The Disruptive Women in Health Care blog continually aims to encourage discussion and debate among readers about emerging issues and topics in the health care world. Historically, one of the ways that we have done that is through our weekly round-ups – that is, posts containing summaries and links to some of the big stories in health care news for the given week, with some original commentary and content sprinkled in as well. The way we see it, there is just too much happening in this burgeoning industry; it’s hard to keep up, especially when you’re busy disrupting and making headlines in the health care world yourselves. We know the weekly round-ups have been on hiatus for a while, but are happy to report that they’re finally making a comeback. Each week, we’ll be gathering some of the biggest health care news you can use from at home and abroad for posting on Wednesdays. Feel free to comment on what’s included and send us some links to articles to be considered for next week!

Has your week been too disruptive for you to keep up with the news?  Disruptive Women are on the case!  Here is this week’s round up of some of the most pressing issues here in America and around the world.

Here at Home:

Thanks to a provision of the Affordable Care Act (ACA), women are now able to receive free birth control, but only if it’s prescribed.  The New York Times explains how Catholic Colleges are using this loophole to combat contraception.

And, speaking of the Catholic Church and the ACA, USA Today says that Obama’s decision on Friday not to expand the conscience exemption to include religious institutions has been met with outrage from Church leaders and parishioners.

Remember that moment of panic you had when the swine flu epidemic came to the United States?  CBS News reports that swine flu numbers are rising again in Mexico. Will the US be next?

Susan G. Komen for the Cure, the nation’s leading breast cancer charity, announced Tuesday that it is halting its partnership with Planned Parenthood (per NPR) – a controversial decision that ignited a backlash from some of its supporters.

Here’s one perspective on Komen’s decision. What do you think? Will this impact your decision in giving donating to Komen, or another breast cancer non-profit in the future?

Sick? Took a sick day?  Is that enough of a reason for you to wind up unemployed?  HuffPo explains how an issue as simple as recovery from the flu has reached the Supreme Court.

With nearly two million women lacking health insurance and a quarter of a million unplanned pregnancies per year, Florida has a lot of challenges in terms of women’s healthcare.  Here’s what the state is doing to try and move ahead.

Around the World:

Brazil is calling for a registration of all pregnant women.  What does this mean for a woman’s right to choose within Brazil?

Japan’s population is shrinking. As more women choose a career over family, Japan faces declining birth rates. Could the United States be next?  ABC News takes a look.

Check back each week for the latest health care news!

CMS Administrator Marilyn Tavenner addressing Care Innovations Summit attendees. Image courtesy of Kaiser Health News.

“I think we would all agree that these are not ordinary times, that this is not an ordinary conference, nor is it an ordinary time in health care,” commented Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner, in her address at the first ever Care Innovations Summit Thursday. In saying so, Tavenner captured not only the essence of the problems facing our nation’s health care system and the reason that over a thousand national thought leaders, senior government officials and industry experts had gathered, but also inspiring attendees with the idea that, by being there, they had the opportunity to be a part of the solution.

Driving the day at the Care Innovations Summit, which was hosted by the Center for Medicare and Medicaid Innovation (CMMI), Health Affairs and the West Wireless Health Institute, was the notion that American innovation could solve any problem, and the thousand-plus attendees were the innovators to solve this one. Emphasizing CMMI’s founding mission of better health, better care and lower costs, speakers across sectors, industries and areas of expertise continued to echo each other’s cries that it was all possible, if people began collaborating and innovating across fields.

Even before HHS Chief Technology Officer Todd Park compared data to rocket fuel, the Summit was beginning to sound like President Kennedy’s speech to Congress announcing the Space Race. In fact, the addresses and panels were broken up by “Ignite Talks” — wherein private-sector stakeholders presented problems and issued challenges to attendees and to entrepreneurs across the country, offering not only prizes, but implementation funding for the best solutions (you can see a list with links to descriptions of the various challenges issued here).

Park best captured the sentiment of the Summit, saying, “There is no problem that Americans can’t invent themselves out of…Transformation driven by a tide of grassroots innovation mojo has already begun.”

While this sentiment and attitude towards repairing and revitalizing our nation’s health care system certainly drove the day, it is not new, nor is it exclusive to CMMI. In fact, it echoes many of the themes that motivated us to launch the Health in Place™ (HIP) initiative last month. The concept of HIP is built around the idea that, thanks to wireless communications and emerging technologies, our homes are more than ju

st houses, our offices are more than just workplaces, our schools are more than just places of learning and our cars are more than just modes of transportation — and that, for this facet of 21st century health care to achieve its full potential, a number of public policy issues are involved, cutting across multiple disciplines from health care regulations and benefit structures to tax policy and technology incentives. HIP aims to connect the dots between industries, inspire innovation and drive policy changes that accomplish CMMI’s goals of better health, better care and lower costs while simplifying things in the process.

