Hesse hopkins 2015

Public Health in the Digital Age

Bradford W. Hesse, PhDChief, Health Communication and Informatics Research Branch

Intraaortic Monitoring DeviceRemon Medical Technologies

Remote Liquid BiopsySingapore’s A*STAR Technologies

March 24, 2015

Apple Computer: Citizen Science

“Designing our Digital Future”

-December 2010

• “Achieving the Nation’s goal of improving people’s health … requires fundamental change in our healthcare system.

• New approaches are needed to manage and prevent chronic diseases.

• Individuals, along with their families and f r i ends , mus t sha re w i t h hea l t h professionals the responsibility for improving health and treating disease.

• Improvements in health and quality of life, particularly as we age, depend upon knowledge and information that can drive appropriate actions.”

Smart and Connected Health

From tradi2onal medicine to smart healthNSF + NIH Combined Perspec2ve

EPISODIC, REACTIVE FOCUS ON DISEASE

HOSPITAL-CENTRIC

FRAGMENTED, LOCAL DATA

NAÏVE,PASSIVE, PATIENTS

TRAINING & EXPERIENCE BASED

RESULTS

Intervention too late, after tissue damage / loss of function“One size fits all” approach is impracticableRise in costs is unsustainableEscalation of chronic disease


EPISODIC, REACTIVE FOCUS ON DISEASE

HOSPITAL-CENTRIC

FRAGMENTED, LOCAL DATA

NAÏVE,PASSIVE, PATIENTS

TRAINING & EXPERIENCE BASED

PROACTIVE and PREVENTIVE FOCUS ON WELLBEING

QUALITY OF LIFE

PATIENT-CENTRIC, HOME-BASED

INTEROPERABLE, EHR AVAILBLE ANYWHERE, ANYTIME

EMPOWERED, ENAGAGED, INFORMED, PARTICIPATING

MORE EVIDENCE – BASED DECISION SUPPORT



QUALITY OF LIFE





Quantified Self

Wifi - Enabled Scale



QUALITY OF LIFE







QUALITY OF LIFE





CitysenseUsing data for city planning

This project supported by NSF Cyber-Physical Systems Grant CNS-0932403, with additional support from the NIH

and a gift from Qualcomm.



QUALITY OF LIFE





Supporting patients’ lives



QUALITY OF LIFE





Using “smart objects” to improve support



QUALITY OF LIFE





Building “smart homes” for in-place care

http://www.digi.com/blog/design/technology-for-connected-art-exhibits-a-model-for-innovative-business/



QUALITY OF LIFE





Building up to “smart communities”



QUALITY OF LIFE





Data Based Decisions: Patient

Aging In Place, Intel



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Data Based Decisions: Hospitals



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Data Based Decisions: Community



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Real Time Update to Decision Support

e.g., Watson, Siri, Google Health

Data Data



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Ubiquitous access to care regardless of place or platform



QUALITY OF LIFE





Creating a patient-centered ecosystem of support services

Wellness Adherence Coordination



QUALITY OF LIFE







QUALITY OF LIFE





The Transformation of Health Care

Patient Engagement, Activation is Crucial



QUALITY OF LIFE





Engaged Patients Lower Health Care Costs



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“Patient Activation” is a Cornerstone of the Chronic Care Model



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Informed consumers begin driving for change

No Meaningful Use without me!

Why is this important?

Incentives Have Driven I.T. Adoption

Meaningful Use Provides Public Health “Levers”

Stage 3 of MU is Under Discussion

Point of need, not just point of care

Learning Healthcare System

Personal Data for the Public Good

Direct Levers for Public Health

CASE STUDY:

“We use online Personal Action Plans (health alerts, data visualizations, reminders, personalized content, email), and results are impressive:”

-President’s Cancer Panel,San Francisco, CA

March 26, 2015

Nirav ShahVP & COO,

Kaiser So Cal

“Within 90 days of identifying a care gap … 6X pap screens completed, … 6X mammograms completed, … 10 X CRC screening completed”

Nirav ShahVP & COO,

Kaiser So Cal

Using data-driven “dashboards,” Kaiser was able to identify missing clinical actions and then flag populations at risk for follow-up action.

Patient’s Electronic Health Record

Dashboard for Population Management

Nirav ShahVP & COO,

Kaiser So Cal

Nirav ShahVP & COO,

Kaiser So CalRhoads, K. F., et al. (2015). "How do integrated health care systems address racial and ethnic disparities in colon cancer?" J Clin Oncol 33(8): 854-860.

“Racial/ethnic disparities in survival were absent in the IHS. Integrated systems may serve as the cornerstone for developing accountable care organizations poised to improve cancer outcomes and eliminate disparities under health care reform.”

The Road Ahead

National Goals

Step 1: Reboot Healthcare with Health IT

Source: Hesse, B. W. (2010). "Time to reboot: resetting health care to support tobacco dependency treatment services." Am J Prev Med 39(6 Suppl 1): S85-87.

Step 2: Connect systems (by 2020)

Push for Open API’s (Application Program Interface) to connect external devices

E.g., Fast Healthcare Interoperability Resources (FHIR®)

Step 3: Adjust incentives for population health

CMS Accountable Care Act

Step 4. Strengthen data flows

Step 5. Use data to inform local action

Step 6. Take advantage of new resources

http://www.countyhealthrankings.org

http://www.countyhealthrankings.org

Step 7. Encourage cross-sector participation

Step 8. Nurture a culture change

• A culture of health• A culture of data, evidence• A culture of participation, community

Step 9: Think globally, act locally

Thomas Friedman, Massachusetts Institute of Technology, May 16, 2005

Take-Away Points

Source: Topol EJ. The creative destruction of medicine : how the digital revolution will create better health care. New York: Basic Books; 2011.

Medicine and public health are evolving rapidly

In the evolved world, data will be the new “Intel Inside”

July 27, 2012

Source: Hesse, B. W., et al. (2013). National Health Communication Surveillance Systems. Global Health Communication Strategies in the 21st Century: Design, Implementation, and Evaluation. D. K. Kim, A. Singhal and G. L. Kreps. New York, NY, Peter Lang: 317-334.

With tools emerging to make access to these data easier, more focused

“Reconsidering Health Impact”

CDC Director: Thomas R. Frieden

Health impact comes from aligning action

State Cancer Profiles Lung & Bronchus Mortality

HINTS 2003: “Smoking leads to lung cancer”

CASE STUDY: Tobacco Control

Source: Hesse, B. W., et al. (2013). "Partnering against cancer today: a blueprint for coordinating efforts through communication science." J Natl Cancer Inst Monogr 2013(47): 233-239.

iNcentivesUnderstand mappingsDefaultGive feedbackExpect errorStructure decisions



Population Intervention



“Greatest success comes from

implementing across levels of influence”



Seize new frontiers

Think data-informed, locally contextualized, precision public health

Source: Office of the National Coordinator for Health Information Technology (2015). Connecting Health and Care for the Nation: A 10-year Vision to Achieve an Interoperable Health IT Infrastructure. Washington, DC, Department of Health and Human Services,: 13.

Thank you!

http://www.slideshare.net/BradfordHesse

Hesse hopkins 2015

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