33 Charts

The Health 2.0 Fantasy

I’m wondering is Health 2.0 is more fantasy than revolution.

What got me thinking is this post by Susannah Fox where she comes to the despondent realization that health 2.0 may not be affecting outcomes.  There’s a nice follow-up here at Walking the Path.

It raises the question:  What do we think Health 2.0 is really going to accomplish?  What should we really expect to come of it?

I don’t have the answer.

Health 2.0 is as much a process as it is a movement.  It can’t be stopped and its outcome is not the choice of any individual.  From a public health perspective the impact of collaboration and communication will be borne out over generations.

We need to be careful about overstating 2.0’s ability to change health on an individual level.  Social networks provide platforms for interaction.  This collaboration creates opportunity but doesn’t necessarily create change.  Behavioral change at its most basic level is an individual issue.  Health is a personal process.

And of course there’s the hive.  But the hive is not about individuals.  It’s all about the collective.  Health change is individual.  Health behavior is intimate, personal, and human.  The hive is not human.  And the hivemind has no regard for the needs of the individual.

You can inform me and we can share and contribute.  But ultimately we answer to no one but ourselves.

It’s fun to think about the promise that Health 2.0 has for all of us as individuals.  But I can’t help but think that some of it is fantasy.  

Breakthrough and Telehealth's Tipping Point

 If you told me last year that web-base psychotherapy would gain traction I wouldn’t have believed you.  That was before I met Mark Goldenson, CEO of Breakthrough, a silicon valley based web startup that matches patient and therapist through a secure online portal.  Breakthrough clients can review a therapist’s qualifications and fees, view sample video, and initiate therapy by video or phone.

In a 2.0 world marked by clouds, hives and democratized healthcare, Breakthrough is cultivating one-on-one relationships through improved access to mental health services.  Everyone should be talking about this.

Goldenson made the TechCrunch 50 this past fall and maintained his continence before the likes of Tim O’Reilly, Kevin Rose and other tech luminaries.  You can check out the coverage in Wired and Forbes. 

The road to viable online teletherapy is littered with skeletons of those who were either ahead of the parade or didn’t have the technical support of Breakthrough.  But telehealth has reached a tipping point.  And Breakthrough may be there to seize the moment and tap the 2/3 of America’s 58 million with mental illness too stigmatized to seek help in person. 

I’d like to say I discovered Mark Goldenson but it was he who discovered me after I delivered a lunchtime keynote on social media at this year’s American Telemedicine Association meeting in Palm Springs.  He’s a pretty sharp guy.  And if the fervency of his questions is any measure of his capacity to lead, Breakthrough may be worth keeping and eye on. 

Social Privacy Campaign at Toronto University Health System

I loved Hospital Song’s original post describing efforts by the Toronto University Health System to thwart social media privacy violations.  What I love more is seeing the posters!

In a healthcare world where social strategy centers around burying one’s head in the sand it’s refreshing to see such a progressive, reality-based campaign. 

This is the first of its kind as far as I’m aware.

I’m convinced that Elizabeth Han's thinking is the product of her environment.

 

 

Will Health Privacy Keep American Doctors Disconnected?

This picture from 3G Doctor is remarkable.  It captures the flier of a Merck supported Mexican Medmobile initiative that apparently connects patients with their doctors via SMS (translation available on 3G Doctor Blog)

But don’t expect fliers of this type in American offices anytime soon.  Risk of privacy violation and difficulty in documentation stifle this level of doctor-patient connectivity.  The very laws created to protect patients may ultimately thwart the timely adoption of new communication channels. 

And the slow march towards a single payer system will only make real connectivity a rare bird.

Look to the groundswell in mobile technology and social platforms will force change in our current privacy laws.  Until then look for innovation to come from the second and third world.

Pharma Names Doctors - Now What?

This was the year that Pharma disclosed the names and payments of their physician consultants.  Look here for physicians speaking and consulting with Merck, GlaxoSmithKline, Lilly, and Pfizer.

Physician disclosure of conflict is important.  It helps put a physician’s opinion and point of view into a context.  Disclosure has long been the standard in the academic world.  This represents the first time that such information has been made available to the general public.

But how will patients use this information and how will it affect care and outcomes?  Should patients flatly avoid physicians or others who have a relationship with a pharmaceutical company?  And should patients routinely screen physicians for conflict?

I don’t know the answer to these questions.  I’m not sure patients know the answer to these questions.  I suspect patients may not like the idea but would be willing to overlook a pharma connection when the reputation of the physician is impeccable.

Transparency is all the rage.  Expect more.  But I’m wondering how the average health consumer will practically process the information.

Should You Give Your Doctor a Gift?

I used to get lots of gifts from patients during the holidays.  Not so much anymore.

I’m more patient-centered than ever.  And the older I get the more relaxed I get with my patients.  I’d like to think that I’m more likeable.  But still fewer gifts than ten or fifteen years ago.

So what gives?

Times have changed.  Doctors nowadays are dispensable.  If a patient doesn’t like what they’ve got they can move on.  But this is probably a good thing.  It’s what patients should do.  In the old days there was less of that.  We needed a tight relationship with our providers.  It was essential.  Gifting may have been seen as a means of getting what one needs.  Not so much now.

But in this evolving world of patient empowerment is there role for the cultivation of a stronger relationship from the patient’s end?

