It is estimated that 60 to 80 percent of Americans have used the Internet to find health information, rivaling physicians as the most common source of information. The term Web 2.0 has been created to signify the idea of an interactive web, one that invites users to share experiences, to lead discussions and change, and to adapt the Internet to make it a public forum rather than a static informational grid. The potential for technology to continue to influence health decisions is impressive; more specifically, its potential in transforming well-being could be enormous.

One area in which technology is nascent is in wellness programs. Employers are just starting to realize the connection for instance of providing employees with a dedicated support structure for quitting smoking or losing weight. In what might seem to be an obvious connection, the happiness of employees directly relates to their perception of work and health, among other factors. By providing them with the network to improve those facets of their lives via integrated seamless programs, employers can close this gap and create sustainability to these endeavors.

The connection between communication, technology and patient care is increasingly becoming more established.  These facts present an amazing opportunity for companies adept enough to take advantage of them. Through the use of new technology (smart phones) health information can be made available to employees at an unprecedented level, taking the emphasis on wellness to an entirely new level and reinvigorating an already thriving area.

As seen on the PRWeekus.com “Insider” blog on April 1, 2010. This blog post is part of a series of three blogs focusing on communications and personalized medicine. Each week PRWeekus.com features a guest blogger on its “Insider” blog.

Interestingly, a movement is taking place within healthcare that may just provide not only a solution, but also an innovative approach that allows stakeholders to become both a hedgehog and a fox. This movement surrounds personalized medicine. National Institute of Health director Elias Zerhouni, has described personalized medicine as the “4 P’s”: predictive, personalized, preventive, and participatory. The very definition itself underscores the inherent connection between understanding one and many things, well, simultaneously. In order for companies to embrace the potential of personalized medicine, it will be imperative to identify each of the four areas as a distinct entity, and yet be nimble enough to link them in a productive manner.

Isaiah Berlin’s essay examines great thinkers and writers in history to explain their approach and genius. The hedgehogs tend to view the world through the lens of one idea, while the foxes base their ideology on a multitude of ideas and experiences. As healthcare continues to evolve and personalized medicine begins to take root, this delineation may become increasingly hazy. And for those who are prepared, that might just translate into an incredible opportunity.

As seen on the PRWeekus.com “Insider” blog on March 29, 2010. This is the first of three blogs in a series focusing on communications and personalized medicine. Each week PRWeekus.com features a guest blogger on its “Insider” blog.

Really?

Before even delving into this argument, it is germane to examine the articles themselves. The first is very specific to a “vulnerable” population aged 65 and older. The results indicate that patient satisfaction is not associated with technical quality of care, not outcomes or even quality of care, but rather technical skill. Plus, the survey results show that communication skills directly relate to higher global ratings of health care, somewhat undermining the very argument the authors ultimately posit.

The second article is completed in England, which is clearly based around a completely different system of health care delivery. Again, the survey results suggest that patient assessment scores of their own care (which is not quite the same as satisfaction) do not correlate with clinical practice such as controlling or monitoring hypertension.

I will be the first to admit that current patient satisfaction methodology does not accurately reflect how patients feel about their care, but my dissatisfaction with it stems from the limitations of the questions in capturing the patient experience. The fact is, and it has been demonstrated in multiple studies over many years, that patient adherence, follow-up, and overall outcomes are directly related to how happy patients are with their care. For all those who have been a patient or a caregiver, they have been subject to the often-chaotic movements of a system that though very good, still has many holes. Hence the 2001 Institute of Medicine report detailing the quality chasm. Those patients and caregivers understand how this complexity and confusion can add to the physical ailments and strain of the situation.

It is interesting that the articles I saw highlighted on this subject are all from physicians. Their united voice argues that physicians should not be compensated, graded, or judged at all on patient satisfaction. As one points out: “a hospital is not a hotel.” As I have argued before, this view is truly a shame. Most hotel owners care about those who stay with them, they want them to have a pleasant experience, and they believe that they can influence their guests’ overall trip/vacation through simple, yet highly effective, services. And for the most part, they are correct. Just like the many studies that have been done in health care point to a very clear connection between patient satisfaction and outcomes.

The disconnect between physician attitudes (and likely other health care stakeholders) and patient expectations conveys a gap that persists in health care delivery that is discouraging and slightly scary. If the very ones who are giving the care believe that its delivery exists in a vacuum and that as long as the correct test is ordered the patient should be content, then the system will change even more slowly than it should. And patient care will continue to suffer.

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The entire staff at Widmeyer Communications has been touched by the devastating earthquake in Haiti. Please join us in supporting one of these organizations by making a donation:

•The American Red Cross is flooded with phone calls and as of January 14th cash donations have topped $3 million. They expect to provide immediate needs for food, water, temporary shelter, medical services and emotional support. They are accepting donations through their International Response Fund.

•UNICEF has issued a statement that “Children are always the most vulnerable population in any natural disaster, and UNICEF is there for them.” UNICEF requests donations for relief for children in Haiti via their Haiti Earthquake Fund. You can also call 1-800-4UNICEF.

This concept can also be applied to health care. In its seminal report “To Err is Human”, the Institute of Medicine highlighted the massive amount of medical errors that occur each year: almost 100,000 deaths! Since then, many changes have been implemented to reduce this number. And new safeguards are being added daily to ensure that patients are not susceptible to flaws in the system. But that is where the system as it is continues to fail: there is simply a paucity of regulated actions within health care to avoid errors.

