Hey Doc, Do You Play Ball?

Sharing information has to start with this – know to whom the information belongs. Hint: it’s not you, Doc, even if you’re the one holding it.

It’s like it was yesterday. It was the first day of school in the second grade. I’d carried my baseball glove and ball for a game of catch during recess. Ricky had done the same. We chose to use his ball. He’d painted it green and yellow to honor his beloved Oakland Athletics. Mine just had a big “T” on it. I left it on my desk.

On the way to recess the new kid asked if he could use my ball. He didn’t have one but he looked like he knew how to play. And since Mom had taught me to share, using mine was fine.

When recess ended I went to retrieve my ball. The new kid threw the ball back to me. But it got by me and the teacher politely picked it up. She and I talked baseball on the way back to class. We were settling back in our seats before I realized that she still had the ball. I watched her put it in her desk drawer. Cool. It would be safe there until I needed it.

After class I went to her desk to ask for the ball. I waited as she talked to another kid. Meanwhile, Mom was waiting in the carpool line. Knowing that, I reached for the handle on her desk drawer to retrieve my ball.

The teacher slapped my hand with a ruler and said, “You can’t look in there.” “Yes, ma’am. But I’m just getting my ball while you’re busy with another patient (oops, I mean student).”

My ball. Someone else used it with my permission. She now stored it. I wanted to use it. She suddenly acted like it was her ball. Okay, maybe I needed some sort of permission to access it. Maybe she had stuff in there from other kids. But at some level it should have been reasonable to let me get my ball – even a second grader knew that.

So is the way it goes with patient data. The ball Ricky and I used was green and yellow. Maybe you’ve heard of the “blue button”.  The Department of Veteran Affairs initially implemented it. Other public and commercial health plans have since adopted it. More than a million patients currently have access to their health data with the tool as found on health plan websites.  And here’s what we learned about its use and patient views on personal health information at last summer’s Consumer Health IT Summit:

Who owns it – “It’s my right to have it,” said one veteran who suffers from a heart condition and Type 2 diabetes. “They’re my medical records and, with the Blue Button, I’ve got control of them.” Not only does he own it, he knows that it can be easy to access.

Who stores it  – “There’s a wide perception out there that HIPAA is a barrier,” said Department of Health and Human Services Director of the Office for Civil Rights Leon Rodriguez, JD. “HIPAA is a valve, not a blockage. HIPAA is meant to regulate health information so that it is used to benefit the patient and for no other purpose.”  So maybe the IT guy should stop offering, “We can’t do that. It’s a security issue,” in response to how it’s stored and accessed and admit that it’s really just an attitude issue. Most of your patients are accessing confidential information from other sources (i.e. the bank). They don’t see their health record as any more valuable than their banking information or any more difficult to access or secure.

Who uses it – allowing access “moves us from personal health records tethered to particular providers to the concept of a personally controlled health record,” National Coordinator for Health IT Farzad Mostashari, MD, ScM, said. Rather than just viewing the record, users are encouraged to take ownership of their data. Patients can add information, point out errors in their records and share their health information with whomever they like.  Heck, they could even put a big “T” on it if it’s theirs.

Individually owned health information is expected to produce better health outcomes in the patient-centered future of healthcare. So let’s agree that the patient owns the data. Let’s let them share it as they like. And let’s accept the notion that whether on the clinic’s system or in the teacher’s desk drawer – we’re going to have to allow the owner to access it when they like even if it’s just for another game of catch.

Hey Doc, (ahem) There's an App for That

First the dramatic lead. We’re facing a health care crisis of enormous proportions. The cost of care is already rising, but the combination of an aging population and changes to diet and lifestyle leaves a growing percentage of the population susceptible to chronic health conditions, such as heart disease and diabetes, which further drive health care costs.

Now, for an overly simple response to the dramatic lead. Then let’s not do those things that will lead to higher health care costs. Well, one of those things is desirable – to age would suggest that we’re continuing to live. So, let’s focus on the others – changes to diet and lifestyle.

Affecting changes to lifestyle or diet may not be as expensive as you think. In some cases it might even be free. And, it may even be fun. But it won’t happen in the exam room. After all, that’s where you raise the flag for your patient and where it later becomes clear as to whether or not what you have suggested is working.

Since it’s not the exam room, then where? Your patient’s ever present smartphone. Yeah, let’s tap into that and see if we can affect their behavior toward a better health outcome.

Did I say, “Tap into?” Uh huh. And that leads us to this: Five Apps That Promote Health and Wellness via patient smartphones.

  

1.     My Medical ($2.99) Start by being organized. This app allows patients to manage their medical conditions by maintaining better records including recent doctor visits, labs, X-rays and medical procedures. Patients can keep track of their records, family members and loved ones, which is helpful for parents and caregivers – and you

2.  Pill Reminder ($.99) Months ago we discussed the impact a text reminder had on health outcomes for those taking prescription meds. Clearly, people have trouble remembering to take their medication whether it’s a daily multivitamin or a medication for treatment of a chronic condition. This app could save a life by simply reminding the patient to take their medicine.

3.     Meal Snap ($.99) What if you could snap a photo of your meal and automatically know how many calories of food were on your plate? This app does that. Could calorie counting get any easier? You can also share what you’re eating with others to build a network of social accountability. Maybe someone will call you out the next time you snap a photo of a beautifully plated chicken and waffles.

4.     White Noise (Free) Studies say that most of us aren’t getting enough sleep and many of your peers suggest that certain health issues could be managed by meditation instead of medication. But how do you get the rest or take the time out? The white noise app drowns out distracting sounds so that you can relax or sleep. Sleep or meditate instead of medicate? I like the sound of that.

5.     Pedometer (Free) Your patient probably has to put down the smartphone when you walk into the exam room. It’s ever present. So, why not use the built-in GPS to transform their iPhone into a pedometer that tracks how far they walk? Set a goal for your patient to walk however many steps a day. Regular exercise can lead to weight loss, reduced blood pressure, improve cholesterol and lead to other positive health changes – one step at a time.

Look, that’s just five that help patients be better organized, take their meds, eat better, rest better, and get regular exercise. I’m not even going to get into the apps that allow patients to pee on a stick to determine whether or not they have an STD. Or, apps that allow users to study intestinal wellness by comparing photos of their stools to healthy stools on the way to your helping them to diagnosis bowel related illnesses. Oops, too late guess I did get into those.

So let’s keep it simple. Perhaps you can help your patient focus on their well being and we can all work to lower health care costs by simply learning to utter what in most industries is already a tired phrase, “there’s an app for that.”  Sorry, I had to say it.

Wanna talk about it? Hit me up at www.twitter.com/timbigfish 

Hey Doc, Meet Dr. Google

According to Pew Internet Research, nearly 35 percent of U.S. adults turn to "him" for answers to health concerns. And that number doubles when you consider those who look to his less specialized brothers Google and Bing. However, they can't turn to any of them for empathy or integrated care. They don't know if he shares their core values. And he will never be at a their civic club or PTA meeting.

Still, there's much to be learned from Dr. Google’s existence.  Such as:

1.       Some things are hard to talk about.

Many adults leverage the anonymity of the web to search for answers to those hard to ask questions about their health. Some of the questions are just too uncomfortable to discuss with even the closest of friends, family or a spouse. Do you know what those hard to ask questions are? Do you offer any sort of local, personal insight in a way that's easy to access even without or before an appointment?

2.       I can take care of myself. Maybe.

About a third of those who seek help from Dr. Google, his colleagues at WebMD, or by peeking through some other health portal, end up handling the problem on their own. That represents some risk for their well-being and frankly, your bottom line. Oh you're probably not going to turn that number around completely. But you’re in it for the sake of the patient. A connection with you might lead to an eventual appointment and could subsequently help them to identify some peripheral issue that led to their health concern. This could make a genuine difference in their health.

3.       I have this friend who, no really.

Many of Dr. Google’s inquiries are from those who are trying to learn more about an issue that's affecting their family or friend. Some 60 percent of U.S. adults from the Pew Internet Research piece say they’re looking to gain an understanding of a friend or family member’s condition in an effort to provide comfort or some other form of support.

Are you enabling a support network with answers that don't compromise patient confidentiality but inform those who give care at home?

Look, Dr. Google exists because there is a need. And many of your peers agree with his diagnosis 4 out of 10 times.

But you know what? You can make Dr. Google and the lessons learned from this exercise work for you. Here are two things that you can do right away.

