Kinetics» Technology

Health 2.0 goes to Washington: Aretha Franklin would be proud

Carol Torgan, Ph.D. — Wed, 16 Jun 2010 13:40:56 +0000

There were several themes that resonated throughout the recent Health 2.0 Goes To Washington conference. Two of the most powerful and provocative ones centered on patients and data.

R-E-S-P-E-C-T
Patients want – and deserve – respect. The kind of R-E-S-P-E-C-T that Aretha Franklin favors. It’s simple: patients are at the center of the health care system and they should be heard and they should participate.

The Health 2.0 conference featured a patient on almost every panel as well as an outstanding Patient 2.0 breakout session. The amazing presenters are helping to redefine what it means to be a patient or a patient advocate. They are educated and empowered. They are active participants in their own health and/or the health of those around them. They demand access, information, and control, which are all the byproduct of respect.

“Content comes from the patient, it belongs to the patient, and it should be up to the patient to decide who to share it with.” – Regina Holliday

While there are very big issues on the table (such as access to medical records), often it’s the small signs of respect that can make a large and lasting impact. A few examples that were given:

Health care providers taking the time to write down a diagnosis or instructions, rather than just providing information verbally in a stream of polysyllabic words. (Regina Holliday)
Health care providers encouraging patients to use the web to set up appointments, ask questions, and interact, so, as Gordon Brown from Myca said, “the waiting room is wherever the patient is.”
Physicians tilting a computer screen that holds lab results so a patient can see their own information (Dr. Ted Eytan).

This message of respect clearly resonates far outside the conference walls. Recently a friend angrily said, “I walked into my doctor’s office, signed in, and no one at the desk even looked up to greet me.” This group clearly is not going to stand for this type of treatment. As moderator Gilles Frydman, founder of ACOR.org and ParticipatoryMedicine.com said, “These patients are not the old type of patients.” Cue Aretha.

Data, data, data
A second overarching theme at the conference centered on health data. The biggest buzz was generated by the newly launched Community Health Data Initiative (CHDI), highlighted by Aneesh Chopra, Chief Technology Officer (CTO), Office of Science and Technology Policy, The White House; and Todd Park, CTO of the Department of Health and Human Services (HHS).

The CHDI data set will ultimately consist of thousands of measures of health care quality, cost, access, and public health (e.g., obesity rates, smoking rates). It will include data produced for the Community Health Status Indicators, County Health Rankings, and State of the USA programs. Data will be available at the national, state, regional, and county levels, as well as by age, gender, race/ethnicity, and income (where available). This initiative is part of HHS.gov/OPEN, and is in search of a better name (vote here to rename the CHDI).

Useful health data abound, but tend to be tucked into nooks and crannies. The key is to “unlock the mojo” according to Todd Park. There is a growing spirit of accessibility, transparency and collaboration towards a big data ‘commons.’

Health data are much more than community health maps, mortality stats, and nucleotide sequences.

Data are in the random observations scratched in lab notebooks that will never be published in scientific journals, but that are being coaxed out in forums and conversations;
Data are in pharmacy records;
Data are in web metrics from sites such as Pillbox, Health Central, and Everyday Health;
Data are in the anecdotal information shared on sites like PatientsLikeMe and Sermo;
Data are in the art on easels and t-shirts. Data are on murals, such as those painted by patient advocate Regina Holliday;
Data are in the posture, tone of voice, and hand gestures of individuals sharing their stories via video on sites such as The Moment.

Health data are numbers and letters and charts and maps.
They are also images and sounds and body movements — or a lack thereof.
Health data are DNA misspellings and raised voices. They are MRI scans and wringing hands.

“Data need to turn into motivators for individuals and ROI for businesses.” – Esther Dyson

What health data are you sharing?
How are you going to change health outcomes with data?
What questions are you answering with the data from others?

Buzz about Health 2.0 Goes to Washington

Susannah Fox, @SusannahFox, e-patients.net: Health 2.0 DC: Passion & Execution at Scale
Gilles Frydman, @gfry, e-patients.net: Why a Patient 2.0 Panel at the Health 2.0 DC conference?
Jane Sarasohn-Kahn, @healthythinker, Health Populi & Mobile Health News: Patient Power Through Data Liberación
Krystle Kopacz, So Health, Health Central: Health 2.0 DC: Most Memorable Moments
Lygeia Ricciardi, @Lygeia, The Health Care Blog: Health 2.0 Came to Washington—And Now it Needs to Stay
Regina Holliday, @ReginaHolliday, Regina Holliday’s Medical Advocacy Blog: A matter of perspective
Ted Eytan, MD, @tedeytan, Still about listening: Health 2.0 DC and Ragan Health Care Communicators Summit
Matthew Browning, @MatthewBrowning, Your Nurse Is On: Health2.0 Goes To Washington-A Summary

Health 2.0 images and video

Leroy Jones, Jr., @TechnicalJones, Talking Technology: Health 2.0 DC ~ images of the day and video interviews
Cindy Throop, @cindythroop, Flickr: Health 2.0 Goes to Washington
Phil Baumann, @PhilBaumann, Video interview of Ted Eytan and Regina Holliday at Health 2.0 2010
icyou: Health 2.0 DC video interviews (search tag is “Health 2.0 Washington”)

Health 2.0 Resources
Health 2.0 Goes to Washington main site
Health 2.0 Conference main site
Twitter tag: #health2con

Available presentations from Health 2.0
Amy Romano (@midwifeamy) Maternity Care 2.0
Regina Holliday (@ReginaHolliday): Patient 2.0

Utilizing Mobile Technology and New Media to Encourage Mobile Lifestyles

Carol Torgan, Ph.D. — Fri, 16 Apr 2010 14:21:49 +0000

The fast moving, participatory world of social media is embraced by the White House and the CDC, as well as by professional athletes and major corporations. This presentation, given by invitation at the 2010 American College of Sports Medicine Health and Fitness Summit, educates health professionals on the basics and illustrates how social media and mobile technology can be used to promote programs and engage, educate and motivate individuals.