With all of this collaboration and innovative thinking, there is no doubt that this is an exciting time in health care, but as Don Casey expressed in his closing remarks at the Summit, there are some significant obstacles to overcome to get the rockets to the moon. “I think a lot of people are skeptical about two things,” Casey said, “the American economy and do we have the ingenuity to get this stuff done, and can we actually engineer a jailbreak for health care.”

Are you planning to take part in any of the innovation challenges issued? Do you think cross-industry collaboration is really possible? And, what do you think we need to do in order to break down the barriers Casey and others at the Summit alluded to?

By Robin Strongin. We, as a nation, have made progress and I believe Dr. King would be proud.  But our work is far from complete–particularly where health care is concerned.  Another doctor, Dr. John M. Eisenberg, a physician of tremendous stature whose life was also tragically cut short (not by an assassin’s bullet but by brain cancer) was equally passionate about the dignity of life and justice for all Americans.   Dr. Eisenberg, who among other things, served as the Director of the Agency for Health Care Policy and Research (as AHRQ was known back in the day), cared deeply about access to and the integrity of health care for all Americans– regardless of skin color.

Twelve years ago, on January 14, 2000, Dr. Eisenberg gave what is, in my opinion, a brilliant speech to the employees of the Department of Health and Human Services.  As with the past two years I want to share his words with all of you today — as a reminder of how far we’ve come, and how far we still have to go.

BIRTHDAY OBSERVANCE OF DR. MARTIN LUTHER KING, JR.: REMEMBER! CELEBRATE! ACT! A DAY ON, NOT A DAY OFF!

When I was invited to welcome you to the Department of Health and Human Service’s 26th observance of Martin Luther King Jr.’s birthday, my first thought was about how honored I was to be asked.  My second thought was about what Martin Luther King’s birth could mean to a rebirth of health care in this country.  Few have had as much impact upon American consciousness.

But what did Martin Luther King think about health care?

My colleagues and I searched through his writings and his speeches, and realized that he didn’t give speeches about health care.  Martin Luther King Jr. was confronting the basic nature of American society.  He had mountains to move–and mountaintops to climb–for this country so that today we can address the issues of high quality health care for all Americans.

If Dr. King were alive today he’d be 71 years old.  He’d be eligible for Medicare.  Like many 71-year olds, he might be dealing with a chronic medical condition–maybe arthritis, or hypertension, or diabetes.  What would he think of the health care system we have today?  What would he think of the medical care he might receive?  And what advice would he be giving the Department of Health and Human Services?

No, Dr. King didn’t give many speeches about health care.  But like the rest of society, health care had to change too.

When I was a teenager in Memphis, before the Medicare program was passed, the Baptist Hospital was the biggest in town, and the proudest of the care it gave.  But if you were African American in Memphis and you went to the Baptist Hospital, you’d go in through a back entrance.  And you’d go to a segregated ward, where you would be in a big room with about 15 or 20 other people.  And your doctor, if he was black, wold not have privileges on staff.  And the same would have been true for Dr. King in Montgomery or in Atlanta.

Dr. Vanessa Gamble, who is the new director of minority afairs at the Association of American Medical Colleges here in Washington, has documented the incredibly important role that Medicare and Medicaid played in helping to desegregate hospitals.  Medicare was a lever that lifted equity and equality in hospitals.  In 1965, our Department issued regulations madating that hospitals had to be in compliance with the Civil Rights Act–which had been passed just the year before–in order to be eligible for Federal assistance or to participate in any federally assisted program.  The passage of Medicare and Medicaid legislation that year made every hospital a potential recipient of federal funds, and therefore obligated every hospital to comply with civil rights legislation if they wanted to get paid.

The law changed, but practice was slower.

When I was a medical student in St. Louis, at Barnes Hospital around 1970, researchers asked why the hospital still seemed to be segregated.  Why?  Because clerks in the admissions office–both black and white–were so accustomed to the old ways that they continued to admit the races to their old units.  The law had changed, but racial stereotypes had remained.  Racist practices were illegal, but racism was institutionalized, and the seeds of racism grew into practices that amounted to discrimination.

I ask you, is it any different today, 31 years after Dr. King was shot in my hometown, and we grieved over the loss of a great American?  Is it different 31 years after I was ashamed of the symbol that my hometown had become, when all that Dr. King wanted was to put into practice the placards that the Memphis sanitation workers wore, that read, “I am a man”?

