinking can lead us there."  This will play out in several ways:

• Empowerment through self-care -- e.g., home-based dialysis or smart glucose monitoring systems
• Empowerment through service innovation -- e.g., company-run health clinics that are wellness-driven; retail health clinics
• Empowerment through Web innovations -- e.g., PHR-targeted platforms like HealthVault; utilizing e-mail, instant chat -- even Twitter -- for meds regimen updates

Also, note the Nov. 15 special "Inside Innovation" report on mapping crowd patterns of activity to enhance corporate -- and now medical research -- strategies.  It highlights the accelerated research model of Myelin Repair Foundation, which Theresa Kanter has blogged about previously.  MRF used advanced mapping software to ferret out which research centers and scholars were working on common issues, and it helped them connect the dots more quickly and effectively in order to make it possible for scientists to collaborate across institutions and projects.

King Kong and Revolutionizing Health Care Quality

Several days after we announced our grant to Archimedes to build the ARCHeS online interface, Risa Lavizzo-Mourey and David Eddy appeared together on a panel at the Health Affairs 25th Anniversary Summit in Washington, DC. Risa moderated the panel on improving health care quality, and David spoke about the role that mathematical models like Archimedes could play in triggering big advances in our learning and in our ability to provide the right care to patients at the right time.

Here is a link to his slides, but I really recommend you download the Web cast to watch and hear David talk you through them.  His talk was at once compelling, funny, sobering and really inspiring. And you'll understand how King Kong factors in to all of this, curiously enough.

David tells the story of Archimedes far better than we ever could. And his co-presenters, Don Berwick of the Institute for Healthcare Improvement and George Halvorson of Kaiser Foundation Health Plan, were stellar as well. It's worth checking out.

HealthVault and Project HealthDesign

Microsoft today announced its release of HealthVault, which will serve as a platform for personal health records. Readers of this blog will know that Pioneer has been working for some time on the concept of personal health records and how best to engage consumers in the management of their health and coordination of their care. Recently, Project HealthDesign, one of our national programs that takes a leading role in exploring these issues, has given birth to its own blog, on which you'll find our team's, and the Project HealthDesign team's, thoughts on the implications of HealthVault and today's announcement.

It's promising to see major players like Microsoft, Google, Intuit and others joining the search for health solutions -- they're already so far out in front when it comes to designing products that meet consumers needs, and the health sector needs their talent and creativity.  Also notable is the fact that Health Vault offers an open platform approach and invites third-party device developers, IT designers and entrepreneurs to build on top of it. What this means is that consumers someday may have a far more diverse, vibrant array of PHR products and services to choose from in the marketplace. And, the way Project HealthDesign sees it, these tools and services can build off of the information in their PHRs to help them make smart decisions and take action to improve their health. Here's hoping that we see continued progress on this front.

Here is a link to Steve Downs's statement on Microsoft's announcement today.

Why Games Matter Entry Deadline Wednesday

Hurry - two more days to submit an entry for Why Games Matter: A Prescription for Improving Health and Health Care! Recent entries include using game technologies to design a surgical training simulator, an immersive game that serves to lower blood pressure and hyperactivity disorder, and virtual solutions to tackling phantom limb pain. Fascinating. 

And many thanks to the other bloggers -- including Matthew Holt of the Health Care Blog and the guys over at Rock Paper Shotgun who have helped spread the word about the last in this series of Pioneer/Changemakers competitions.

The voting period will start on October 24, with winners announced on November 7.  Thanks for your participation.  Any questions?  You know where to find us.

Congratulations to the Disruptive Innovations Winners

You voted, and your top three entries in the RWJF/Changemakers competition, "Disruptive Innovations in Health and Health Care: Solutions People Want," are .......

• Project Echo: Knowledge Networks for the Treatment of Complex Diseases in Remote, Rural, Underserved Communities, University of New Mexico Health Sciences Center (Albuquerque, NM) – Project ECHO (Extension for Community Healthcare Outcomes) teams up an academic medical center with a network of rural health clinics, the New Mexico Public Health Service and the state Department of Corrections to deliver health care to patients residing in underserved areas who have common, chronic diseases. The key component is a disruptive innovation called a Knowledge Network, through which the expertise of a single specialist is shared with several primary health care providers, each of whom sees numerous patients. Telemedicine and Internet connections enable specialists in the program to co-manage patients with complex diseases using best practice protocols, case-based knowledge networks and learning loops.