The resources cited or utilized for this presentation are listed below. If you have questions, comments, suggestions, or more examples, feel free to contact me through the ‘contact’ page or post a comment below. I’d love to hear from you!

Basic Guidelines and information

Reports

Pew Internet & American Life Project http://www.pewinternet.org/ Recent relevant reports include:

Policies

mHealth

Examples

Terminology

Stats

Journals

Miscellaneous

Staying up to date

Related posts

Childhood Obesity By The (Big) Numbers

Carol Torgan, Ph.D. — Mon, 15 Mar 2010 03:44:00 +0000

Childhood obesity is epidemic. We see evidence of it every day – at mall food courts, in video arcades, at school bus stops. But just how bad is it and how much is it costing us?

‘Child Obesity: The Way Forward’ is the theme of the March 2010 issue of Health Affairs, a leading health policy journal. In a special briefing held in Washington, D.C. to highlight the journal issue, authors summarized their work, policy briefs were circulated, and passionate individuals shared questions and experiences. Here are some key numbers from the meeting and journal papers to quantify the magnitude and implications of what we see every day. (Full references are below.)

How bad is the childhood obesity epidemic?

Nearly one in three U.S. children and adolescents aged 2 through 19 years are overweight or obese (more than 23 million youth). [Odgen 2010]
About one in six children (16.4%) ages 10 to 17 are obese. [Bethell, Singh]
Nearly one in three very young children who enroll in Head Start programs are overweight or obese. [Tarullo]
Over the past 40 years the rates of overweight and obesity have more than quadrupled among children ages 6 to 11, and have more than tripled for adolescents ages 12 to 19. [Data spanning from 1963 to 2004; Ogden 2002, 2006]

Disparities, and disparities within disparities

Across states, there is a wide range in the prevalence of overweight and obesity among children ages 10-17, ranging from 23.1% in Utah and Minnesota to 44.4% in Mississippi. [Bethell]
Between 2003 and 2007, the disparity in the prevalence of overweight and obesity in U.S. children ages 10-17 grew wider between publicly and privately insured children, lower-and higher-income children, and Hispanic and non-Hispanic children. [Bethell]
Nationally, in 2007, 44.8% of children in poverty were overweight or obese, compared to 22.2% of children living in households with incomes above 400% of poverty. The disparities based on poverty vary two- to threefold across states. [Bethell]
Illustrative of the substantial disparities that exist within states as well as among states, Minnesota had the highest disparity ratio (2.61) between children with private vs. public health insurance, despite having one of the lowest overall overweight/obesity rates nationally. [Bethell]

Food and drink

Sugar-sweetened beverages and 100% fruit juice comprise 10-15% of the total calorie consumption of children and adolescents (ages 2-19). [Frieden, Wang]
Americans’ average daily calorie intake in 2007 was 400 calories higher than in 1985, and 600 calories higher than in 1970. [Wallinga]
The inflation-adjusted price of carbonated soft drinks decreased ~24% from 1985 to 2000, while the prices of fresh fruit and vegetables rose 39% (based on USDA data). [Wallinga]
Less than one in ten Americans meet the levels of fruit and vegetable consumption recommended in the 2005 Dietary Guidelines for Americans. [Wallinga]

Physical activity

Only 42% of children ages 6-11 years, and only 8% of adolescents’ ages 12-19 years, obtain the recommended 60 min/day of physical activity. [Troiano]
A quarter of high school students do not meet recommended levels of physical activity (60 minutes of moderate-to-vigorous activity per day) on any day. [Frieden, Eaton]
Less than 4% of adults engage in enough physical activity to improve health, although approximately 40% of adults claim they do. [Frieden, Troiano]
The odds are 1.21 times greater for a child to be overweight or obese if they do not participate in sports and other activities outside of school. [Bethell]
The odds are 1.21 times greater for a child to be overweight or obese if they do not have local access to a park or recreation center. [Bethell]

Lifestyle & environment

Children who have a TV in their bedroom or watch more than 2 hours of TV on average per day are more than 1.5 times likely to be overweight or obese. (This relationship holds when socioeconomic and other factors are adjusted for). [Bethell]
For U.S. children ages 10-17, 35.0% have no access to recreation or community centers; 26.7% have no neighborhood access to sidewalks or walking paths; and 19.2% have no access to parks or playgrounds (as reported by their parents). [Singh]
Children living in neighborhoods with the most unfavorable social conditions are 50% more likely to be physically inactive; 52% more likely to watch TV more than 2 hours a day; and 65% more likely to engage in recreational computer use of more than 2 hrs/day, as compared to children living in most favorable social conditions (based on 2007 data). [Singh]
Children living in unsafe neighborhoods have 61% higher odds of being obese and 43% higher odds of being overweight than children living in safe neighborhoods (after adjusting for age and sex). [Singh]
Children living in neighborhoods with no access to sidewalks or walking paths, parks or playgrounds, and recreation or community centers, have 32%, 26% and 20% higher adjusted odds of obesity than children in neighborhoods with access to these amenities, respectively. [Singh]