When it comes to my relationships I care less about cookies and gourmet pears.  Intent resonates more with me these days.  Much like a handwritten note, which seems to be so much more powerful than twenty years ago.

The world of patient care is changing quickly and not for the better.  Caring for the chronically ill is stressful, backbreaking work.  If you’ve got a relationship that works think about pointing out the value in what you’ve got.  Gourmet pears aside, remember that a sincere, heartfelt thank-you represents one of the best gifts you can give your doctor.  

Learning the Power of the Blog

To start, this is how I came to blogging:

In 2006 when writing Colic Solved I read somewhere that every author needed a blog.  Blogs, I was told, were particularly important for authors who weren’t famous.  I wasn’t famous.  So I ran to the bookstore and bought Robert Scoble and Shel Israel’s Naked Conversations, the essential book for understanding blogs.  Then I began my first blog, Parenting Solved, with the shallow intent of selling books.  

But just a few months after starting Parenting Solved I posted on an infant product company with my take on a merger they were undertaking and what it meant for parents.  The post was picked up on a feed for one of the foreign stock exchanges and I enjoyed a nice spike in traffic.  The following day a call came from the company’s headquarters in Europe to my chief who happened to be a consultant to the company.  They wanted to know my story.

Until then I had no idea that anyone was listening.  Until then I didn’t care that anyone was listening.  I just wanted to move books.  But at that point I realized blogging wasn’t a marketing gimmick but instead a real tool for positioning myself and my ideas.  

You could say I started shortsighted and ended up global.

I continued posting to Parenting Solved until early 2009.  But burnt out with my ‘reassuring voice of authority’ (which I still dispense liberally in person) I felt it was time to focus on something else.

I started 33 Charts in April 2009 when I saw room for physician commentary at the intersection of social media and health care.  I thought it would be a great place to experiment and shape my ideas.

That’s how I started and wound up here.  And so far it’s been a blast.  Look for me to stop when it isn’t.

The 2000 Word Patient Email

We assume that technology will improve communication between doctors and patients. 

But not always.  Look at the 2,000 word email.

While it isn’t yet the standard means of communication in our clinic (it will be soon) we occasionally take email from patients.  My experience has been that they’re sometimes long and unfocused with tangential information irrelevant to the problem at hand.

Of course we can’t blame the patient.  They are acting in what they think is their best interest:  put it all out there so the doctor has the information.

But too much information can cloud good communication. 

In person I can pull the wandering interview back to center.  Within a limited time frame I can help a patient understand what information I need to get the job done.  But I’m not on their shoulder when they pen their email.

When a patient hits the send button with a 2,000 word email it’s the responsibility of the receiving office to act on what’s been suggested, alluded to or hinted.  An interpreting human has to get to the bottom line:  Is there one simple question buried here or is there a new problem that requires an office visit?  Consider a practice with 10,000 patients all wanting to email at 2am when they can’t sleep.  This can create real problems for a tightly staffed medical office operating on a slim margin.

Consider too that every one of those 2,000 words is subject to legal discovery.

Shortly my clinic will begin using a HIPAA-compliant email system integrated with our EMR.  And at that point we’ll realize email as a standard means of communication.  With my patients I’ll insist that email be used with tightly defined boundaries that specify the kind of problems and questions considered as well as their appropriate length and format.

The 2,000 word email illustrates just one challenge that doctors face when adopting new technology.  Expect similar discussions surrounding other social media formats.

Why Slideshare Shouldn't Work

I’ve got this thing with Slideshare.  I feel odd posting presentations that make no sense.  What I mean is that my presentations visuals make no sense without my narrative.  When I speak my presentation is from me to the audience.  The money’s in what I have to say, not what I show.  My visuals only accent my message. Consequently my ‘slides’ alone make only a little sense.

For example when you see an image of a question mark or a child standing alone in a field the Slideshare viewer obviously misses something.  Sure there are other graphics that can stand on their own but to suggest you’ve experienced my presentation is crazy.

I like to think I’m growing as a speaker. 

In my younger days my bullet-ridden Powerpoint slides (always with the classic blue background) doubled as a handout.  And speaking was easy:  I leaned against the podium, waved a shaky laser pointer and dutifully read along with the listeners.  Life was so much simpler.

But now as a presenter I prefer speaking to reading.  And as a participant I much prefer listening to reading.   This is why I find Slidshare so tricky.  The solution, of course, is to record voiceovers for my Keynote presentations.  I’ll do that in my free time.

Do You Need Goals in Social Media?

I hear it all the time: When you jump in to social media you need goals. 

But goals in social media may be overstated – much like the nagging concern with ROI.  I even wonder if the preoccupation with goals might hold some people back.

You may not know what potential a platform holds for your organization until you’ve dabbled in the space.  Get in, listen, contribute and see what happens.  Keep an open mind and you’ll see how it dovetails with your operation.

I see excessive planning as a roadblock for my physician colleagues considering entrée into the social world.  They wonder what precisely they should do, what’s in it for them and how much of what they’ll get when (“I sent a tweet, now what?”).  On a broader scale Lee Aase encourages healthcare organizations to jump in without having it all figured out from the beginning (“Don’t let strategy become an excuse for inaction”).

For most starting out in the social media, less calculation and more open-minded experimentation will carry us further than our goals.