1. THE RISE OF THE E-PATIENT Trends in the use of digital technology for health purposes Lee Rainie Director – Pew Internet Project Medical Librarians Atlantic City 10.7.09

2. Rise of the e-patient October 7, 20092 New information ecosystem: Then and Now Industrial Age Info was: Scarce Expensive Institutionally oriented Designed for consumption Information Age Info is: Abundant Cheap Personally oriented Designed for participation

3. Rise of the e-patient October 7, 20093 2000 46% of adults use internet 5% with broadband at home 50% own a cell phone 0% connect to internet wirelessly <10% use “cloud” = slow, stationary connections built around my computer The internet is the asteroid: Then and now 2009 77-79% of adults use internet 63% with broadband at home 85% own a cell phone 54-56% connect to internet wirelessly >two-thirds use “cloud” = fast, mobile connections built around outside servers and storage

4. Rise of the e-patient October 7, 20094 Media ecology – then (industrial age) Product Route to home Display Local storage TV stations phone TVCassette/ 8-track broadcast TV radio broadcast radio stereoVinyl album News mail Advertising newspaper delivery phone paper Radio Stationsnon-electronic Tom Wolzien, Sanford C. Bernstein & Co

5. Rise of the e-patient October 7, 20095 Media ecology – now (information age) Product Route to home Display Local storage cableTiVo (PVR)VCR TV stations DSLTVSatellite radio player Info wireless/phoneradioDVD “Daily me” broadcast TVPCWeb-based storage content books iPod /MP3server/ TiVo (PVR) Cable Nets broadcast radiostereoPC Web sites satellitemonitorweb storage/servers Local news mailheadphonesCD/CD-ROM Content from express deliverypagersatellite playercell phone memory individuals iPod / storageportable gamerMP3 player / iPod Peer-to-peer subcarriers / WIFIcell phonepagers - PDAs Advertising newspaper deliverynon-electroniccable box Radio stations camcorder/cameraPDA/Palmgame console game consolepaper Satellite radioe-reader / Kindlestorage sticks/disks e-reader/Kindle Adapted from Tom Wolzien, Sanford C. Bernstein & Co Ubiquitous computing age Cloud computing “Internet of things”

6. Rise of the e-patient October 7, 20096 Information and media ecosystem changes 1.Volume of information grows 2.Variety of information increases 3.Velocity of information speeds up 4.The times and places to experience media enlarge 5.People’s vigilance for information expands AND contracts

7. Rise of the e-patient October 7, 20097 Information and media ecosystem changes 6.The immersive qualities of media are more compelling 7.Relevance of information improves 8.The number of information “voices” explodes – and the voices become “louder” and more findable 9.Voting and ventilating are enabled 10.Social networks are more vivid

8. Rise of the e-patient October 7, 20098 Behold Networked Individuals … those with a different sense of … Expectation about access to, availability of, and pathways to information Place, distance, presence, intimacy – it’s all ambient Time use The possibilities of work, learning, and play The scalability of conversation and community The persistence of “digital me” and “digital you” Personal efficacy and the payoff for personal effort Boundaries and contexts – public and private The rewards and challenges of networking for social, economic, political, and cultural purposes – new layers and new audiences

9. Rise of the e-patient October 7, 20099 A new pattern of communication and influence built around social networks and participatory media The four A’s of searching and acting attention acquisition assessment action

10. Rise of the e-patient October 7, 200910 Networked Individuals as e-patients 61% of total population – 83% of online population 64% of women; 57% of men 65% of whites; 51% blacks; 44% Hispanics Age –72% of 18-29-year-olds –71% of 30-49-year-olds –59% of 50-64-year-olds –27% of those 65 and older Skews upscale and educated Parents http://e-patients.net/

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20. Rise of the e-patient October 7, 200920 Other e-patient activities 47% of adults have used the internet to get information about doctors or other health professionals 38% have gotten information about hospitals or other medical facilities 33% have gotten information about how to lose or control their weight 27% have gotten information about health insurance 12% have gotten information about how to stay healthy on an overseas trip

21. Rise of the e-patient October 7, 200921 60% of e-patients engage with social media 41% have read someone else's commentary or experience about health or medical issues on an online news group, website, or blog. 24% have consulted rankings or reviews online of hospitals/other medical facilities. 24% have consulted rankings or reviews of docs or other providers. 19% have signed up to receive updates about health or medical issues. 13% have listened to a podcast about health or medical issues.