• Family Coaching Clinics, UCLA Semel Institute Global Center for Children and Families (Los Angeles, CA) – The Family Coaching Clinics offer a new model of preventive mental health for children and families. Located in retail centers and focused on a variety of specific child-rearing issues, the clinics reach families who might never seek out traditional counseling services or might not do so until crises arise. The clinics provide coaching designed to give families the tools they need to resolve common challenges before they develop in to serious problems, by changing family behaviors in ways that have been proven to be effective.

• Instant Birth Control, Planned Parenthood of the Columbia/Willamette (Portland, OR) – Instant Birth Control provides women in Oregon and Washington online access to hormonal contraception such as birth control pills. Instant Birth Control patients receive all necessary health screening and monitoring to assure safe quality care. By providing access to contraception services online, Instant Birth Control empowers women to take charge of their reproductive health by providing access to primary care 24/7, in the privacy of their home. Because they can avoid taking time off from work, school or family commitments, as well as travel and waiting time to see doctors in person, patients can manage their contraceptive and sexual health care in ways that are far more convenient for their schedules.

Descriptions of all finalists' innovations are on the Pioneer site. 

Blog and Press Accounts of Games for Health Day

There's a great recap of several Games for Health Day-Seattle presentations on Mark Danger Chen's blog...it's always good to get the perspectives of a self-confessed gamer in academia.  Thanks, Mark...from one who was writing about this event from her desk in Jersey, this was nearly as good as being there!  The Seattle Post-Intelligencer also ran a story on the event in today's paper.  Games for Health director Ben Sawyer had this to say:

"There's this caveman logic that it's all about kids and games, but there are so many other people we can reach....We can get the (health care and gaming) worlds to crash together and apply the different ideas in new and innovative ways."

And If You're in Seattle...

Games for Health Day will be held August 23 -- the eve of the 2007 Penny Arcade Expo in Seattle. The event runs from 9 am to 7 pm, and includes a networking reception. The site is the Hotel Deca, 4507 Brooklyn Avenue, NE, Seattle.  Click here for the full schedule. Attendees will have the opportunity to hear what leaders in the casual gaming world have to say about the intersection of games and health. I'm not going to this one but Chinwe Onyekere and Theresa Kanter will be there and should have some interesting things to report back. 

Games for Health Competition Results

This week, Games for Health and Pioneer announced the winners of the first-ever Games for Health competition. People submitted entries in three categories—congrats to the three winners:

In the Open Competition, open to U.S. residents over the age of 18:

• Open Prototype: Neuromatrix, submitted by Morphonix of Sausalito, Calif.—$20,000.
  Neuromatrix is a game designed to teach adolescents ages 11-14 about the brain and sustain their interest over time. The game shows that the brain is not an abstract topic, and aims to inspire more students to enter the field of neuroscience. It takes players through a series of short movies and games where students participate in a brain exam and make decisions very much like a neurologist would encounter in a real-life setting. Neuromatrix was funded by research grants from the National Institute of Health's Small Business Innovation Program.
• Open Storyboard: Food Finder, Erin Hoffman, Albany, N.Y.—$5,000.
  Food Finder is an action-packed game envisioned for the Nintendo DS system. It shows children ages 8-14 how to make healthy eating choices through an interactive quest to find nutritious food groups. A status bar is present during the entire game that monitors nutritional facts such as calcium, protein and vitamin C levels and effect on heart health, so children can see how different foods affect their bodies. As players work through the game, the healthier food choices become harder to find. Food Finder's objective is to engage young children in the gaming experience and to simultaneously combat childhood obesity through the content and design of the game.

In the Student Storyboard Competition, open to U.S. college students:

• Bizarro Olympics, Team Fun, Indiana University—$5,000.
  Bizarro Olympics is an interactive video game concept designed for the Nintendo Wii™. This exergame, or video game requiring physical activity for game play, blends the traditional surreal gaming environment with an exercise theme. The game takes players through a series of futuristic Olympic-style events, while educating players about the important lifestyle choices that should be made to maintain good health—and win the game.

We had an outstanding panel of judges, including: