Proportional News Coverage - Skewing Health Perception

Our perception of health and risk is all wrong and instantly accessible media is one of the key reasons. The recent coverage locally in the Washington area demonstrates the point well. A quick Google search of "Metro Crash" in the news reveals a total of 6,132 results (no doubt this will increase over time). A tragedy occurred on the Washington DC Metro when one train collided with one car riding up and over the other. There were several fatalities (9 at the time of writing this post) and a range of injuries from severe to minor. Coverage in the hour long evening news on the night of the tragedy could be summarized as follows:

• Evening News Length: 60 Minutes
• Advertisements Time: ~20 mins
• Time dedicated to the Crash: 35 mins
• Time dedicated to remaining news: ~5 mins

This disproportionate level of attention skews our perception of risk. Anyone watching the news last night would find themselves focusing on the safety of the Metro system. A quick search for statistics (interestingly the Wiki Page on the Washington DC Metro's Security and Safety had already been updated with details of the latest crash!) reveals a list of accidents but no suggestion of significant problems or challenges facing this system. In fact the overwhelming commentary suggests "The DC Metro has a very good safety record". When compared to data on Traffic Fatality Rates for DC:

• Traffic's most recent data for 2007: 44 fatalities (US total fatalities 41,059)
• DC Metro 15 (subject to change based on the most recent crash) over the last 20 years

Healthcare is the same and our perception of risk is skewed based on media coverage and our own personal experiences. If the news media gave proportional coverage based on risk and causes of death it might look something like this

• Evening News Length: 60 Minutes
• Advertisements Time: ~20 mins
• Time dedicated to the Heart Failure and Cancer: 20 mins
• Time dedicated to Cerebrovascular Disease: 4 mins
• Time dedicated to remaining causes of death 6 mins
  

How can technology help - in this instance it appears not to be. The instant availability of news, our ability to blog and tweet the latest information and the way in which information can take on a life of its own (can anyone say Swine Flu H1N1). We need to filter information and it is the link to our clinician that helps provider that input and balance. Id be the first to encourage everyone to be their own primary care practitioner - in fact I said so last week but this has to be balanced with appropriate input from trained experienced professionals. There are a range of tools to help diagnose problems including some online symptom checkers and they have a place in the range of choices available to us. But this is not about replacing the education and experience of your clinical team. This is about supporting them with appropriate information.

In a recent discussion with a clinical colleague he was adamant that clinicians must use technology and clinical systems to be able to deliver better and safer care. I agree that technology must be used to help support the decision making - in fact I think it is as much about information as it is about technology. Technology just helps bring the information closer to the decision making point. This can be as simple as patients searching for information and bringing in printed material to the consultation (I know to some clinicians this is their nightmare but I remain convinced that there is no stronger more dedicated advocate for the successful outcome than the patient themselves).

But getting to this data and providing it not only in digital form but better yet in a form that can be consumed and processed by electronic systems takes this to the next level. Linking this information to the full Healthstory allows for some automated processing and relevance mark up that will help in filtering useful from distracting data.

Personal health management includes the capture of information and the intelligent sharing of this between the patient, the clinician and clinical systems. This is a team approach and the team will help balance the perception of risk. Finding balance is one of the keys to navigating through life. Have you found balance and if so how. What's your perception of coverage, risk and the media coverage distorting our perception of risk.

Social Networking and Healthcare

The network is buzzing with excitement over twitter and social networking and there are increasing numbers of guides, top ten lists and other material aimed at the new participants in the world of twitter. Ashton Kutcher is doing it, Oprah Winfrey is doing it (albeit in CAPITALS initially) - interestingly the race to 1 million followers was close but now Ashton is almost double.

For the Record recently featured an article titled: Healthcare All Atwitter Over Social Networking that looked at the range of social networking tools. Everything from You Tube, Facebook, twitter and blogging is being used by the University of Maryland Medical System (twitter, facebook, blog and youtube links). They attract around 700 people per day that watch videos and read their material - new members, existing patients and more awareness of the system are all good results that will translate into business and good will.

Although healthcare organizations must deal with a unique set of challenges when it comes to establishing and maintaining a presence on social networking sites, they should nonetheless be taking the steps to utilize these sites and tools to reach out to patients and consumers. It is also imperative to monitor what is being said about them by others in the social media space to protect their brands and reputations.

It reminds me a lot of the discussions i was having ten years ago about a web presence with similar resistance to the idea of publishing or spending resource on a web site. Here we are today and it is hard to imagine any facility without a web site (usefulness, design etc widely varied) that is for the most part the online store front. It is not unreasonable to suppose that Social networking is the next innovation in the online/digital world.

In healthcare here is clearly a concern relating to protected health information (PHI) but this is a low cost

"It’s a grand experiment and it may fail, but the cost of entry is so low. It’s not like we have to decide to spend a million dollars to participate on Facebook. It’s more like investing a percentage of an employee’s time to set up an account. Hospitals should be saying ‘We’re here and we’re ready to talk to you.’ … You can just post press releases, or you can become very chatty and friendly. You’ll find out what the best match is for your personality and the way you think of yourself.”

Go ahead take a dip....join me on Twitter (and ranked #27 in the list of top CMO's on twitter), Facebook, LinkedIn, My other Blog - Navigating Healthcare or Plaxo....amongst some of the places I can be found online

Why Participating in Blogs is Important

I had the privilege of meeting e-PatientDave at the TEPR conference this week. He was there to bring the patient's views to this conference - wow - that's a novel thought! Getting patient input at a conference on healthcare......this does not happen often enough. It was a commanding performance and one that should have been videoed and then youtubed but I think he has this in the plan based on what I read.

He has his own blog(s) e-PatientDave and is of course on twitter and is an advocate for the inclusion on the patient in the care process (whew - two eureka moments in a single post!). He made many compelling points, delivered an emotional and riveting diary of his incidental finding of an especially aggressive form of Renal Cell Carcinoma that he fought and won. He joined an impromptu tweetup at the evening reception and continued to engage throughout the conference. Much of what he does is on his own coin and time and done with the attitude that given the history every second is a bonus.

A post from last month on why he loves participating in blogs and healthcare is descriptive and a great study of the relevance of this media to our future.....if you are not involved in this media the world is going to pass you by. This post linked to Paul Levy's "Running a Hospital blog that is definitely leading the crowd in communication and openness. He had cited the news of the day on "Check Lists" - I talked about this last year in this post - Simple things save lives crediting Peter Pronovost and congratulating him on his recognition as a newly inducted fellowship. There was a great article in the New Yorker titled "The Checklist" that detailed the concepts and the amazing results

Social media power. Connecting and engaging everyone. If you aren't on board you should be. Do you agree or is this just more "stuff" to distract us form delivering care - you tell me.

There are so many ways to participate and here are some of mine (it's horses for courses - pick the media you like):

Twitter
Technorati
RSS Feed - Speech Understanding
RSS Feed - Navigating Healthcare
Linked-In
Plaxo
Facebook
Digg
del.icio.us
Follow me on Twitter
DM Reply on the Twitter

A Facebook Medical Record

What are we trying achieve with medical records....? Asides from the obligatory proof that the care was delivered (billing) and determining how much should be paid for the delivery of that care medical records are about sharing information between care givers. It has always been that way. Years back the number of care givers was lower and specialization less so the number of people needing accessing to the this information was lower. Now with the tsunami of medical information it is impossible for single care givers to deliver all the possible ranges of care and it takes a village team to deliver care.

And the latest explosion on online activity - one who's traffic can exceed that of Google and you tube is Facebook, which according to their own description

...is a social utility that connects people with friends and others who work, study and live around them. People use Facebook to keep up with friends, upload an unlimited number of photos, share links and videos, and learn more about the people they meet.

Now take this concept and adjust the wording.....

FaceBookHealthRecord is a social utility that connects patients with their care givers and others who provide diagnostic services, imaging, laboratory tests, results and pay for that care. Patients and clinical care givers use FaceBookHealthRecord to keep up with the status of their healthcare, their wellness and long term disease outlook as well as communicate quickly and effectively with specialists. All images, diagnostic study videos and diagnostic testing information can be uploaded and shared withe the clinical team allowing everyone to learn more about he care of that patient.

The interaction concept has been tested and reported on - Bob Wachter wrote an article just recently on this very concept "Creating a Facebook-like medical record" where he slams home the point on interoperability

In fact, today’s medical record virtually guarantees the silo-ization of care. Few physicians ever read nurses’ notes, even though all of us depend on the nurses to be our eyes and ears. And the situation iteratively worsens every day. Why would a nurse, realizing that no doctor ever reads her notes, even try to write them to be useful to physicians? And visa versa, obviously. Over the years, this divergence has been codified into ritual, calcified by templates, and hard wired through regulations whose original rationale no one can remember

Interestingly he points out that the spooks have gotten in on the concept with FaceBook-007 aka A-Space (I am guessing short for Analytical Space...?). Launch is set for Sep 22, 2008. UCSF back in 2003 launched a concept very much in line with the sharing of information amongst all the related parties (notably not the patient in this case) called Synopsis

As with all folklore associated with good concepts it was an rapid victim of its own success receiving requests for access, being copied and installed at other locations by users and even covered on a Web based M&M rounding on the Agency for Healthcare Research and Quality (AHRQ) site

There is work on these concepts underway and even some launches - if you live in New York you can sign up with HelloHealth from MyCA Health group who liked the approach taken by Jay Parkinson (the Hipster-MD from New York- pdf) who launched his own home made system with a similar ideal of sharing information digitally and providing easy, affordable access to patients some months ago. The NHS in the UK is getting in on the act with the "Individual Health Record" and covered in a recent article "Personal Healthcare Management" (subscription required) in my regular column in the British Journal of Healthcare Management.

There is even a Facebook application - MedCommons available today for a subscription plus monthly storage charges. Unfortunately much of what will be transferred in is likely to be scanned images and print outs. The introductory video even shows your physician office receiving access to your medical data and printing it out.....sigh! This will change but for now we are stuck with the legacy information

No doubt there will be detractors and there are bound to be issues and problems but overall you have to like the idea of sharing data on the quickly and effectively with the full clinical team. And there lies a key point.... the information must be be clinical data and should be tagged to a controlled medical vocabulary to make this information valuable for automatic machine processing. But lets not burden the clinicians with entering data in online forms but provide tools that capitalize on clinical documentation and the natural expressivity of language while still creating the structured data that can be used by these connected applications.