1. Build a website. Yes, these are still relevant. But it must address the difficult issues and most common concerns of your patient community not just physician profiles and office hours. If you really want to make a relevant site, enhance it with a utility that enables interaction with you or the appropriate person on your staff. Maybe that Nurse Practitioner who sees the first tier of patients can now interact with others online.

2. Create a social media presence and use it. Building is not the same as doing. Your presence need not offer diagnosis or dispense medical advice. And it shouldn’t be one that copies content from everyone else. However, it should share information that is helpful to others, demonstrate your core values, and present the culture within your practice.

Hey Doc, here’s the best news in all of the hype about Dr. Google - patients with serious concerns still consider doctors the main and best source of information. 

Be encouraged but not complacent. The best of both worlds would find you available online to, if nothing else, direct patients and those who care about them toward trustworthy resources. Do that and Dr. Google becomes just another part of your team. He’s a health information partner. Meanwhile you tend to the 70 percent of us who say that what we want when it really matters is – you.

Want to talk about it? Find me at www.twitter.com/timbigfish 

Hey Doc, Follow the Yellow Brick Road

Dorothy, the Tin Man, the Lion and Scarecrow each had a need. To know the way home, to have a heart, to have courage and to have a brain were the things each thought if achieved would make their situation better. They were delighted to learn that there was someone who might have within his know-how the ability to see those hopes fulfilled. To find him, they had to know the way. To achieve their goals, they had to connect with him.

Finding You

The yellow brick road isn’t what it used to be. In the past, the way to find you might have been through the phone book, a web search or the occasional referral.  Dorothy had the Good Witch and Munchkins on her side. “Follow the yellow brick road,” they said. Your patient’s yellow brick road is social media.

Healthcare research tell us that:

• Over one-third of consumers use social media for health-related activities
• 40% seek reviews of treatments, physicians, and other patient experiences
• 45% say information from social media sources affects their decisions

The Tin Man, Lion and Scarecrow heard about The Wizard through Dorothy as she made her way along the yellow brick road. Hey, one good referral begets another. Today those referrals happen at the speed of “like” and the yellow brick road that your patient is traveling is social media.

Overcoming Adversity

Like Dorothy's journey, the road to your patient’s goal is wrought with challenges. These include bad information sources, consumers with negative experiences and others with special interests (no, I’m not going to call the pharmaceutical companies the Wicked Witch or insurers her flying monkeys). Dorothy would occasionally get a word from the Good Witch to keep her going. Dorothy trusted her. Likewise, your patients need an ongoing connection with someone. They trust you.

• 73% would welcome social media based tools to make appointments or ask a question
• Consumers are much more likely to trust social media information from their doctors or hospital, less likely to trust insurers or drug companies (oops, I wasn’t suppose to mention them).
• Patients want you there for them in sickness and health. Yet 70 percent say their doctor has never checked on them when they weren't sick in order to help them stay healthy. 

Social media is driving these expectations and could be the avenue for meeting it.

Knowing You’re Real, Involved and Have Answers

At first, the Wizard tried to bluff Dorothy and her companions. Of course we know that’s not you. But the 21^st century version of this is the unwillingness to share information – even if the information is tough to reckon with. Heck, the Wizard told Dorothy and her friends that they’d have to kill the Wicked Witch to achieve their goals. Your patient is often fighting no less real an advisory in the form of some chronic disease. But like Dorothy and company, they’re up to it if that’s what you prescribe. Don’t send them out alone. Your being involved will improve the likelihood of their success and could even impact your bottom line.

Keep in mind these folks aren’t simply social, they’re social and on-the-go. Communicating along the yellow brick road requires some connectivity. What’s that mean?

•  Surveys say 25 percent of people forget to take medications as prescribed. You can have a  positive impact on health and reduce costs with something as simple as a text message.
•  Nearly 20 percent of patients cancel or miss appointments, at an average cost of $236 per. You can improve this via mobile and social connections for patients who are hard to reach and want varied modes of interaction
• With 50 percent of U.S. citizens on smartphones today and 40 million U.S. consumers coming under coverage with the Affordable Care Act, you have to make social/mobile part of your strategy.

We know how the story ends. Dorothy makes it home. The Lion gets his courage. The Tin Man his heart. And the Scarecrow his brain. Thriving patients with realized expectations. But the good news doesn’t end there. The Wizard gets what he wants as well. A little less time behind the curtain and a little more time to see the world.

Let's talk. I'm on twitter as @timbigfish or email me tim@gobigfishgho.com