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Posts Tagged ‘Health care’

Healthcare Social Media: Healing or Hurting?

April 20, 2012 11 comments

The Social Health Web

Social web sites are growing as a health care medium. They connect patients with each other and with care givers. Social media are a conduit for patients to share their health concerns and gain knowledge. But they may also be a rumor mill of misinformation.

So far the US healthcare system has been slow to adopt social media for the exchange of health information, leaving patients to find other sources.  Two recent studies show a growing gap between patients’ needs and hospitals’ delivery of a quality social health experience.

Hospitals Not Delivering

A new report by CSC shows US hospitals lag far behind hospitals in countries such as the Netherlands and the UK in the use of social media to deliver health information. According to the study, only 27% of urban hospitals and 10% of rural hospitals in the US deploy social media sites.

Yet according to a report by consulting firm PWC, patients use social sites like Facebook as an important source for health information. Of 1,024 consumers studied, 24% say they post health information on social media sites and 45% said they would use information from social media sites as justification for seeking a second opinion.

Health professionals should be alarmed by these findings. Facebook and Twitter take second guessing physicians’ medical recommendations to a new dimension.

Why anyone would use hundreds of Facebook friends as a sounding board for whether to have surgery is beyond me, but the evidence suggests that it’s happening with more frequency.  And with the ease and anonymity of internet publishing, anyone can present themselves as a medical expert.

Privacy Concerns Versus Information Sharing

Why don’t more hospitals use social media? Concerns about liability and patient privacy are the primary reason. Clearly, the freewheeling give and take of social media commentary interferes with the doctor-patient relationship.

But here’s the problem, patients will seek the information wherever they can find it. We humans are a curious sort. We pay no attention to our health until we get sick. Then we plumb the internet for any source we can find for as much information we can get.

Physicians often spend more time wading through patients’ questions about alternative treatments and self diagnoses than they do in actual treatment. The physician’s role as the sole source of medical information went out of fashion with Marcus Welby, M.D.

It’s a classic case of if you can’t lick ’em, join ’em. Why not be seen as the best source of medical information and clinical sharing? It’s unfortunate that aversion to risk prevents hospitals from using social media’s potential for healing by placing the patient at the center a continuum of care through social communities of physicians, case managers, family and friends.

What do you think? Are hospitals obligated to create social media sites and share health-related information with patient communities? Share your comments by clicking on “comments” at the top of the page.

Photo credit: Health in 30

Four Ways Personalized Medicine will Change Doctor-Patient Relationship

March 27, 2012 12 comments

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Personalized Medicine Gains Traction

Since completion of the Human Genome Project  in 2003, the promise of personalized medicine (PM) caused many to consider its effect on bio-science, pharma and healthcare delivery.  Physicians contemplate a future in which patients enter their office equipped with symptoms and a list of the genetic variants they posses and questions about what they mean.

The problem hasn’t materialized because  the cost of discovering and developing drugs customized to the needs of a sub-genetic group have been prohibitive. Today however,  IT frameworks like Hadoop deploy massively powerful, inexpensive processing power. Now the huge genomic database becomes a more accessible resource to develop medications that are effective for targeted patient populations.

These new drugs offer improved cost-effectiveness over blockbuster drugs  for conditions like high cholesterol or hypertension.  Physicians will spend less time and money in trial and error to find which drugs work for which patients.

Disruption in Healthcare

In my last post, I raised the question, “Will Personalized Medicine have a disruptive influence on medical practice?” Those familiar with Christensen’s theory of disruptive innovation understand that market leaders focus resources on product development for advanced users who don’t care about cost. Often products contain features and benefits that don’t matter to most users. This leaves room for competitors to develop new technologies and business models to meet the needs of average consumers and “disrupt” the market leader’s business from the bottom up.

Healthcare is not like other businesses. The role of payers and policymakers as well as the interests of public health intervene and create barriers to natural market forces.  These factors slow the rate of disruption. Yet there will be fundamental change in the way physicians and patients interact as PM gains traction.

Four ways PM will disrupt healthcare delivery

#1 Predictive, not reactive:

  • Rather than waiting to treat symptoms of a disease that occur, physicians can predict which diseases a patient is susceptible to.
  • The physician develops a personalized health plan to prevent or detect these diseases early.
  • Patients will become a true partner in the delivery of healthcare, monitoring their progress and reporting results to their caregivers.
  • Home testing may replace testing in the doctor’s office.
  • Fewer office visits, less face time with the PCP is less expensive, but is it better medicine?

#2 More information on more treatment options:

  • Physicians  prepare to answer patients’ questions about new genetic tests and the treatments for their sub-group.
  • Continuous access to up to date, peer-reviewed medical information will increase dramatically.
  • As more options for care become available, will the patient’s trust in the sources of clinical information and outcomes begin to erode?

#3 New ethical and moral obligations: 

  • What is the physician’s role with patients on the moral and ethical questions surrounding access to genetic tests?
  • If one family member wants genetic testing and another doesn’t and a serious disease potential becomes known, what is the physician’s obligation to inform?