22. Rise of the e-patient October 7, 200922 20% of e-patients are e-participators 6% have tagged or categorized content about health issues. 6% have posted comments about health issues in an online discussion, listserv, or other online group forum. 5% have posted comments about health on a blog. 5% have reviewed a doctor. 4% have reviewed a hospital. 4% have shared photos, videos or audio files online about health or medical issues.

24. Rise of the e-patient October 7, 200924 A handy tech-user typology http://www.pewinternet.org/Reports/2009/5-The-Mobile-Difference--Typology.aspx

25. Rise of the e-patient October 7, 200925 What we measured Assets Actions Attitudes

26. Overall picture 39% are motivated by mobility 5 groups that are being drawn into deeper use thanks to mobile connections Wireless connections prompt them to use the internet more and feel better and better about its role in their lives Self expression and networking matters to them, but some have mixed feelings 61% are tied to stationary media 5 groups that do not feel the pull of mobility – or anything else – drawing them deeper in the digital world Some have lots of technology, but it is relatively peripheral in their lives They have plateaued in internet use and enthusiasm -- or are on the outskirts of digital life

27. Rise of the e-patient October 7, 200927 Motivated by mobility – Group 1 Digital collaborators (8% of population) Tech lifestyle attributes With the most tech assets, Digital Collaborators use them to work with and share their creations with others. The lead the pack in every dimension of our analysis: assets, actions, attitudes towards technology. Always-on broadband and always-present cell connection is key to their lives. These veteran users are enthusiastic about how ICTs help them connect with others and confident in how to manage digital devices and information.

28. Rise of the e-patient October 7, 200928 Motivated by mobility – Group 1 Digital collaborators (8% of population) Demographics Male: 56% Median age: 39 Race: Diverse Education: 61% college + Household income: 53% make > $75K Employment status: 70% employed FT Community type: 52% suburb; 36% urb. Funky facts: 12 years online 73% married 51% parents minor children

29. Rise of the e-patient October 7, 200929 Motivated by mobility – Group 1 Digital collaborators (8% of population) Important because They are your most consistent, primary users They are early adopters They are most potent influentials; they are evangelists and their word of mouth really, really matters When you want to explore new services, they will give you feedback

30. Rise of the e-patient October 7, 200930 Motivated by mobility – Group 2 Ambivalent networkers (7% of population) Tech lifestyle attributes Ambivalent Networkers have folded mobile devices into how they run their social lives, whether though texting or social networking tools online. They tie for first or take second in all assets and actions categories. They also rely on ICTs for entertainment. But they also express worries about connectivity; and some find that mobile devices are intrusive. Many think it is good to take a break from online use. Their keyword about technology might be “obligation” – can’t afford to be off the grid, even though they want to be.

31. Rise of the e-patient October 7, 200931 Motivated by mobility – Group 2 Ambivalent networkers (7% of population) Demographics Male: 60% Median age: 29 (youngest) Race: Little more minority than DigCollab. Education: 23% college + Household income: 44% make < $50K Employment status: 64% employed FT Community type: 44% suburb; 45% urb. Funky facts: 30% are students 34% are NOT email users 83% are cell texters

32. Rise of the e-patient October 7, 200932 Motivated by mobility – Group 2 Ambivalent networkers (7% of population) Important because They are tomorrow’s primary e- patients and library-service users and influencers They have seen change in libraries and liked it

33. Rise of the e-patient October 7, 200933 Motivated by mobility – Group 3 Media movers (7% of population) Tech lifestyle attributes Media Movers have a wide range of online and mobile habits, and they like to find or create an information nugget, such as a digital photo, and pass it on. These social exchanges are central to this group’s use of ICTs – rather than work- related uses. Cyberspace as a path to personal productivity or an outlet for creativity is less important. They are not into online content creation the way Digital Collaborators are, yet they are big-time sharers.