Health

Approximately 70% of obese youth have at least one additional risk factor for cardiovascular disease, such as high blood pressure or high cholesterol. Nearly 40% have at least two additional risk factors. [Frieden]
Children who are obese after age 6 have greater than a 50% chance of being obese as adults, even if their parents are not obese. [Frieden]

School achievement

The odds are 1.32 times greater for an overweight or obese child to repeat a grade in school. [Bethell]
The odds are 1.59 times greater for an overweight or obese child to miss more than 2 weeks of school during the school year. (These data do not include children who have special health care needs.) [Bethell]

How much does obesity cost?

Almost 10% of all medical costs in 2008 were attributable to obesity. [Finkelstein]
The estimated cost of treating obesity-related illness was $147 billion/year in 2008. [Finkelstein]
The direct costs of childhood obesity include annual prescription drug, emergency room, and outpatient costs of $14.1 billion, as well as inpatient costs of $237.6 million. [Cawley]
Obesity-related job absenteeism costs $4.3 billion annually. [Cawley]
The decrease in productivity in obese individuals while at work (presenteeism) totals $506 per obese worker per year. [Cawley]
Obesity-related illnesses cost Medicare $19.7 billion and Medicaid $8 billion in 2008. [Cawley]
Private health insurance plans paid $49 billion to treat obesity-related illness in 2008. [Cawley]
According to mathematical modeling, U.S. children who were age twelve in 2005 will incur an estimated $2.77 billion in attributable medical expenditures over their lifetime. The twelve-year-olds who were overweight and obese and become obese adults will incur an estimated additional $3.47 billion in medical expenditures. Further mathematical modeling indicates a one-percentage point reduction in obesity (from 16.3% to 15.3%) in children who were age 12 in 2005 would save $260.4 million in total medical expenditures. [Trasande]

What numbers do you find the most frightening?
What numbers are you going to change?

Definition of child overweight and obesity
Child overweight and obesity are based on body mass index, or BMI, which is based on height and weight measurements. Overweight is defined as the 85th through 94th percentiles of age- and sex- specific BMI; obese is defined as the 95th or greater percentile of age- and sex- specific BMI. The CDC has information on BMI for children and teens, including a Child and Teen BMI Calculator.

References

Bethell, C., et al. National, state, and local disparities in childhood obesity. Health Affairs, 29(3): 347-356, 2010. doi: 10.1377/hlthaff.2009.0762
Cawley, J. The economics of childhood obesity. Health Affairs, 29(3): 364-371, 2010. doi: 10.1377/hlthaff.2009.0721
Eaton, D. K., et al. Youth risk behavior surveillance — United States, 2007. MMWR Surveillance Summaries 57(4): 1-131, 2008.
Finkelstein, E. A., et al. Annual medical spending attributable to obesity: Payer-and service-specific estimates. Health Affairs, 28(5): 357-363, 2009. doi: 10.1377/hlthaff.28.5.w822
Frieden, T., et al. Reducing childhood obesity through policy change: acting now to prevent obesity. Health Affairs, 29(3): 357-363, 2010. doi: 10.1377/hlthaff.2010.0039
Odgen, C. L., et al. Prevalence of high body mass index in US children and adolescents, 2007-2008. JAMA 303(3):242-249, 2010. doi:10.1001/jama.2009.2012
Ogden C. L., et al. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA 295(13):1549-55, 2006.
Ogden C. L., et al. Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA 288(14):1728-32, 2002.
Singh, G. K., et al. Neighborhood socioeconomic conditions, built environments, and childhood obesity. Health Affairs, 29(3): 503-512, 2010. doi: 10.1377/hlthaff.2009.0730
Tarullo, L., et al. Beginning Head Start: Children, families and programs in fall 2006 (PDF). FACES 2006 baseline report, Mathematica Policy Research, Inc., December 2008. (Available at www.acf.hhs.gov/)
Trasande, L. How much should we invest in preventing childhood obesity? Health Affairs, 29(3): 372-378, 2010. doi: 10.1377/hlthaff.2009.0691
Troiano, R. P., et al. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc, 40(1): 181-188, 2008. doi: 10.1249/mss.0b013e31815a51b3
Wallinga, D. Agricultural policy and childhood obesity: a food systems and public health commentary. Health Affairs, 29(3): 405-410, 2010. doi: 10.1377/hlthaff.2010.0102
Wang, Y. C., et al. Increasing caloric contribution from sugar-sweetened beverages and 100% fruit juices among US children and adolescents, 1988–2004. Pediatrics, 121(6): e1604-e1614, 2008. doi: 10.1542/peds.2007-2834

Health Affairs

Table of contents from ‘Child Obesity: The Way Forward’ thematic issue (This issue is made possible with support from the Robert Wood Johnson Foundation)
Child Obesity Policy Briefs
Video and slides from the March 2, 2010 briefing

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Kids and Media Use: Letting their fingers do the walking?

