Leveraging Social Science and Technology to Harness the Power of Information Democratization Joshua Seidman, Ph.D. President Bethesda, MD

Why “Ix” and “Information Therapy”? Corollaries between Ix & Rx Side effects Overdose Titrate the dosage Appropriate frequency & duration

Ecology of Medical Care & the Internet Green et al. The Ecology of Medical Care Revisited. NEJM; 344: Use of Internet

Pew Internet Project Data “Dr. Google Phenomenon” More consumers go online for health info than see a doctor What do consumers do when their physicians tell them to stop going online? Switch doctors Go underground

“Parallel Play”

IN THE MD’s OFFICE: Research: Patients recall only 20%-50% of what MDs tell them 5 minutes after the fact (Eiser, 1982) EVERYWHERE ELSE: Tangled web of health infoTangled web of health info Info is hard to:Info is hard to: -Find (relative to need) -Find (relative to need) -Understand -Understand -Remember -Remember -Contextualize -Contextualize Ix: Bring Two Worlds Together

HOW DO WE HARNESS INFORMATION TO ACTIVATE CONSUMERS?

Integrating Best of Science into Information Democratization Information Democratization Decision Sciences Evidence- Based Medicine Behavior Change Sciences Predictive Modeling

Information Triggers: Delivering the Information  EMR/PHR  Claims data  Patient portals  Secure messaging  E-prescribing  CPOE  Call center  Automated lab results  Automated pharmacy data  Appointment Scheduling  Automated referral system  Online multimedia clinical content

Potential Information Triggers to Deliver SDM Decision Aids ICD-9 code for back pain & referral to orthopedist LOW BACK PAIN DECISION AID Scheduling of 50-year-old male well-care visit PSA TEST DECISION AID Lab data: LDL>130 mg/dL STATIN THERAPY DECISION AID

Institute of Medicine (IOM) “Ten simple rules for the 21 st - century health care system” “Rule 1: Care based on continuous healing relationships” Encourage “all types of health care interactions that improve information transfer…”

Ix for Visit Prep Ix for In- Person Clinical Encounter Ix for After- Visit Summary Ix for Health Care Promotion, Care Management Ix for Decision Support IOM Rule #1: Continuous Healing Relationships

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