Today, research shows that African Americans are one-third less likely to have coronary bypass surgery than whites with the same conditions.  Why? And today, African Americans with HIV are less likely to receive antiviral treatment.  Why do these disparities occur?

The easy answer is that it is because African Americans are more often uninsured.  And that is true.  But even with the same insurance, African Americans don’t have the same access to primary care doctors, specialists and hospitals.  And most distressing, even with the same insurance and being cared for at the same hospitals, African Americans get different care.  In one study I did, if you were a black woman you were much less likely to get referred for cardiac catheterization.

The reason–I fear–is that, despite Dr. King’s advances, and despite civil rights laws, and despite Medicare, racism is a part of the institution of American life, and the seeds of racism still grow into discriminatory practices.

So, now 31 years after Dr. King’s death and 35 years after Medicare broke down segregated wards in the nation’s hospitals, the question for us is:  What can we do today in our Department to eliminate these disparities, whether they grow out of the lack of insurance, lack of access, or lack of quality care for those who get access?

No matter where we work in this Department–

• At the Health Care Financing Administration
• At the Health Resources and Services Administration, where programs are supported to help access
• At the Food and Drug Administration, where safe drugs are assured
• At the National Institutes of Health, where research can identify the causes of disease
• At the Agency for Healthcare Research and Quality, where we find out why the quality of care isn’t what it can be, and where our name itself speaks of an arc, of closing gaps.

In every operating and staff division, We can use the levers that we are so lucky to have, and so privileged to use, to eliminate the barriers to high quality health care.

Because we shall overcome.

We shall overcome the disparities in health care, whether they are due to economic barriers, or institutionalized racism, or even unconscious discrimination.  We–as public servants–can build on Dr. King’s contribution to the moral health of our country to make our own contributions to the physical and mental health of all of its people.

Let’s make that commitment today.

The day may come, however, when our family may need to provide her with the support I see my friends providing to their parents. Some individuals who would like to be more independent, can’t be. The enabling systems to allow that aren’t sufficiently well developed and public policies haven’t yet caught up with the needs of older people and their family caregivers.

That’s why just a few weeks ago Disruptive Women launched Health In Place. This blogsite reported on the launch event. I recommended it as reading to catch up on and a movement to follow – and better yet, engage in.

Perhaps it was HIP that raised my own awareness and made a very small article news article jump off the page over the holidays.

It was about the Aetrex GPS Shoe (www.aetrex.com/aetrex-gps/), which uses GPS tracking technology embedded in the right heel to do real-time tracking of the wearer.  GPS tracking sends a signal to a central monitoring station to show the wearer’s location and relays that information to a tracking website for monitoring by caregivers.

Even better, caregivers can set up a geographic boundary known as a “geozone” and if the individual wanders off and leaves it, are notified via an email or SMS text to a mobile phone. Caregivers can also get emergency tracking in case they need to locate a loved one immediately.

What a wonderful application of availably technology to health and caring. I’ve written extensively about the nature of healing and healers and how our traditional definitions (which restrict “healers” to those in clinical roles) are narrow and no longer sufficiently embracing of the variety of those who contribute to our health and care.

I’m not sure if the folks at the GTX Corporation (www.gtxcorp.com) believe they are healers, but in my book, they are. Bravo to them for what they’re doing to contribute to lowering costs of care, lowing the risks associated with family caregiving and improving the quality of life for those involved.

By Olaoluwatomi Lamikanra. Since the introduction of mobile phones in Nigeria, the number of users has increased exponentially and usage is pretty much found in both rural and urban areas.

With regards to the internet, Nigeria has about 43 million users (total population over 155 million) which far exceeds by more than double the next African country on the list-Egypt.¹

 
There are many projects associated with mobile health in Nigeria and with the exponential growth of mobile and internet users; there is an ever increasing market. Different sectors of the economy which have an impact on the health of the populace also stand to gain a lot from the introduction of mHealth initiatives. Water, Sanitation, Agriculture, Finance and Development are a few of the sectors. In Kenya, the introduction of the mPESA, a mobile phone application where moneys can be sent via mobile phones all around the country has solved the problems of money transfers. No longer do people in rural areas have to wait until someone is visiting from the city before money arrives. They receive the money as soon as it is sent from a PESA center. At a recent WaterHackathon event organised by CCHub in Lagos, one o f the tools suggested for Water development was a mobile system to facilitate the sharing of water resources in hard hit areas.²

Examples of some projects already in place include Mobile Community based Surveillance.mCBS is a mobile platform which is given to Traditional Birth Attendants to report vital maternal and child health indicators in real time using mobile phones. Using texts designed for this purpose the TBA can transmit alerts to nearby health officials who can respond immediately thus reducing delays in reaching appropriate care at a facility.³ Other mHealth projects currently being developed in Nigeria  is being collated by Ime Asangasi (@Imeasangasi- twitter handle) here.

REFERENCES:

1. http://www.internetworldstats.com/stats.htm (accessed 26th December 2011)
2. http://www.cchubnigeria.com/watermeetup (accessed 26th December 2011)
3. http://ehealthnigeria.org/where-we-work/list-of-implementations/mobile-community-based-surveillance-mcbs/

“If we are going to prevent the projected escalation in chronic illness, which threatens to overwhelm our health care system, we need to develop new and better ways to elevate the health of our fellow citizens. The good news is that the next frontier in consumer health and well-being is right on our doorstep – literally,” said Robin Strongin, Creator of the Disruptive Women in Health Care blog and HIP. “We crafted this new initiative to advance the next wave in consumer health and well-being, bringing the best of health care to the places where we spend virtually every hour of every day.”

This project will be unique, not only in its vision of 21st century health and wellness, but also in its scope and composition of experts supporting this new direction. It will involve leaders from health care, technology, telecommunications, housing, travel and other sectors that will have a stake in the success of this exciting endeavor.

The concept of Health In Place™ is built around the idea that our homes are more than just houses, our offices are more than just workplaces, our schools are more than just places of learning, and even our cars are more than just modes of transportation. Thanks to wireless communications and emerging technologies, each of these venues has become potential health and wellness centers. No matter where we are or what we’re doing, we can protect and enhance our well-being.

For this facet of 21st century health care to achieve its full potential – for more Americans to have the tools to link to their caregivers, to protect against illness and monitor their well-being – a number of public policy issues are involved, cutting across multiple disciplines from health care regulations and benefit structures to tax policy to technology incentives.

HIP aims to connect the dots between industries, inspire innovation and drive policy changes that improve health outside of the Affordable Care Act.

Large, industry leaders like Philips Healthcare and UnitedHealthcare have gotten behind the idea of HIP.

“Philips is on the forefront of health care delivery—that’s why participating in a concept like Health in Place is a natural fit,” states Deb Citrin, Senior Director of Strategy and Business Development, Home Monitoring, for Philips Healthcare. “With experience in both the hospital and home settings, Philips understands that health care is evolving and we need to evolve with it by expanding care whenever, and wherever, people need it.”

For more on Health In Place™, read mHimss’ Editor Eric Wicklund’s piece, ‘Health in Place’ initiative seeks mHealth ideas from…everyone.

“My daughter took a self-defense class,” Jill explained, “And she was taught the ‘fight or flight’ response to escape harm. I’m 60 years old. I’m not good at fighting and not very fast at fleeing. So what’s my third option?” Jill created the WatchMe 911 app to provide the solution.

“I first started thinking about a personal alarm system before smart phones even existed. I saw that there were car alarms and house alarms, and wondered why there weren’t personal alarms. At the time I imagined that the personal alarm would go through an answering service system, but since smart phones were created, it can all be tied together in an app format.”

Jill demonstrated the WatchMe 911 app to me during our interview. It contains features such as a panic button that can be armed in advance. Two taps on the smart phone screen and a circle of friends and 9-1-1 are contacted immediately with your GPS location and an alert message. The panic button is a favorite for women who are concerned for their safety when walking late at night or in dimly lit parking lots or alleys.

The “Monitor Me” feature allows the user to schedule messages to friends in advance of a potentially dangerous situation. The message will be sent at a specific time unless disarmed by the user. This is helpful in situations where, for example, a user is out for a run without their phone and might become injured or threatened. They can set the alarm to send out a call for help to friends, with a pre-programmed description of the trail that they’re on. This feature is also popular during blind dates when users would like their friends to check in with them at a certain time.

WatchMe 911 also contains a simple “call 9-1-1″ button, a check-in button (that reminds me of a combination of  FourSquare and Twitter), and allows select groups of people to join a “neighborhood watch” type network to support friends who might need help. There is a campus version of WatchMe 911, called OnWatch that is modified for college students, allowing them to connect with campus police, for example.

Although the WatchMe 911 app only launched in September of this year, its sister program (OnWatch) has already won the Apps Against Abuse Technology Challenge, sponsored by the Office of the Vice President, the White House Office of Science and Technology, and the Department of Health and Human Services.

Jill told me that WatchMe 911 is available for free download on iTunes now, with in-app purchase fees ranging from $5.99/month to $99.99/year. Call 911 feature is always free. Users are offered a 30-day FREE trial of the entire app.