Carol Torgan, Ph.D. — Mon, 25 Jan 2010 04:17:10 +0000

‘Cell phones’ courtesy of JR Paris on Flickr

Seven hours and 38 minutes. It’s how much time you may spend sleeping each night or working each day. It’s also how much time kids ages 8-18 spend on average each day consuming media, such as watching TV, listening to music, and using a computer, according to a new Kaiser Family Foundation (KFF) study.

The study, Generation M²: Media in the Lives of 8- to 18-Year-Olds, reveals astounding numbers that surprised the researchers and created their own media mayhem. Some of the mind-boggling numbers include:

Of the 7 hours and 38 minutes (7:38) 8-18 year-olds spend on average using entertainment media across a typical day, much of that time is spent ‘media multitasking’ (using more than one medium at a time). The result is that youth pack a total of 10 hours and 45 minutes (10:45) worth of media content into those 7½ hours.
Black and Hispanic children consume nearly 4½ hours more total media daily (13 hours of total media exposure for Hispanics and for Blacks, and about 8½ for Whites). Black children spend nearly 6 hours and Hispanics just under 5½ hours watching TV, compared to roughly 3½ hours a day for White youth. Differences by race/ethnicity remain even after controlling for other factors such as age, parents’ education, and single vs. two-parent homes.
Youth ownership of cell phones increased from 39% to 66% over the past 5 years. Ownership of iPods and other MP3 players soared from 18% to 76%.
This group spends more time listening to music, playing games, and watching TV on their cell phones (a total of :49 daily) than they spend talking on them (:33). (Texting was not measured.)
Media use increases substantially when children hit the 11-14 year-old age group, to a total media exposure of almost 12 hours per day (vs. about 8 hours for 8-10 year-olds).

“Try waking a teenager in the morning, and the odds are good that you’ll find a cell phone tucked under their pillow–the last thing they touch before falling asleep and the first thing they reach for upon waking.” – Victoria J. Rideout, Ulla G. Foehr and Donald F. Roberts, Generation M²: Media in the Lives of 8- to 18-Year-Olds.

What are the health consequences?
There is already growing concern that this generation of children may be the first in two centuries to have a shorter life expectancy than their parents, fueled by the childhood obesity epidemic. Will even more years be trimmed off due to the increase in media use? Television viewing was found to be associated with an increased risk of death in a recent national study of 8,800 adults in Australia (Television viewing time and mortality). Is this M² generation destined to live many less hours; with many more of those precious hours spent staring at screens?

The study focused on what kids are spending their time doing: watching TV, playing video games, sitting at computers. But the key issue pertaining to their health and well-being may very well be what they are NOT doing during those 7+ hours each day that they are engaged with a screen.

They are not having face to face conversations with family members and friends.
They are not climbing, jumping, or running.
They are not fully engaging their senses in our 3-dimensional world.

What do we do now?
Technology is here and it’s here to stay. These numbers will increase: the only questions are how fast and how much. The huge increase in cell phone ownership emphasizes the ‘anywhere, anytime’ aspect of media penetration. Sure, it can mean more texting of LOL and OMG in bedrooms and buses across the country. But it also provides an opportunity to reach and educate youth that otherwise might slip through the cracks.

As I’ve discussed previously with respect to the mHealth Summit, mobile technology offers an exciting platform by which to develop new tools and messaging strategies that don’t require a high level of literacy, and to develop programs to increase literacy and knowledge in a targeted, non-stigmatizing, non-threatening manner. The report Pockets of Potential: Using Mobile Technologies to Promote Children’s Learning (PDF) from The Joan Ganz Cooney Center at Sesame Workshop, illustrates how innovative, strategic thinking will help us redefine teaching and learning by harnessing the power of mobile technologies.

“Because I said so!”
This new KFF report clearly highlights the need for parents to…be parents. The data are crystal clear – rules and guidelines work wonders. In the study, only about one third of the youth reported having rules about how much time they can spend watching TV, playing video games, and using the computer. The report shows that when parents do set limits, children spend less time with media: those with any media rules consume nearly 3 hours less media per day than those with no rules.

There are numerous resources available to help parents, including the National Heart, Lung, and Blood Institute’s We Can! Program. Start with a family screen time log, work with your kids to set parameters, set a good example, and press the ‘Off’ button on the TV remote. Teachers may wish to look at Every Waking Minute? Examining Personal Media Habits, from The New York Times blog, The Learning Network.

Exchange screen time for green time.
Kids can’t stare at a screen and their hands aren’t available to text or play video games when they are climbing trees, swinging from monkey bars, building a snowman, splashing in a pool, scaling a rock wall, or digging in a garden. Head outside–whether it’s a backyard or a national park–where there is some combination of sand, rocks, water, mud, and even some odd noises. The hands will start exploring, and soon it will be the senses that are multitasking.

New Year’s Resolutions: The Magnetic Poetry of TEDx MidAtlantic

Carol Torgan, Ph.D. — Sat, 02 Jan 2010 01:45:08 +0000

This word cloud represents the essence of the messages of the inaugural TEDx MidAtlantic event as culled from my scribbled notes. The speakers were amazing role models, and their messages, which were so passionately delivered, words to live by.

In the true spirit of TED, the terms cut across numerous disciplines, including technology, arts, medicine, business, health, entertainment, and design. As I reviewed my notes, it struck me that the key messages represent a wonderful sort of magnetic poetry mosaic from which New Year’s resolutions can be crafted.

The theme of the TEDx MidAtlantic event was The Power of Stories. I’ve selected five words that spoke to me to build personal resolutions and craft my 2010 story. They are empower, execute, listen, acknowledge, evolve.

