Joshua Seidman, Ph.D.

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Ix 101
Joshua Seidman, Ph.D. President Center for
Information Therapy Molly Mettler, MSW Senior
Vice President Healthwise
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Outline

• Brief background
• Context/re-conceptualizing delivery system
• Data/practical issues that support Ix need
• Solutions/Ix strategies

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What is the IxCenter?

• Washington Place you cant explain what you do
  to your parents
• Luckily, weve got our kids

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Daddy, are you a real doctor?

• What does doctor mean today?
• Not really about MD vs. PhD
• Boo-boo doctors vs. question doctors

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The IxCenter

• Founded/nurtured by Healthwise
• Now independent, not-for-profit organization
• Mission Advance Ix practice science to improve
  health, consumer decision making, and healthy
  behaviors
• Vision Drive health care delivery innovation by
  widespread diffusion of Ix strategies through
  research, education, and collaboration.

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Members to Date

• Ix Implementers
• Aetna
• Cheshire Medical Center/Dartmouth-Hitchcock Keene
  Clinic
• Fox Chase Cancer Center
• Group Health Cooperative (Seattle)
• Group Health Cooperative (Madison)
• Health Partners
• Kaiser Permanente
• Mass General Physicians Organization
• MGHs Stoeckle Center for Primary Care Innovation
• Partners Community Healthcare Inc (PCHI)
• Priority Health
• St. Alphonsus Regional Medical Center
• United HealthCare

• Ix Supporters
• American College of Cardiology
• eHealth Initiative
• Foundation for Informed Medical Decision Making
• Healthation
• Health Hero Network
• HPN Worldwide
• Institute for Alternative Futures
• MedMovie.com
• Pro-Change Behavior Systems
• Telemedik

Ix Solutions Partners

• Emmi Solutions
• Enhanced Medical Decisions
• Health Dialog

• Health Outcomes Sciences
• Healthways
• Healthwise
• MedSeek

• NorthPoint Domain
• Resolution Health
• Silverlink
• WebMD

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Members to Date

• Ix Implementers
• Aetna
• Cheshire Medical Center/Dartmouth-Hitchcock Keene
  Clinic
• Fox Chase Cancer Center
• Group Health Cooperative (Seattle)
• Health Partners
• Kaiser Permanente
• Partners Community Healthcare Inc (PCHI)
• Priority Health
• St. Alphonsus Regional Medical Center

• Ix Supporters
• American College of Cardiology
• eHealth Initiative
• Foundation for Informed Medical Decision Making
• Healthation
• Health Hero Network
• HPN Worldwide
• Institute for Alternative Futures
• MedMovie.com
• Patient Education Institute
• Pro-Change Behavior Systems
• Telemedik

Ix Solutions Partners

• Eliza Corporation
• Emmi Solutions
• Enhanced Medical Decisions
• Health Dialog

• Health Outcomes Sciences
• Healthways
• Healthwise
• MedSeek

• NorthPoint Domain
• Resolution Health
• Silverlink
• WebMD

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Information Therapy

• Ixcorollary to Rx
• Right info to right person at right time
• Timely prescription and availability of
  evidence-based health information to meet
  individuals needs and support sound decision
  making

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• Group Health Cooperative (Seattle)
• Information therapy f(
• care delivery system,
• sophisticated member portal,
• full-featured clinical information system,
• appropriate content,
• capable and motivated clinicians)

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• CONTEXT
• A NEW WAY OF CONCEPTUALIZING THE CARE DELIVERY
  SYSTEM

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• THE NEED FOR INFORMATION THERAPY

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Consumers Trust MD Recommendations
Source LaurusHealth.com, 2000.
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Majority of MDsPrescribing Information
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Impact of Outside Information on
Physician-Patient Relationship
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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

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Parallel Play
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Parallel Play
IN THE MDs 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 info
• Info is hard to
• -Find (relative to need)
• -Understand
• -Remember
• -Contextualize

Ix Bring Two Worlds Together
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The Dangers of Generic Information
For Marathoners
Source New York Times
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Where to Go for Good Information?
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If you dig deeper
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For a more targeted Ix

• On multivariate analysis, hyponatremia was
  associated witha racing time of 400 hours
  (odds ratio for the comparison with a time of
  2.9 to 23.1)

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DATA vs. INFORMATION
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Available at http//www.chcf.org/topics/view.cfm?
itemID114624
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How Ix Works

• Information triggers
• ICD-9/10, CPT-4, SNOMED

• Moments in care
• Diagnosis, Treatment, Discharge
• Questions Decisions Faced

• Information prescription

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All About Mary

• 63 year old administrative assistant
• Health Plan HSA
• Conditions
• Diabetes
• High Cholesterol
• Obese
• Back Pain
• Asthma
• Physicians
• Internist
• OB/GYN
• Chiropractor

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Marys Concerns

• Sees multiple doctors
• Has multiple chronic conditions and needs help
  managing multiple chronic conditions
• Has limited financial resources
• A significant percentage of her take- home pay
  goes to prescriptions
• Has an HSA health plan through her employer

No Exercise No Eating Plan
Sporadic Compliance
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Three Approaches to Ixfor Mary

• Patient Prescribed
• System-Prescribed Ix Campaigns
• Physician Prescribed

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1 Patient PrescribedStart with a Consumer
Portal and Let Mary Look it Up

• Broad Easy to Use
• Deep Decision-focused
• Evidence-based, Up-to-date Referenced

US Example Kaiser Permanente
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The HW KnowledgebaseBroad and Easy to Use

• Over 5500 Topics
• Symptoms
• Health Conditions
• Treatments
• Medical Tests
• Medications
• Wellness Consumerism

Because the only information that matters is
about my health concerntoday
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Deep Decision-Focused

• 100 Decision Points
• Self-Management ActionSets
• Diabetesover 300 pages
• Indexed and tagged for specific retrieval

• Because if it doesnt help make a better
  decisionit doesnt really help.

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Decision Points What Should I Do?
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Action Sets How Can I Manage This?
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2 System-PrescribedIx Campaigns

• Core Campaigns
• In-depth Campaigns
• Prevention Prescriptions

Information Push
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Core CampaignsPrescribed by Marys Health
Plan(based upon claims data and other triggers)
Helps Mary find the best Web starting place for
each new diagnosis, test or medication.
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Core CampaignsFor any health problem
Into the library, to the right section, the
right shelf and the right book. ( The patient
takes it from there.)
Countway Library of Medicine, Harvard
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In-Depth Campaigns

• Long-Term Conditions
• Targeted to the Moment in Care
• Tailored to the Individual

Builds self-management skills and knowledge
little by little over time
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In-depth CampaignsFor your health problem
Into the library, to the right section, the
right shelf and the right book, and
Countway Library of Medicine, Harvard
the right page and the right sentence
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In-depth Campaign Self-Management Messages
Treatments
Prevention
Self care
Surgery
Medications
Home Tx
When to See
Living with It
MRI
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All at once vs a little at a time?
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Campaigns by Moment in Care
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Campaigns by Moment in Care
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Campaigns by Month
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Ix for Preventive Services?Marys checklist

• Immunizations Influenza Pneumococcal? Tetanus?
• Cholesterol Check
• Blood Pressure Checks
• Colon Cancer Screens
• Body Mass Index
• Depression Screen
• Alcohol Use Review
• Test for eye problems (diabetic retinopathy
  glaucoma)
• Test for kidney problems (diabetic nephropathy)
• Foot exam
• HbA1c Fasting Blood Sugar Test

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Why not Ix before and after every medical test?

• Pre-test
• Decision aid
• Test prep
• Post-test
• How to interpret
• Next steps

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Type 3 Clinician Prescribed

• Recommended by the MD
• Personalized to the patient
• At every moment of care
• Included in the record

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Before every visit Triage and Visit Prep

• When to call
• How to prepare
• Self-care for now

• US Examples
• Group Health CooperativeSeattle
• Kaiser
• Palo Alto Medical Foundation--California

After every visitA Visit Summary

• Diagnosis/ Vital signs
• Treatment options
• Self care

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Summary
Ix can help every patient, even
Mary Particularly when combined with care
management services
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Are Patients Ready?Consider this

• Elevators and gas pumps
• Bank deposits/withdrawals
• Airline tickets/hotel reservations
• Stock market buys and sell orders

A transformation of convenience and efficiency
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Thanks!For more info

• www.ixcenter.org
• www.healthwise.org