#4 Physician’s role in decision to test:

  • Should patients have their own testing done without supervision of a physician?
  • Should tests be offered for genetic disorders for which no treatment is available?
  • Who pays for development of testing and treatment for small sub-groups of patients?

What do you think? Will PM disrupt or enhance healthcare delivery?

Mission-Driven Social Media

February 28, 2012 7 comments

A few years ago I took a consulting assignment for an incoming college dean.  My job – write the school’s new communications plan.  In my first meeting I asked what the school’s mission was.  “Every college and university has basically the same mission,” she said.  I explained that a unique mission is key to a high quality communications program.

There was an effort among the senior faculty to write a mission statement but it became the product of consensus.  I’ve learned it takes a lot of hard work to create a mission statement, particularly if you’re not a founding father.

It was a missed opportunity to create something powerful.  Mission-driven communications integrate naturally; stories gain context.  They are the basis of great brands like IBM and Apple.

I remembered that time when I learned about a unique and powerful social media strategy at the Mayo Clinic, The Center for Social Media.  A video presentation by CEO John Noseworthy, M.D.  introduces the center as extending their founders’ mission, now over 100 years old.  Drs. William and Charles Mayo wrote, “The best interest of the patient is the only interest to be considered and in order that the sick have the benefit of advancing knowledge, union of forces is necessary.”

Dr. Noseworthy explains how that mission came to life in the early years of the Mayo clinic, “It drove the Mayo brothers to invent the concept of group medical practice at a time when the notion was considered a breach of physicians’ individual responsibility.” They used that concept to create other best practices and shared them with physicians around the world.

How does this tie in with social media? Social media are a great way to assure that the patient receives a continuum of coordinated care.

One early Mayo innovation was the unified patient medical record. “It’s goal is to build a network around the patient.” says Dr. Noseworthy. That is the opportunity for social media. Networks of physicians, support staff and other patients may improve outcomes when coordinated through the clinic.

Lee Aase is the director of the center.  In a “Conversations on Health Care” podcast, Mr. Aase details the many ways in which the center’s programs define excellence in patient centered care through social media.  In each case, the linkage to the Mayo Clinic mission is clear to see.

Visit the center’s website, see the video blogs from physicians, read the patient stories. There is nothing slick or artificial. An aura of authenticity surrounds this program.  This its true in part because of its connection to the clinic’s mission.  Other academic medical centers have similar programs and they are well executed.  But the visceral connection to the institution is often missing.  The whole is lesser than the sum.

Well done Mayo Clinic.

Photo credit: Salvatore Vuono

The Perils of Free Market Healthcare

February 22, 2012 6 comments

Affordable Care

Increases in healthcare spending have slowed to near the rate of general inflation in recent years. Why has this happened? Is it a sign that the market is gaining traction and we don’t need big government to rein in spending?  J. D. Kleinke of the American Enterprise Institute thinks so.  In his Wall St. Journal opinion piece, The Myth of Runaway Health Spending ,  Mr. Kleinke states that market forces are conspiring to regulate spending and “… it puts the lie to the claim that we need government to put the brakes on an “out-of-control” health-care system.”

Here’s the lowdown on these market forces. Employers and insurers reacted to a decade of healthcare inflation by introducing tiered hospital access, tiered pharmacy payments, and high deductible insurance plans.  “You want top-notch care and better drugs?  You pay for them, and by the way, whatever choices you make, the first $5,000 is out of your pocket.”

The result – consumers today decide how much healthcare they consume, and where they consume it.  Are they qualified to make those decisions?  What is the cost of poor decision-making?

Physician office visits declined by 4% from 2009 to 2010 according to IMS Institute for Healthcare Informatics. JP Morgan analyst John Rex reported an 8% decrease in visits from 2010 to 2011.  A Commonwealth Fund study of 18,000 adults in 11 countries, posted Nov. 9, 2011 on the Health Affairs website, showed “sicker” American adults intentionally missed doctor visits, did not fill prescriptions, skipped doses of medication and went without recommended care.

Half of U.S. adults under 65 (51%) went without care because of costs, compared to 19 percent of adults age 65 or older; 35 percent of those under 65 had problems with medical bills, compared with only 6 percent of adults 65 or older. One in four (27%) American adults said they had trouble paying for care or could not cover medical bills.  These draconian “market” solutions to health costs may actually increase health spending as more Americans develop chronic illness from lack of care.

There are positive market forces at work lowering costs.  In Massachusetts, insurers and hospitals renegotiated existing contracts and agreed to bundled payments systems that reward outcomes, not volume.  Accountable Care Organizations and Patient Centered Medical Homes are spreading throughout the system.  The impetus for these changes? The Affordable Care Act.

There’s no doubt the healthcare system would have morphed into something resembling the structure outlined by the ACA. But how long would it take to become an effective nationwide continuum of care?

The ACA is not a magic bullet, but it started the ball rolling in the right direction.  Payers and providers saw the writing on the wall.  ACA gave it shape and focus.  Now the market is pushing ahead of the schedule and hopefully patients will not have to choose between eating and seeing their caregiver.

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