Although my one concern about these apps is the potential for false alarms (I can imagine how annoying it could be for forgetful joggers to send out unintentional, automated alerts to friends), I believe that version 2.0 of WatchMe 911 could provide revolutionary real-time aggregated data to law enforcement. Nation-wide and local crime hot-spots could be identified easily from users who opt-in to share their alerts, allowing police to allocate resources more effectively – deterring violent crimes before they even occur.

I hope this app gets the traction it deserves, because the potential for benefit is incredibly large. And for all the other women and grandmas out there who are looking for an alternative to “fight or flight” this may well be your ticket.

Originally published on Better Health on December 9th.

Today, you can receive text messages, voice mail, or email reminders for just about anything from medications, to testing, to health tips, or appointments.  Information and help where you want it, when you want it, and how you want it are transforming the relationship between you and your providers.  Teens get help with diet and smoking cessation as well as disease management.  Elders and their care givers get live follow up and real time transmission of important vital signs through remote patient monitoring that can alert providers to developing problems at home.  Ambient assisted living systems that track movement at home, and personal emergency response systems help elders stay at home but alert others when a condition changes over time or in an emergency.

Mobile personal monitoring is getting a boost from other companies who recognize people want to be on the go, and are not held back by the need to monitor or address health needs in traditional ways.  In the next several years, Ford Motor company plans to provide “First Assist” emergency health care instruction through its OnStar system. They will provide allergy alerts based on day-to-day location indices of allergens, and glucose level monitoring alerts via dashboard applications.  Future plans also include voice requests for health information and updates, seat sensors to detect electrical heart rhythms/problems, and stress reduction responses.  Leveraging existing technologies such as GPS, telecommunications, and internet access is catapulting us into an age of ubiquitous computing where our environment is instantaneously and unobtrusively enabled by computer assisted functions.

Electronic medication reminder boxes and vials already offer services to remind people what to take, and when to take it with flashing lights and compartments that release.  Failure to respond on schedule triggers follow up to the consumer and family members. Simple transmission of daily weight and other vital signs is easily performed through a variety of economical products including one scale that will post your weight on Twitter.  Edible computer chips are being tested to report proper drug ingestion. 

Thousands of cell phone applications provide tools to receive and send health information as data points, documents, and static as well as moving images.  With 24/7 expectations, we now have 24/7 access to information and data interactivity.  Technology is delivering on the promise to help improve care.  It is always on, and fits in our pockets. 

*Mark D. Smith. Disruptive Innovation: Can Health Care Learn From Other Industries? A Conversation With Clayton M. Christensen.  Health Affairs, 26, no.3 (2007):w288-w295. (published online March 13, 2007; 10.1377/hlthaff.26.3.w288)

According to ABC News’ Bob Woodruff, Giffords lost her speech as a result of aphasia, defined as “the inability to speak because of damage to the language pathways in the brain’s left hemisphere.”

Tomaino, the Executive Director and co-founder of the Institute for Music and Neurologic Function (IMNF), is an international authority on the clinical applications of music and neurologic rehabilitation. She has studied extensively the role of music therapy in treating aphasia sufferers.

Tomaino speaking at the 2010 Disruptive Women Holiday event -- Music and Art Therapy: A Demonstration of Healing.

As she explains, “For someone recovering from a brain injury, music can be a gateway to speech. They may not be able to speak words, but they often can sing lyrics to familiar songs.”

Prompted by the inspiring story of Giffords’ successful treatment, the American Music Therapy Association asked Tomaino to teach a full-day class about Traumatic Brain Injury (TBI) and music therapy at their annual conference (you can see a description of the class and learn more about the conference here).

The work of Tomaino and others in the music therapy space has revolutionized how doctors treat not just aphasia, but a wide range of other neurological conditions as well. An article in today’s edition of USA Today highlights music therapy treatments for other medical conditions and diseases (and includes an interview with Tomaino!). You can learn more by visiting IMNF’s Facebook page and YouTube channel.

Tomaino participated in last year’s Disruptive Women Music and Therapy Holiday Event (see a recap — including photos and video of the event – here.

The report says that by 2014 – there will be 400 million consumer sensor oriented devices, comprising a $4 billion market! Disruptive Women in Health Care hopes to contribute to developements in this area through its Health in Place Initiative.

To view the Rock Health report click here.

The Ovarian Cancer Symptom Diary App will help you learn about the risks, signs and symptoms of ovarian cancer. This first-of-its-kind application allows a woman to track symptoms that could indicate ovarian cancer, and alerts her if she should make an appointment with her doctor for further testing. To download app click here.