What 5 words would you choose to craft your 2010 story?

To start your new year with a dose of inspiration, check out videos of the talks, which are available at both TED and TEDx MidAtlantic. Some of my favorite TED talks include:

For more insight into the TEDx MidAtlantic event held in November 2009 in Baltimore at the Maryland Institute College of Art (MICA), check out these reviews:

Duende: TEDx MidAtlantic. (A wonderful ‘visual recording’)
GrayMatter Minute: TEDx MidAtlantic, Eggs, Bones, Cows and Social Media.
Jim Doran: TEDx MidAtlantic. (The ‘top five favorite talks’ represents a perfect list of videos to watch and then craft 2010 resolutions)
Stellargirl: Inspired by TEDxMidAtlantic. (Key phrases that capture the event essence)
Christiana Aretta: Visual High Notes from TEDxMidAtlantic. (Stunning photos that convey the passion of the speakers)

Related posts:

Image generated by Wordle, http://www.wordle.net/.

Health 2.0 STAT: Plugged in and Unplugged

Carol Torgan, Ph.D. — Fri, 20 Nov 2009 16:53:35 +0000

Cyber Ghost courtesy of Foto Pamp on Flickr

Health 2.0 STAT was just that – STAT. A Health 2.0 Meetup organized by David Blackburn of Aquilent and billed as ‘Rapid Fire Presentations from Health 2.0 Leaders,’ seven of us spoke for five minutes each on a range of topics. The health realm we spanned was digital, virtual, plugged in, meta-tagged, and, well, stat.

During the panel discussion, we were asked a zinger of a question by moderator David Hale from the National Library of Medicine. David drew from Clay Shirky’s concept of cognitive surplus. The amount of time Americans collectively spend watching commercials on TV each weekend is 100 million hours – enough time to recreate Wikipedia, as of 2008. And so David asked each of us what we would have every person in the United States do if they had a surplus hour over a weekend.

I proclaimed that everyone should unplug and go outside. Experience all their senses. Be in the present.

Wait a minute. Shouldn’t I have said something about infectious diseases or preventable chronic illnesses or world peace?

Engage your five senses. Touch. Smell. Move. Live in four dimensions rather than the two dimensions of the computer screen. Engage with others in the real world, in the present.

I thought I would be booed and tweckled. But an amazing thing happened. There was applause, and “a collective ‘hooray’ and a couple ‘amens’” (much thanks to Mary Kay Alegre for documenting this).

Is unplugging really a key to good health? Is this really a good way to channel an extra hour of our collective time? Yes.

Keyboard helper courtesy of M.H.ick9s on Flickr

The more we learn about the health impact of online time, the more important it may be to encourage individuals to go offline.

Dr. Aric Sigman, noted psychologist and biologist, cautioned in a recent interview with Online Educa Berlin:

“Social networking appears to be actively displacing the time people spend socially interacting with real (non-virtual) friends and even with people in their own house – members of their own family. Furthermore, this displacement is most noticeable in younger and younger children who are now experiencing less social interaction and have fewer social connections during key stages of their physiological, emotional and social development. At the same time, a large number of medical and physiology studies are finding a strong link between this lack of non-virtual social interaction and connection and biological changes in the immune system and genes, along with higher rates of illness, disease and premature death. So, obviously Facebook does not directly cause these changes but social networking is merely a new distraction away from real face-to-face social interaction and this lack of interaction is the health risk, not the act of social networking. If people only spent a short amount of time each day online, there wouldn’t be any need for this discussion.”

For stunning visual evidence of the impact of screen time, take a stroll through the online photography exhibit, A Disenchanted Playroom.

If you were given an extra hour during your weekend, what would you do with it?

Many thanks to David Blackburn for founding the DC/MD/VA Health 2.0 Meetup group (Twitter: @DCHealth2_0) which has now been recognized as a local chapter of Health 2.0, and to sponsors Aquilent and Palladian Partners.

Fellow panelists and their topics included:

Tim Clarke, Jr., NMHM Deputy Director (Communications) – Web 2.0 at the National Museum of Health and Medicine, a Division of the Armed Forces Institute of Pathology
Lindsey Hoggle, RD, MS, PMP, Health Project Partners, LLC – Can Health 2.0 Drive Health 2%?
Mark Scrimshire, Senior Web Strategist, CareFirst Blue Cross Blue Shield – HealthCamp: Built on Health 2.0 and Web 2.0
Michael Paley, PhD, Executive Vice President, Aptima – Using Virtual World Technologies for Application in Disaster Preparedness Training
Chris Lindsley, Web Editor, UMMC – University of Maryland Medical Center Adoption of Web 2.0
Ram Singh, CEO, informediq – Using mobile devices to provide better healthcare

Related posts

The mHealth Summit: Local & Global Converge

Carol Torgan, Ph.D. — Fri, 06 Nov 2009 15:29:20 +0000

“The world is one call away.” – Dr. Feng Zhao, eHealth Coordinator, Africa Health Department, World Bank

The inaugural mHealth (mobile health) Summit was recently held in Washington, D.C. Hosted by the Foundation for the National Institutes of Health with partnering sponsor Microsoft Research, the Summit mission was “to explore the use of mobile technologies to improve public health, particularly regarding underserved populations; health research, training, and education applications; and delivery systems, in the U.S. and around the world.” The World Bank Day @ mHealth Summit served as a warm-up act the preceding day.

As defined at the meeting, mHealth is “the delivery of healthcare services via mobile communication devices.” Much more than just a subset of eHealth, mHealth offers an unparalleled opportunity to reach individuals and affect change. After three days of incredible talks by passionate experts, I was struck by several themes and future directions.

The individual is at the center
The applications that really work and really make a difference all start with the needs of individuals, whether they are patients or healthcare workers. A need is recognized, and at some point mobile technology is viewed as potentially playing a role in a solution. This seems incredibly intuitive, but it can be tempting to do the opposite: start with a killer technology and then go in search of an issue to solve with it.

In parallel to this, the technologies that ultimately work well are the ones that undergo extensive iterations based on user needs (for example, redesigning misunderstood icons). It was repeatedly (and I mean repeatedly!) stressed that mHealth is not about technology, but about how to use it.

“At the end of the day, it’s health that’s important, not eHealth.” – Dr. Souheil Marine, Head of ICT Application and Cybersecurity, International Telecommunication Union

Knowledge is power
Mobile technology offers access, access provides knowledge, and knowledge bestows power. There is an expanding list of exemplary mHealth programs that have empowered individuals to take a more active role in their health and well being, and of the health of those around them. Thus there is a substantial need for credible, trustworthy, understandable, concise health information that is relevant, culturally sensitive, and actionable.

Personalized medicine redefined
Personalized medicine has been defined as “an emerging practice of medicine that uses an individual’s genetic profile to guide decisions made in regard to the prevention, diagnosis, and treatment of disease. Knowledge of a patient’s genetic profile can help doctors select the proper medication or therapy and administer it using the proper dose or regimen.” The mantra for this type of personalized medicine is typically: right drug, right dose, right purpose, right time, right person. It’s personalization based on cellular DNA.

mHealth expands the definition of personalized medicine while maintaining the context of the individual: right person, right information, right place, right time. Mobile means anytime and anywhere, at the discretion of the individual. It’s personalization based on cell phone DNA.

Communicable and noncommunicable diseases
Presentations highlighted mHealth programs to address infectious diseases such as HIV/AIDS and tuberculosis, as well chronic noncommunicable diseases (NCDs) which include heart disease, stroke, chronic lung diseases, diabetes, and cancers. NCDs kill more than twice as many individuals worldwide as the number of those that die from infectious diseases, maternal and perinatal conditions, and nutritional deficiencies combined. NCDs account for about 60% of all deaths globally and 80% of these deaths occur in low- and middle-income countries. A World Health Organization global report notes it is the “invisible” epidemics of NCDs that will take the greatest toll in deaths and disability for the foreseeable future.

As mHealth programs and tools are further developed to combat both communicable and noncommunicable diseases, it will become increasingly important to share best practices, messaging, outcomes, and lessons learned with respect to education, prevention, screening, treatment, and management. These conditions do not exist in isolation in individuals and should not be addressed in isolation.

Literacy: Can you read me now?
General literacy and health literacy remain huge issues. Almost a quarter of adults possess no more than the most simple and concrete literacy skills in the United States. Over one third of adult Americans have basic or below basic health literacy, which is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Poor health literacy is associated with a failure to seek preventive care, medication and treatment errors, higher rates of hospitalization, and higher use of emergency services.

The use of iconography and outreach to family members and friends were mentioned as ways to overcome literacy and language barriers (children often translate for their parents). mHealth offers an exciting platform by which to develop new tools and messaging strategies that don’t require a high level of literacy and also to develop programs to increase health literacy in a targeted, non-stigmatizing, non-threatening manner.

Senses and dimensions
The mobile communication strategies highlighted during the meetings most often featured icons and text, with some photos and a bit of video. The human senses that these engage are vision and hearing (excluding the touch of pushing buttons). In this sense, mHealth is in its infancy – it relies on 2 senses and 2 dimensions to communicate (3 dimensions if you include time). Imagine the future of telemedicine: 3-dimensional imaging, and biomarkers and sensors that detect and transmit smell, taste and touch. Multi-sensory, multi-dimensional technology will exponentially increase accuracy and engagement; further increase compliance and outcomes; and bridge languages, literacy, and cultures.

“What used to take up a building now fits in my pocket, and what fits in my pocket will fit inside a blood cell in 25 years.” – Ray Kurzweil, inventor and futurist

The inaugural mHealth Summit was a huge success and portends an exciting future. What do you envision for the future of mHealth?

mHealth Summit Commentaries

Learnings from mHealth Summit John Moore, Chilmark Research
World Bank Day @ mHealth Summit – Aftermath Florian Sturm, ICT4D.at
mHealth Summit: HHS sees enormous potential Brian Dolan, Mobihealthnews

mHealth Reports & Related Features

mHealth for Development: The opportunity of mobile technology for healthcare in the developing world. (PDF) UN Foundation-Vodafone Foundation Partnership, 2009.
2008-2013 Action plan for the global strategy for the prevention and control of noncommunicable diseases. (PDF) World Health Organization, Geneva, 2008.
Public policy and the challenge of chronic noncommunicable diseases. (PDF) Adeyi O, Smith O, Robles S. The World Bank, Washington, D.C., 2007.
The pocket spy: Will your smartphone rat you out? Gedes, L. New Scientist, 14 Oct 2009.
Mobile marvels. A special report on telecoms in emerging markets. The Economist, Sept 24, 2009.

mHealth Resources

Mark your calendars: Next year’s Summit will be Nov 9-10, in Washington, D.C.
Twitter hashtags: World Bank Day #mHealth09; mHealth Summit #mHS09

A special thank you to those who took the time to tweet the meetings, write up reviews, and share insights, photos and videos. The mHealth crowd is incredibly sharp, passionate, and engaged, and I look forward to future discussions.