34. Rise of the e-patient October 7, 200934 Motivated by mobility – Group 3 Media movers (7% of population) Demographics Male: 56% Median age: 34 (second youngest) Race: Diverse Education: 32% college+ (average) Household income: 56% make > $50K Employment status: 70% employed FT Community type: 55% suburb; 30% urb. Funky facts: 31% record video on cell 87% own dig. camera 90% online health seekers

35. Rise of the e-patient October 7, 200935 Motivated by mobility – Group 3 Media movers (7% of population) Important because They are least intense e-patients, though lots of them have sought medical information online They are eager social networkers who pass along your material They add to the diversity of your audience

36. Rise of the e-patient October 7, 200936 Motivated by mobility – Group 4 Roving nodes (9% of population) Tech lifestyle attributes Roving Nodes are active managers of their social and work lives using their mobile device. They get the most out of basic applications with their assets – such as email or texting – and find them great for arranging the logistics of their lives and enhancing personal productivity. They love email and texting, but are too busy to blog or create other content. Think “working Little League mother”, or caregiver for aging parent when you think of Roving Nodes

37. Rise of the e-patient October 7, 200937 Motivated by mobility – Group 4 Roving nodes (9% of population) Demographics Female: 56% Median age: 39 Race: Diverse > Latino Education: 44% college+ (2nd highest) Household income: 52% make > $50K Employment status: 68% employed FT Community type: 48% suburb; 39% urb. Funky facts: 100% have cell phones heavy internet use at home and work – hard to give up say tech gives them control

38. Rise of the e-patient October 7, 200938 Motivated by mobility – Group 4 Roving nodes (9% of population) Important because They are kin-keepers and caregivers They will appreciate you if you help them be efficient and thorough

39. Rise of the e-patient October 7, 200939 Motivated by mobility – Group 5 Mobile newbies (8% of population) Tech lifestyle attributes This group rates low on tech assets, but its members really like their cell phones. Mobile Newbies, many of whom acquired a cell in the past year, like how the device helps them be more available to others. The act of getting a cell phone was like a conversion experience for them in the way it opened up the world. They would be hard pressed to give up the cell phone. And they express general support for the role technology can play in people’s lives even though most do NOT use the internet.

40. Rise of the e-patient October 7, 200940 Motivated by mobility – Group 5 Mobile newbies (8% of population) Demographics Female: 55% Median age: 50 (oldest MBM group) Race: A bit weighted to minorities Education: 72% HS or less Household income: 45% make <$40K Employment status: 53% employed FT Community type: 24% rural Funky facts: just 39%=internet users 46% use computers none create internet content love new connectedness

41. Rise of the e-patient October 7, 200941 Motivated by mobility – Group 5 Mobile newbies (8% of population) Important because They are very unlikely to be e- patients and quite unaware of the wealth of material available online They greatly diversify your audience They are traditionally under-served customers

42. Rise of the e-patient October 7, 200942 Stationary media majority – Group 1 Desktop veterans (13% of population) Tech lifestyle attributes This group of older, veteran online users is content to use a high-speed connection and a desktop computer to explore the internet and stay in touch with friends. They are happy to be connected with they are stationary and sitting. So, they place their cell phone and mobile applications in the background. For them, online life hit its zenith about 3-5 years ago when they first got broadband connections. And their 2004 cell phone still serves its primary purpose for them – making phone calls.

43. Rise of the e-patient October 7, 200943 Stationary media majority – Group 1 Desktop veterans (13% of population) Demographics Male: 55% Median age: 46 Race: Skews white Education: 41% college+ (3 rd highest) Household income: 32% make >$75K Employment status: 56% employed FT Community type: 52% sub.; 30% urb. Funky facts: just 77% have cells int. user 10.5 years heavy int. users at home and work average content creators

44. Rise of the e-patient October 7, 200944 Stationary media majority – Group 1 Desktop veterans (13% of population) Important because They are relatively intense e- patients They already know about the things you do They are influencers, too

45. Rise of the e-patient October 7, 200945 Stationary media majority – Group 2 Drifting surfers (14% of population) Tech lifestyle attributes Many have the requisite tech assets, such as broadband or a cell phone, but Drifting Surfers are infrequent online users. They also are not big fans of mobile connectivity. When they use technology, it is for basic information gathering. It wouldn’t bother the typical Drifting Surfer to give up the internet or cell phone. Likely to be secondary user of technology in household.

46. Rise of the e-patient October 7, 200946 Stationary media majority – Group 2 Drifting surfers (14% of population) Demographics Female: 56% Median age: 42 Race: Diverse Education: 33% college+; 33% HS Household income: 46% make >$50K Employment status: 66% employed FT Community type: 46% sub.; 35% urb. Funky facts: 85% have home broadbd 86% have cells below aver. tech user tech doesn’t help much 46%=“good to take break”

47. Rise of the e-patient October 7, 200947 Stationary media majority – Group 2 Drifting surfers (14% of population) Important because They are not aware of the material that is available online and through other resources They will need you some day

48. Rise of the e-patient October 7, 200948 Stationary media majority – Group 3 Information encumbered (10% of population) Tech lifestyle attributes Most people in this group suffer from information overload and think taking time off from the internet is a good thing. Their attitudes about the role of technology in the world have worsened since 2006 and they see no great benefits from technology in their personal lives. The Information Encumbered are firmly rooted in old media to get information and communicate.

49. Rise of the e-patient October 7, 200949 Stationary media majority – Group 3 Information encumbered (10% of population) Demographics Male: 67% (highest) Median age: 53 Race: Skews white Education: 33% college+; 37% HS Household income: 42% make <$40K Employment status: 40% employed FT Community type: 48% urb; 20% rural Funky facts: 99% are int. users 75% are cell users only 52% online typ. day 52% feel overloaded 62% need help new gad.

50. Rise of the e-patient October 7, 200950 Stationary media majority – Group 3 Information encumbered (10% of population) Important because They are the alienated and society functions better with their participation and involvement

51. Rise of the e-patient October 7, 200951 Stationary media majority – Group 4 Tech indifferent (10% of population) Tech lifestyle attributes Members of this group are not heavy internet users. Although most have cell phones, they don’t like their intrusiveness. The Indifferent could easily do without modern gadgets and services. They are too much trouble with too little payoff.

52. Rise of the e-patient October 7, 200952 Stationary media majority – Group 4 Tech indifferent (10% of population) Demographics Female: 55% Median age: 59 (2 nd oldest) Race: Diverse (little higher Af-Am) Education: 73% HS or less Household income: 59% make <$50K Employment status: 34% employed FT Community type: 26% rural Funky facts: just 39% are int. users 46% computer users but 86% are cell users least likely users of everything

53. Rise of the e-patient October 7, 200953 Stationary media majority – Group 4 Tech indifferent (10% of population) Important because They are on the far side of the digital divide even though they have some relationship to technology Very few e-patients

54. Rise of the e-patient October 7, 200954 Stationary media majority – Group 5 Off the net (14% of population) Tech lifestyle attributes Members of this group have neither cell phones nor online access, and tend to be older and low-income. Some have experience with ICTs. They used to have online access and as many as one in five used to have a cell phone. But it broke, or didn’t provide much enhancement to their worlds, so they did not return to using the technology.

55. Rise of the e-patient October 7, 200955 Stationary media majority – Group 5 Off the net (14% of population) Demographics Female: 57% (highest) Median age: 67 (oldest) Race: Skews to minorities Education: 80% HS or less Household income: 38% make <$20K Employment status: 17% employed FT Community type: 30% rural Funky facts: just 16% have desktop or laptop they see no lifestyle improvements with technology

56. Rise of the e-patient October 7, 200956 Stationary media majority – Group 5 Off the net (14% of population) Important because These are often the people who most need medical information Their caregivers need you, too

57. Rise of the e-patient October 7, 200957 8 tips on how to be a node in a social network Think like a friend Remember your strengths and play to them by being an expert, a filter, and a recommender (linker) Be aware that your audience is bigger than the available evidence provides – lurkers and future arrivals are part of the mix Look for opportunities to provide support to users and chances to build communities with your material

58. Rise of the e-patient October 7, 200958 8 tips on how to be a node in a social network Help people cope with technology Participate in the Web 2.0 world Embrace the move towards mobility, constant connectivity, perpetual contact –This changes the realities of time and space and presence Ask for help/feedback

59. Rise of the e-patient October 7, 200959 Thank you! Lee Rainie Director Pew Internet & American Life Project 1615 L Street NW Suite 700 Washington, DC 20036 Email: Lrainie@pewinternet.orgLrainie@pewinternet.org Twitter: http://twitter.com/lrainiehttp://twitter.com/lrainie 202-419-4500