This got me thinking about the Disruptive Women in Health Care – past and present and how their vision of the future has also enlightened our world.  Here is a snapshot of my list. Who is on your list?

• Marie Curie—a contemporary of Lady Liberty, the original poster-child for STEM having discovered radioactivity, winner of not one but two Nobel prizes (for physics and chemistry) and, in her spare time, she became the first woman professor at the Sorbonne.
• Hillary Clinton—architect of health reform 1.0, and oh yes, a Senator and Secretary of State, who continues to champion the rights of women and girls, and
• Florence Nightingale—the original health services researcher who laid the foundation for today’s field of nursing; not only do new nurses take the Nightingale Pledge but International Nurses Day is celebrated around the world on her birthday. And, oh yes, she too is known as the Lady with the Lamp.
• My Mother. Enough said.

For her birthday, Lady Liberty is getting  a high-tech uplift: Internet-connected cameras on her torch that will let viewers gaze out at New York Harbor or see visitors on the grounds below. For more information on the birthday celebration or the webcams click here.

To kick the tires on the survey a bit, I spent time on the phone with the “3 M’s” of Manhattan Research — Meredith Ressi, President; Monique Levy, VP of Research; and, Maureen Malloy, Senior Healthcare Analyst who can recite the survey data backwards and forwards. Together, they guided me through the topline on digital health information use among U.S. adults in 2011.

The 56 million US adults who access data via electronic health records (EHRs) was a surprise to me, and to this trio, as well — so much so that they revisited the study methodology and samples to ensure that this was not a statistical anomaly. It’s not. But as with all numbers, it’s insightful to know what lies beneath the raw stat.

The big number to consider here is 24% of U.S. adults who are accessing their personal health information (PHI) from their physicians’ EHRs. In this case, the 56 million tend to be younger, better educated (more with college education), higher internet adoption, and more likely to own smartphones and tablet computers. They are also more likely to observe a physician doing digital activities during the consult – such as seeing the doctor entering information into the EHR.

What’s common among those consumers interacting with their EHR-borne health information is that they are more frequent online health information seekers than people who are non-users of their EHR data: three times more likely.

Monique Levy pointed out that EHR information users are “more acutely aware of the pain points they have in the health system: they are more likely to identify certain problems and barriers in managing care. They are a more self-aware group about what’s working, what’s not working, and what they need” out of the health system.

What’s beyond the 56 million (24%) U.S. adults who Manhattan Research calls “users” of EHR information? Another 41 million who are interested in doing so but haven’t yet.

This leaves millions more people in America who don’t appear interested in accessing their health information via a doctor’s EHR. Cybercitizen Health identified the least-engaged group within this cohort: 15% of people who have seen a doctor in the past twelve months whose doctors provided access to medical information on an EHR, but neither accessed their EHR data nor are interested in doing so.

Thus, the consumer side is only one-half of this equation: physicians, of course, play yang to the patient’s yin. In Taking the Pulse, Manhattan Research’s annual physician poll, the company found that doctors’ adoption of tablets (especially the iPad) continues to quickly grow. Their use will turbocharge physician adoption of mobile EHR capabilities, and physicians’ ability to share data, up-close-and-personal, and in seamless ways without disrupting workflow in the exam room which can happen when sitting behind a computer monitor.

For Cybercitizen Health, Manhattan Research surveyed 8,745 U.S. adults age 18 and over via online and phone in the third quarter of 2011.

Health Populi’s Hot Points: In The Two-Way Street of Patient Engagement in Health IT, I wrote in California HealthCare Foundation‘s iHealthBeat on September 27, 2001, “In the two-way street that is patient engagement, it is health care providers  who will play a key role in getting the mass-middle of people more involved in  their health data. That may be a lot to ask of health care providers given their  already-cramped workflow, but doctors and hospitals will be motivated by at  least two market drivers: payment and consumer pressure.”

Manhattan Research found that people who have begun to embrace their PHI via EHR tend to have physicians who bring them into the process in the exam room: physician engagement with meaningful use is drawing patients into conversations about their personal health information and, therefore, their health.

Further fanning the flame of physician involvement is Meredith Ressi’s observation that, “once you get an iPhone or Droid in physicians’ hands, it changes their behavior.” She noted that access to the web is the first changed behavior: doctors are doing medical information searches via smartphones wherever they are — and with iPhones, the use of simple-to-access apps further bolsters their mobile health behavior.

Originally posted on Health Populi on October 14th.