Bench Top Roundup: Nobel Edition

Carol Torgan, Ph.D. — Fri, 09 Oct 2009 14:57:10 +0000

Dr. Marshall Nirenburg in his office with molecular models. He shared the 1968 Nobel Prize in Physiology or Medicine for his work on deciphering the genetic code. (I had the honor of working in the Laboratory of Biochemical Genetics at the National Institutes of Health, where Marshall is laboratory chief.) Photo courtesy of National Library of Medicine Profiles in Science.

Here’s a roundup of recent thought-provoking, amazing, and/or just plain cool items that are worth a look. In this week’s Nobel edition we celebrate the awarding of the 2009 Nobel Prizes.

Can you hear me now?
“Hello, you’ve won the Nobel.” A chat with Gunnar Öquist, the man who makes The Phone Call. From Seed Magazine.
“Then, the phone really started ringing. It was a reporter from The A.P. who said she was in front of our apartment and wanted to get a picture of me. I said, ‘I’m in my pajamas.’ She said, ‘That’s exactly the photo I want.’ I said, ‘But you’re not going to get it.’” A brilliant interview with Martin Chalfie, 2008 winner of the Nobel Prize in Chemistry, who slept through The Phone Call. From The New York Times.

Sidewiki
Are you familiar with Sidewiki? If not, brush up with these thought-provoking posts.
Been Avoiding Social Media? It Just Kicked In Your Door, The Scholarly Kitchen
Google SideWiki: How to Brace Yourself for a Communications Bitch Slap, Phil Bauman
A Google colonial sideswipe, Andrew Keen of the UK Telegraph
Martin Frank, Executive Director of the American Physiological Society, points out via Twitter that Sidewiki could allow for commentary along side research articles. (@ExecDirectorAPS)
Make sure to watch the demo video and ponder the implications. What are your thoughts?

Stick figures
Watching life unfold as a social network where every link is a human relationship and every circle is a waistline. “The Buddy System: How Medical Data Revealed Secret to Health and Happiness,” from Wired. Includes stunning data visualizations.

4 billion served
“More than 4 billion [cell phones] are now in use worldwide, three-quarters of them in the developing world.” From The Economist special report on “The power of mobile money.”
4.1 billion SMS messages are sent daily, according to the latest Semi-Annual Wireless Industry Survey results from CTIA-The Wireless Association®

Art imitating life
Anatomical illustrations by Fernando Vicente that merge science and art and add a dash of fashion. They are reminiscent of Andreas Vesalius’s classic 1543 De Humani Corporis Fabrica (this link is to an amazing ‘touch and turn’ version of the book.)

Fat body = skinny wallet
NPR interview with Safeway Inc. CEO Steve Burd, about the company’s wellness incentive program. Employees receive a discount on their health insurance if their body mass index is below 30, the number over which people are considered obese. (Here’s a BMI calculator so you can see if you qualify for a discount.)

Don’t bother with the CliffsNotes
“There was no rule book, we just did what we thought was interesting and might prove fruitful. You can’t write a book on how to do that.” Dr. George Smith, 2009 winner of the Nobel Prize in Chemistry, in “‘Masters of Light’ Get Nobel,” a wonderful article in The Wall Street Journal.

What I did during my summer vacation: HealthCamp

Carol Torgan, Ph.D. — Tue, 08 Sep 2009 03:14:48 +0000

HealthCampMd tag cloud

As a kid, during summer my friends and I would head off to swim camp, horse camp, art camp and various other camps. As an adult, my friends and I head off to HealthCamp.

HealthCamps are part of the BarCamp phenomenon and take place all over the world. They are ‘user-generated’ with the focus on participation and interaction. The agenda is decided by participants at the start of the day and can change as the whims and the attendees change.

HealthCamps are often described as ‘unconferences’ and are based on the philosophy of open space technology. Typical camp rules, as outlined by our camp counselor Mark Scrimshire during HealthCampMD (Maryland), include:

Whoever comes are the right people
Whatever happens is the only thing that could have
Whenever it starts is the right time
When it’s over, it’s over.

As with the summer camps of our youth, the philosophy of HealthCamps is that there are no spectators, only participants.

Unlike regular camp, when it comes to HealthCamp you don’t have to write your name in your clothes, you don’t have to worry about ticks, and there’s no KP duty. And although there weren’t s’mores, we had cake in celebration of the one year anniversary of HealthCampMD.

During my summer vacation at HealthCampMD a small sample of what I learned through engaging with other happy campers includes:

When it comes to health 2.0, the patient (or participant) is the common denominator and is at the center.
In designing applications for mobile technology, one needs to appreciate the arc of movement the thumb joint must make in order to perform the desired task.
There really is no “go to” source on the web for nutrition information.
There are numerous metrics one can use to quantify social engagement. This includes Twitter.
In addition to the ICD, there is also the ICF (International Classification of Functioning, Disability and Health) from the World Health Organization which shifts the focus from cause to impact.
To stay relevant, healthcare must embrace openness.
Some of the most important health real estate is on (and in) pill bottles. One label has to work for everyone (docs, pharmacists, patients, caregivers, etc). What information must be on the outside, and what information can go inside?
Conversations in health providers’ offices are changing. Patients used to bring in information from online health sites. Now they also bring in information from other online patients.

