Technology in the American Healthcare Context

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

Stresses  on  Healthcare  ❑ Aging  demographics  

❑ Increasing  chronic  disease  

❑ Complexity  in  care  

❑ Increase  for  diseases  in  remission  

❑ Shrinking  work  force  

❑ Rise  in  treatment  costs

Stresses on the Healthcare System: The Case of Cancer

New Sociotechnical Models Needed to Deal with Crisis

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.

HITECH Act of 2009 Was Passed to Improve Quality of Healthcare

A Core Element of Meaningful Use is Patient Engagement

“The single most unused person in health care is

the patient”*

*Cutler, D. Why medicine will be more like Walmart, MIT Technology Review, September 20, 2013

The Role of Patient Empowerment.

Engaged Patients Lower Health Care Costs

Healthy People 2020 Encourages Use of Health Comm & IT for Patients / Public

HP 2020 Goal: Internet Access

Source: Hesse, B. W., et al. (2014). "Meeting the healthy people 2020 goals: using the Health Information National Trends Survey to monitor progress on health communication objectives." J Health Commun 19(12): 1497-1509.

How about subpopulations?Age

Education

Source: Hesse, B. W., et al. (2014). "Meeting the healthy people 2020 goals: using the Health Information National Trends Survey to monitor progress on health communication objectives." J Health Commun 19(12): 1497-1509.

Gender

Race /Ethnicity

How is the Public Using the Internet?

51%$

58%$

78%$ 79%$

0%$

10%$

20%$

30%$

40%$

50%$

60%$

70%$

80%$

90%$

2003$ 2004$ 2005$ 2006$ 2007$ 2008$ 2009$ 2010$ 2011$ 2012$ 2013$ 2014$

Percen

t'Online'Po

pula/o

n'(18+)'

Year'

Looked$for$Health$Info$Online$

How is the Public Using the Internet?

51%$

58%$

78%$ 79%$

48%$ 47%$

55%$

77%$

0%$

10%$

20%$

30%$

40%$

50%$

60%$

70%$

80%$

90%$

2003$ 2004$ 2005$ 2006$ 2007$ 2008$ 2009$ 2010$ 2011$ 2012$ 2013$ 2014$

Percen

t'Online'Po

pula/o

n'(18+)'

Year'

Looked$for$Health$Info$Online$

Went$Online$First$(for$cancer$info)$

How is the Public Using the Internet?

51%$

58%$

78%$ 79%$

48%$ 47%$

55%$

77%$

7%$10%$

14%$

19%$

30%$

9%$13%$ 15%$

18%$20%$

0%$

10%$

20%$

30%$

40%$

50%$

60%$

70%$

80%$

90%$

2003$ 2004$ 2005$ 2006$ 2007$ 2008$ 2009$ 2010$ 2011$ 2012$ 2013$ 2014$

Percen

t'Online'Po

pula/o

n'(18+)'

Year'

Looked$for$Health$Info$Online$

Went$Online$First$(for$cancer$info)$

Email$Physician$

Order$Medicines$Online$

Awareness & Use of Electronic Health Information Exchange

56%$

82%$

88%$85%$

88%$

48%$

63%$66%$

61%$ 62%$

14%$

19%$

28%$

0%$

10%$

20%$

30%$

40%$

50%$

60%$

70%$

80%$

90%$

100%$

2003$ 2004$ 2005$ 2006$ 2007$ 2008$ 2009$ 2010$ 2011$ 2012$ 2013$ 2014$

Percen

t'Pop

ula-

on'(1

8+)'

Year'

Docs$have$EHRs$

Important$PHI$Shared$Electronically$

Keep$track$of$PHI$

HITECH Act

How is the Public Accessing Net? The Rise of Mobile

22%#

47%#

40%#

74%#70%#

66%#62%#

0%#

7%#

46%#50%#

56%#58%#

0%#

10%#

20%#

30%#

40%#

50%#

60%#

70%#

80%#

2003# 2004# 2005# 2006# 2007# 2008# 2009# 2010# 2011# 2012# 2013# 2014#

Percen

t'Pop

ula-

on'(1

8+)'

Year'

Broadband#Access#

Mobile#Access#

Example of Health System Innovation

“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

Health IT Improved Adherence

“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

Enabling a Learning Health System

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

Where are we going?

The Internet of Everything

Dramatic Increases in Adherence

June 2015, Office Behavioral and Social Science Research NIH-OD

The Consumer Electronics Market Aids in Prevention

Creating a self-improving healthcare system with patients as partners

Thank you!

hesseb@mail.nih.gov