In Cleveland, Clinic CEO Delos Cosgrove has essentially declared war against preventable chronic disease.  Smoking is completely banned anywhere on the campus (and, in fact, physicians have been fired for violating this prohibition), deep fryers and sugared sodas have been removed from the Clinic premises, and Clinic employees pay higher health insurance premiums if they don’t take part in some form of fitness or stress management classes.  Employees’ health conditions – blood pressure, blood sugar, weight and other measurable – are monitored to make sure they are being proactive in improving their health.

The results, as Klein writes, are indisputable.  The Clinic has reduced its employee healthcare costs.  Smoking rates and blood pressure are way down.  Employees have lost a collective 125 tons of weight since 2005.

There will undoubtedly be disagreements over whether the Clinic’s tough love approach is an appropriate policy.  And if the same policies were brought to a large non-healthcare workforce like a General Motors or a Xerox, one could even project that there would be charges of discrimation against smokers, the obese and people who just happen to love a Wendy’s Baconator.

But this is a conversation that America needs to have.  At the same time in which policymakers are debating whether to cut reimbursement levels in the Medicare program, affecting access to quality care and medical innovation, there are billions of dollars being spent to treat cases of diabetes, heart disease, pulmonary illness and other conditions that are caused or exacerbated by lifestyle choices.

Employees and healthcare providers throughout the country are developing innovative ways to strengthen wellness and prevent chronic disease.  We’ve chronicled many of the very effective ones in the HLC Wellness Compendium.

If the Cleveland Clinic’s aggressive methods on employee wellness stir a widespread debate, that’s a very good thing.  The Center for Disease Control and Prevention projects that one of every three Americans will have diabetes by the year 2050.  If that occurs, today’s healthcare cost concerns will seem like child’s play compared to what we’ll be facing later this century.  Wellness has to become a national priority.

This post originally ran on the Prognosis Blog on October 18th.

Steve Jobs 1955-2011

The day before my daughter Elise’s 15th birthday, the new iPhone went on sale.  My birthday was 4 days later.  So Elise figured out we should buy each other an iPhone to mark our big days.  She planned (and saved) for months.  She spent weeks talking to friends, researching apps on line, planning for such accessories as protective covers, and educating herself on how to maximize her minutes.

When the big day came, we made our way to the Apple store and stood shoulder to shoulder with hundreds of others waiting on a very long line.  Two and a half hours later we were invited, actually escorted, in to the store by an extremely friendly, knowledgeable young man who stayed with us during the entire purchase transaction.

He answered tons of questions (mine, not Elise’s…she already knew everything), politely reviewed various functions with me (Elise was extremely patient during this process), and made great suggestions about which plan was best for us.

While we were waiting on line, I looked around at the people waiting with us–we were an extremely diverse group–and wondered (a) Why in the world were we all willing to wait hours to buy a telephone, a very expensive telephone?  (b) How did the folks at Apple get us to this point? and (c) What lessons could we take away and apply to health care?

Here’s what I came up with:

Cool. The iPhone is not your mother’s rotary dial wall phone.  The engineers and creative types figured out how to make a very uncool, but necessary, object not only aesthetically pleasing, edgy, and fun, but useful, convenient, and easy to use.  They stimulated demand.

Now if the Apple  folks could only do for colonoscopies what they did for telephones.  I am only half joking.  How do we make taking care of ourselves and our loved ones cool?  How do we make boring, sometimes not so pleasant preventive measures cool and edgy?

Hospitals are scary places–while some newer facilities have made efforts to look more appealing (open atriums with green trees, brighter colors and lighting), many are dark, smell strange, are old and creaky, have tons of frightening tubes, machines, noises, and for most people are places to be feared and avoided.

What amenities can be added to make it harder for patients to find excuses not to get that mammogram (valet parking, anyone?), not to go for that follow up, not to just give up and leave after waiting for two and a half hours in the waiting room (Elise and I waited that long–and the friendly folks at Apple handed out water, and updated us on our progress).  The only water I could find in my local hospital emergency room last week (when we were there with my son) was a nasty water fountain that had stuff in it that would make a petri dish cringe.  There were vending machines with chips, candy and soda, but it was broken.

Service. Imagine for a minute that when you enter a clinic, doctor’s office, or hospital, you are accompanied by a knowledgeable, helpful, pleasant individual who can speak to you in a non-condescending, judgmental manner, in language that you understand.  Someone who can help you navigate a complex system of decision making.

Quality. Pretty obvious attribute.  Quick–think Mayo, Cleveland Clinic, Johns Hopkins.  What is it about these institutions that people think of when asked to list “best” hospitals.  How do you (should you?) rate different doctors? Nurses?  Most people buy the iPhone because they believe they are buying a high quality product.  How can we be sure we are buying high quality health care?