Questions I was left pondering after attending HealthCampMD:

Will we need to adjust our definition of health literacy?
How do we measure ROI in the health2.0 space?
How can consumer genomics be made actionable?

HealthCampMD made me realize the future of online health is all about P’s:

Portable
Partnerships
Participatory
Personalized

As with all great camp experiences, it all comes down the people. I hung out with wonderful old friends from past HealthCamps and made lots of cool new friends. And, similar to the camps of my youth where we went by nicknames (Frogger, River Spirit) at HealthCamp we often went by our Twitter names.

Here’s a few of the happy campers/thought leaders who attended HealthCampMD. I’m looking forward to seeing these old friends, and making new friends, at the next HealthCamp.

@ekivemark Mark Scrimshire http://ekive.blogspot.com/ (camp counselor)
@jensmccabe Jen McCabe http://www.contagionhealth.com/
@lostonroute66 David Hale http://lostonroute66.posterous.com/
@PhilBaumann Phil Baumann http://philbaumann.com/
@edbennett Ed Bennett http://ebennett.org/
@gfry Gilles Frydman http://www.participatorymedicine.com/
@LaBlogga Melanie Swan http://melanieswan.com/
@cindythroop Cindy Throop http://www.open-health.us/
@modulist Claudio Luis Vera http://www.studiomodule.com/
@jbselz Joel Selzer https://www.ozmosis.com/public_blog
@MJChatter Maumi JC Chatterton http://maumi.stevensonuniversity.org/
@heathersrunning Heather C http://trialsoftraining.wordpress.com/
@AndrewPWilson Andrew Wilson http://www.newmedia.hhs.gov/
@DaphneLeigh Daphne Leigh Swancutt http://jsykdm.blogspot.com/
@MeredithGould Meredith Gould http://jsykdm.blogspot.com/
@lindseybh Lindsey Hoggle http://www.healthprojectpartners.com/
@ShrinkRapRoy Steven Roy Daviss http://psychiatrist-blog.blogspot.com/
@changrongji Changrong Ji http://www.synerjisolutions.com/
@HITshrink Steven Daviss http://www.linkedin.com/in/drdaviss
@tstitt Tom Stitt http://www.lastmileblog.com/
@aviars Alan Viars http://blog.videntity.com/

Americans Jump Online for Exercise Information

Carol Torgan, Ph.D. — Sun, 02 Aug 2009 18:13:35 +0000

More than half of all American adult internet users have looked online for exercise or fitness information, according to a new Pew report, The Social Life of Health Information. As shown in the graph above, that’s an astounding 38% of all American adults. The Pew Internet/California Healthcare Foundation survey, authored by Susannah Fox and Sydney Jones, queried over 2,250 adults by both landline and cell phone.

This sizable percentage of internet users that went strolling for clues to burn calories represents a whopping 88% increase from the percentage that went online for exercise information in 2002, which is the greatest increase over time of any topic covered in the survey. Perhaps most astounding,

More Americans looked online for information about exercise and fitness than for information about prescription or over-the-counter drugs, doctors, or hospitals.

The extensive data presented in this report are exciting and thought-provoking:

86% of respondents reported turning to health professionals for information or assistance in dealing with health or medical issues. Thus even in the age of the internet, Americans turn to the traditional white coat when it comes to their health. This speaks volumes about the importance of the Exercise is Medicine Initiative which encourages white-coated health care providers to include exercise when designing treatment plans for patients.

Individuals who go online for health information often seek out user-generated content, or what’s referred to as “just-in-time someone-like-me.” However, few online individuals actually engage through creating content or participating on social network sites (e.g., Facebook, Twitter) for health queries and updates. In fitness terms, it appears individuals are seeking a virtual workout buddy, but then tend to hang out at the water fountain rather than actually break a virtual sweat. These data imply that when it comes to participation, the real world trumps the virtual world. While someone can easily just lurk in a virtual exercise community, in the real world a workout buddy would never let you just sit around.

Almost half (49%) of individuals who look online for health information say their most recent search changed the way they think about diet, exercise, or stress management. Given the preponderance of lifestyle-related conditions such as heart disease and type 2 diabetes, it’s clear we need to not only change how people think about diet and exercise, we need to change what they do.

While 83% of internet users go online for health information, 81% report they go online and do something related to health less often than once a week. This is not surprising, since for those who are healthy there’s little enticement to routinely click a mouse or tap keys to log minutes or steps walked. It will be interesting to see how these numbers change with increased availability of mobile technologies whereby individuals can automatically track laps while running on a track.

Overall, this report is great news for those of us in the health and wellness field. And in a wonderful coincidence, just days after these data were released about 250 of us met at the National Physical Activity Plan Conference in Washington, D.C. to draft the United States’ first comprehensive national plan, which follows the release of the first ever Physical Activity Guidelines for Americans by the federal government.

This new Pew report highlights the road that lies ahead. Many Americans are aware of the benefits of physical activity and are actively searching to learn more, both on- and off-line. Our challenge as health professionals is in getting Americans to let more than their fingers do the walking.

Great analyses of the Pew Report that offer food for thought: