1. Future of Consumer Healthcare Lisa Gualtieri, PhD, ScM, Course Director Tufts University School of Medicine July 20, 2012 1

2. “The internet saved my life” 2

3. It isn’t easy to find pictures of bat’s teeth 3

4. “Armed” with information, Diana educated the people who treated her 4

5. e-patient Dave “Nothing beats a smart partner who listens to you and wants you to do well.” 5

6. Janice Adams: “I asked our doctor if I should look something up on the Internet and he said, ‘No. Come and ask me; it’s too frightening if you read the wrong things.’ And we do.” 6

7. Volker Wulf: “My sister is a doctor.” 7

8. Scott Bateman and Adrian Reetz 8

9. Scott’s feet 9

10. Anja Habas-Korbar: “It was easier to get information from the Internet than from doctors… being in pain is motivating.” 10

11. Lynda’s story Lynda has vertigo – “I go online all the time” – My specialists don’t talk to each other Ear, nose, and throat doesn’t talk to allergist – My specialists have blinders Impact of seasonal allergies – I’m not alone - others have it worse 11

12. Nancy Flournoi: “I looked up side effects for my husband’s medication and one was ‘stops breathing’. The doctor didn’t bother to tell him that.” 12

13. Ron Perkins: “I don’t find credible sources. Maybe they’re all sponsored by the drug companies?” Ron Perkins: “I don’t find credible sources. Maybe they’re all sponsored by the drug companies?” 13

14. What is typical health information seeking behavior? Is it Diana? Is it Dave? Is it Janice? Is it Scott? Is it Anja? Is it Lynda? Is it Nancy? Is it Ron? 14

15. People’s use of the online health information for themselves or others Triggers – Different reasons – Different contexts People use – Obsessively to rarely or never People bring – Different skills – Different needs – Different health literacy skills 15

16. Some commonalities People generally look on their own Common triggers – Pain – Economic – Immediacy – Determine if doctor needed – Learn what doctor didn’t say – Learn what others have done 16

17. Healthcare is changing Potential to fundamentally change healthcare – Concierge medicine – Shared medical (or group) appointments – Walk-in clinics – Telehealth – Home visits Use of the internet for healthcare directly impacts far more people today than EHRs – But that’s where $$$ are spent 17

18. Easy to have eye contact with a barista 18

19. Technology can get in the way 19

20. Patients TechnologyPhysicians Idealistic scenario 20

21. Technology can be a partner 21

22. Patient centeredness - AHRQ Patient centeredness – Healthcare that establishes a partnership among practitioners, patients, and their families – To ensure that decisions respect patients' wants, needs, and preferences – Patients have the education and support they need to make decisions and participate fully Patient-centered care – Encourages patients to comply with treatment regimens – Can reduce the chance of misdiagnosis due to poor communication – Has been shown to reduce underuse/overuse of medical services – Can reduce the strain on system resources and save money by reducing the number of diagnostic tests and referrals – Can sometimes increases providers' costs, especially in the short run 22

23. Take a historical perspective Pre-internet… 23

24. Marcus Welby brought medicine into our homes 24

25. Democratization of medical information Usenet AOL Brochureware Web, social media, mobile 25

26. Incredible opportunities!!! 26

27. And many pitfalls 27

28. Pitfalls include People going online instead of going to a doctor People using poor quality or deceptive information – the barriers have dropped People misusing or misunderstanding information People obsessively searching People who are scared to death People confronting their doctors or not telling their doctor about their “Dr. Google diagnosis” 28

29. “Don’t ask, don’t tell” culture Doctors don’t ask and patients don’t tell Yet patients are increasing relying on technology especially with social media and mobile Technology becomes a cognitive prosthetic device for many Are patients less likely to ask their doctor questions because they plan to look it up? 29

30. Interventions can avoid “don’t ask, don’t tell” 30

31. Patients TechnologyPhysicians How can the pitfalls be avoided 31

32. Better health literacy skills Better training of healthcare professionals Better design 32

33. Better health literacy skills How to search What to look for – dates, authors, seals How to communicate with a physician What to believe and when and how to be skeptical 33

34. Better training of healthcare professionals What and when to ask patients What and when to recommend Which to recommend How to increase health literacy skills 34

35. Better design of health sites, social media, and apps Test on real users with mixed health literacy skills in context Conduct formative evaluations from the start Have clear health goals and measure success at achieving them Use better imagery Clear branding and accreditation 35

36. Accreditation Works when – Accreditation exists – Processes are transparent – Processes are not criticized – Healthcare consumers know to look Happens in other domains Is there a better way in healthcare? 36

37. Which resources have you used to obtain information on a health-related question? 37

38. Patients TechnologyPhysicians Intermediaries Introduce intermediaries 38

39. Who are intermediaries? 39

40. Patients TechnologyPhysicians Intermediaries: Medical librarians, Pharmacists, Health coaches, Patient navigators, etc. Who are intermediaries? 40

41. Intermediaries help patients How to search and what to search for How to detect the quality of expert-generated content How to use user-generated content When to contribute user-generated content How to communicate with physicians about online activities 41

42. Intermediaries help physicians What their patients are doing online What resources their patients need How to communicate with patients about online activities 42

43. Patients TechnologyPhysicians Intermediaries: Medical librarians, Pharmacists, Health coaches, Patient navigators, etc. Toward a better future for consumer healthcare 43