It’s interesting when you look at the literature.  Quality is defined in many different ways by health care professionals and by patients.  Sure there’s overlap.  But in addition to better health outcomes, living longer and better–patients highly rank items such as convenience, hours of operation, waiting times, and location as quality indicators.  Apple stores have better hours than most clinics and physician offices.  My dog’s vet has better hours than most doctors.

Value. Why was a 15 year old willing to save her hard earned money for an expensive phone (and why was I willing to pay not insignificant monthly charges) for the iPhone?  Because we thought it was worth it.

If only we could figure out a way to get people to see that it’s worth it to exercise, eat healthy, get annual check ups, not smoke… and get that colonoscopy.

I know, I know it’s October…but hey, we are disruptive so celebrating on the exact day seems so well, ordinary.  And the past three years have been anything but ordinary.  We all had something to say about the new health reform debate and ultimate passage.  We still have much to say about the new law, as well as a multitude of other topics.

One area that I have been thinking a lot about is the exploding area of mhealth (mobile health), remote monitoring, and telehealth.  Technology alone is not the answer of course.  But technology, coupled with innovative care delivery models (think health reform), and patients, caregivers and clinicians more comfortable with smartphones, apps, data sharing and online connectivity have all contributed to a new framework of health and wellness.  Aging in Place, staying connected, eICUs, PHRs and EHRs.  Exciting stuff.

But, like most solutions in health care, success must look beyond the health sector.  Here’s what I mean by that: staying healthy can’t just take place in a health setting or even in your home.  Maintaining your health and wellness or managing your chronic disease or disability requires a connection where ever you are — in other words, Health In Place.  Young people with epilepsy and diabetes still attend school, go on vacation and use public transportation.  Elderly individuals aging in place still travel to visit gradnchildren. And, adults maintaining exercise and nutrition regimens who travel for work need to stay connected to maintain wellness.  The Health In Place concept takes this broad view and will be bringing together thought leaders from not only the health field, but the telecom, travel, automobile and real estate sectors as well. 

The organizers of the 2011 mHealth Summit were so taken with this idea that they invited Disruptive Women to launch the Health In Place or HIP initiative with a reception on December 6th–we couldn’t be more thrilled or more flattered. So SAVE THE DATE:

Health In Place (HIP)™ — Disruptive Women in Health Care is Launching a New Initiative

Tuesday, December 6, 2011, 5:00–7:00 PM
Location: Pose Ultra Lounge & Nightclub–at the Gaylord Hotel in National Harbor (Washington DC)

Overview: The concept of Health In Place™ is built around the idea that our homes are more than just homes, our offices are more than just workplaces, our schools are more than just places of learning, and even our cars are more than just modes of transportation. Thanks to wireless communications and emerging technologies, each of these venues has become potential health and wellness centers or HIP. No matter where we are or what we’re doing, we can be protecting and enhancing our well-being. For this facet of 21st century health care to achieve its full potential — for more Americans to have the tools to link to their caregivers, to protect against and manage illness, while monitoring their well-being — a number of public policy issues are involved, cutting across multiple disciplines from health care regulations and benefit structures to tax policy to technology incentives. That’s why Amplify Public Affairs and the Disruptive Women in Health Care® blog (along with our media partenr, The Hill) have formed the Health In Place™ Initiative — to bring together policymakers and change agents from multiple industries.

 Please join us as we unveil this new initiative.

 Speakers:

• Robin Strongin, President & CEO, Amplify Public Affairs & Creator, Disruptive Women in Health Care — Moderator
• John Marttila, President, Marttila Strategies (a national polling expert)
• John C. (Jack) Lewin, MD, Chief Executive Officer, American College of Cardiology
• Pamela Cipriano, PhD, RN, NEA-BC, FAAN, Professor, University of Virginia School of Nursing, Editor-in-Chief, American Nurse Today, 2010-11 Institute of Medicine Nurse Scholar-In-Residence (and a Disruptive Woman blogger)
• Halle Tecco, Founder & Managing Director of Rock Health (and a Disruptive Woman blogger)

Stay tuned for more information.  And by all means, please come out on December 6th and celebrate with us.

At three years of age, we are not only Disruptive, we are also HIP.

You can read the full HuffPost story here: http://www.huffingtonpost.com/2011/08/20/dolphin-with-prosthetic-tail_n_927463.html#s330792&title=Dolphins_Fake_Tail

How do you feel about health-related social networking? Would you join an online health program? What concerns – privacy, quality of service, etc. – do you think this presents?

Read the full text of the Healthcare IT News post here: http://healthcareitnews.com/news/social-media-tools-may-reduce-attrition-online-health-programs