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e-Patient Dave at Brookings Merkin Feb 2014

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Information about e-Patient Dave at Brookings Merkin Feb 2014
Health & Medicine

Published on February 19, 2014

Author: ePatientDave

Source: slideshare.net

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Slides to support my panel appearance.
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Information at the point where it’s needed makes all the difference. “e-Patient Dave” deBronkart Twitter: @ePatientDave facebook.com/ePatientDave LinkedIn.com/in/ePatientDave dave@epatientdave.com

Social media is like capillaries, moving information like a nutrient.

Social media is like capillaries, moving information like a nutrient.

If you’re looking for information in a “1.0” way and it’s moving in 2.0 ways, you won’t know what’s happening.

Web 2.0: “When the web began to harness the intelligence of its users.” – Tim O’Reilly

Liquidity transforms what’s possible because it alters the availability of a vital resource.

Not Liquid •  Moving it takes effort •  Slow and predictable •  Unexplained arrivals are suspicious Liquid •  Frictionless – controlling the flow takes effort •  Fast and unpredictable •  “Tracks” everywhere, free

“Shift Index” “We are shifting from a world where the key source of strategic advantage was in protecting and extracting value from a given set of knowledge stocks ...

“Shift Index” “...into a world in which the focus of value creation is effective participation in knowledge flows.” –Thomas Friedman Pulitzer prize winner (3x) New York Times January 19, 2010

What could be more patient-centered than your child’s doctor not being ten years out of date?

Physician adoption of new practices years after discovery The “17 years” thing From A. Balas, Institute of Medicine, in Yearbook of Medical Informatics 2000 Flu vaccine, year 32: 55% doing it, 45% still not Beta blockers, year 18: 62% doing it, 38% still not Cholesterol, year 16: 65% doing it, 35% still not Diabetic foot care, year 7: 20% doing it, 80% still not Creative Commons Attribution / Share-Alike May be distributed with this license included

The Fourth Paradigm on years to disseminate new medical knowledge Scurvy! 264! years!!

h Scurvy! oft 264! years!!

Dr. Lindberg: 400 years If I read two journal articles every night, at the end of a year I’d be 400 years behind. It’s not humanly possible to keep up.

The lethal lag time: 2-5 years The time it takes after successful research is completed before publication is completed and the article’s been read. During this time, people who might have benefitted can die. Patients have all the time in the world to look for such things.

Death by Googling: Not. (Dr. Gunther Eysenbach, Europe: 0 deaths found in a three year search) Compare with To Err is Human (98,000 deaths/yr Nov 1999)

Physician as trusted authority “The oft-expressed fear that patients are using the internet to self-diagnose and selfmedicate without reference to medical professionals does not emerge in national phone surveys or in this special raredisease community survey.”

“There’s crap on the internet. We need to get out there and balance it” Wendy Sue Swanson, MD Mother & pediatrician @SeattleMamaDoc Facebook too

An OB/Gyn on social media?? @MacObGyn •  “The more info we push out, the better decisions they make” •  “We’ve taken a demographic group and through connected technology they’re engaged in their health” •  “Our patients tell their friends – ‘and he’s on Facebook’”

Patients know what patients want to know.

Sugata Mitra (TED Prize): Self-organized learning environments

Will we ever see

Self-organized patient environments?

Not Liquid •  Moving it takes effort •  Slow and predictable •  Unexplained arrivals are suspicious Liquid •  Frictionless – controlling the flow takes effort •  Fast and unpredictable •  “Tracks” everywhere, free

Physician is still the trusted authority (Susannah Fox, Pew Research) “The oft-expressed fear that patients are using the internet to self-diagnose and selfmedicate without reference to medical professionals does not emerge in national phone surveys or in this special raredisease community survey.”

My favorite complaint about patient engagement:

“Patients are the only ones who don’t have any skin in the game” – Practice manager, quoted in Health Leaders, Fall 2011

What happens when a consumer tries to be responsible about costs?

The choices they offered Premium' ' Deduc+ble' ' Co0pay' a4er'' deduc+ble' Max'OOP'' Stop0loss'max' (deduc+ble'' (in0network'+' +'co0pay)' out)' Op#on&A& $894&& $1,000&& 20%& $3,500&& $12,500&& Op#on&B& $705&& $2,500&& 20%& $5,000&& $12,500&& Op#on&C& $581&& $5,000&& 20%& $7,500&& $12,500&& Op#on&D& $495&& $10,000&& 0%& $10,000&& n/a& Op#on&H& $624&& $5,950&& 0%& $5,950&& $12,500&&

I know – run some scenarios!

=IF(maxoop<J17+J18,maxoop,J17+J18)

I know – graph it!

Insurer actuaries have this picture. Patients don’t. That’s called information asymmetry (an advantage in war)

People perform better when they’re informed better.

It’s perverse to keep people in the dark and call them ignorant

Speaking of skin in the game…

“How much will this cost me?” Hospital: “We don’t know – ask your insurance.” Insurance: “We don’t know – ask your hospital.”

So I did what empowered buyers do dave.pt/skincancerRFP

Of course, I got no responses to my RFP. So I spent months calling around and asking “What will show up on the bill?”

So at TEDMED, this guy irked the crap out of me:

Him: “Patients spend 10x more time choosing a TV than choosing healthcare” [Me: Dude! There’s no info for patients to research!]

Punch line: When I was shopping, his lab was one of the ones who said “We don’t know”! Fix that,THEN we’ll see what patients do.

Information at the point where it’s needed makes all the difference. “e-Patient Dave” deBronkart Twitter: @ePatientDave facebook.com/ePatientDave LinkedIn.com/in/ePatientDave dave@epatientdave.com

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