Operating room procedures and blood transfusions are two areas that have progressed tremendously in the last decade. Standard protocols now dictate actions. The same is true for giving medications, as nurses are now required to check a patient’s identification band and ask the patient’s name before providing any pills. Some have argued that creating these protocols for all areas of hospital care would be absurd and impossible. One calculation estimated that in intensive care, there are over 120 steps for a patient’s care just in the morning. Between drawing blood, checking supportive machinery like IVs, and recording vital signs, among many others, following a checklist type protocol would severely limit staff ability to care for patients. IVs are a perfect example in fact of a mandate that may ultimately be destructive for patients. Current regulations recommended changing an IV every 3 days; but for many patients, losing access is a nightmare requiring multiple attempts to regain it and potentially even a more invasive procedure to ensure it. The benefit to cost ratio in those cases is not as simple to calculate.

Recent reports suggest that patients are in fact more attuned to potential medical errors than most members of a hospital staff. Unfortunately, they are not part of the chain of information. As I have pointed out before in these blogs, patient satisfaction surveys continually highlight the number one complaint of patients: that communication with staff is subpar. Understanding this problem is essential to improving the system as a whole. There is a definitive reason why reimbursement is soon to be increasingly tied to patient satisfaction and it transcends improving patient relations. Rather, it is in large part due to the complex interconnection between patient satisfaction (or as I like to point out their concerns) and outcomes. In multiple scientific studies, happy patients have been proven to have better short and long-term results along a number of variables. Concentrating on this element of health care then is critical to improving the system.

It is true that financial markets in general rise, but ask the millions of Americans who just watched their IRAs plummet over the last year how comfortable they are with that statement and you are sure to hear a great deal of skepticism. In health care, most satisfaction surveys are pointing to tremendous results and giant leaps forward; however, examining them closely delineates a different set of responses that point out some of the persistent deficiencies in health care today. Closing this gap by improving patient satisfaction may just help fend off the infrequent but devastating effects of a black swan in medical care. Because I feel confident in saying that as bleak as it is to watch one’s savings evaporate, the effects of a health-related mistake can be far more pronounced.

Stacia Tipton: You’ve been working on climate issues for decades. What’s the key lesson from Copenhagen?

Charlie Miller: If anything was clear at Copenhagen, it’s that the world’s nations are waiting for the U.S. to act. When it does (we’re pushing very hard for a Senate vote this spring), President Obama can knit together the historic breakthroughs obscured by the end of the Copenhagen meeting. The coalition of the willing that emerged represents roughly 60 percent of the world’s carbon emissions. It will undoubtedly be joined by others. A lot of hard work remains, but a lot of hard work is now finished. When most of the pieces of the puzzle are in place, it’s much easier to add the missing ones later. But Senate action is critical.

ST: When you and I were doing media around Kyoto in 1997, we had daily phone briefings and sent press releases by fax. How do digital and social media change the information flow today – and possibly the outcome?

CM: Ah, the good old days! Glad I sold my stock in fax machine companies, shortly after I sold my buggy whip holdings (just kidding!). Things have changed a lot since then. We were blogging from Copenhagen and sending out twitter feeds, and we were also sending out material for our Facebook page. We’re still running the analytics, but it appears that a lot of people were paying attention – our hash tag for Copenhagen was showing up anywhere, and many blog posts were using our twitter quotes. It’s pretty difficult to demonstrate that we were influencing the outcome, but we sure changed the reporting of the negotiations. Much more influential in shaping the outcome, of course, were the 40+ EDF staffers who attended Copenhagen.

ST: A climate bill always seems to be “next” on the Senate’s agenda. How do communications help advance an issue, when policymakers are focused on other priorities?

CM: Many Senators understand the urgency of climate action, but everyone understands that getting a bill through the Senate will be extraordinarily difficult. Majority Leader Reid has said financial reform is next in line, along with a jobs bill. But we’re optimistic that a climate bill will come after that, sometime this spring. We’re hoping that Senators get beyond the rancor and hyper-partisanship of the health care reform bill, and start focusing on the climate emergency. We’re using communications to convince fence sitters that a climate bill will create jobs and help the economy, that we’d rather have those jobs here in the U.S. instead of China, and that the consequences of failure will be far more costly. We’re using all the traditional campaign media tools, and most of the new ones too.

ST: What can we look forward to from EDF and its climate team in 2010?

CM: We’re focused like a laser on the Senate. EDF has been working to get to this point for years – we were the first environmental group to recognize this threat, and we’ve devoted more staff and resources to climate than any other group, by a wide measure. Getting a Senate bill is indispensible for action in the U.S., and action around the world, including China and India. I think that the EPA “endangerment” finding, and the threat of EPA regulating greenhouse gas emissions, will help nudge some Senators our way. In fact, it already has. We would vastly prefer a bill through Congress to EPA regulation, however. Climate should be a more bipartisan issue that health care, in part because of the extensive ground work we’ve laid over the last five years.

Other sources that might be of interest:

The New York Times: Copenhagen Climate Talks

Environmental Defense Fund in Copenhagen

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Recent articles on the health care reform bill have pointed out that it may be focusing on the wrong factors. Rather than identifying methods to cut costs and make the system more efficient, drafters of the bill are attempting to provide access without considering the full picture. As the costs of our health care system continually escalate, the necessity of addressing this situation is magnified. Perhaps the health care industry could learn a lesson from the strategy UPS adopted: that is, eliminate the waste and redundancy in simple processes to streamline the system as a whole. In doing so, costs may be dramatically reduced. A few examples are provided below:

And these are just three examples, the system is rife with processes and methodology that wastes resources. Whereas at UPS, literally every turn and second of the day is timed for perfection, health care wanders in a seemingly endless maze of inefficiency. Of course, as Atul Gawande pointed out in his seminal article a few months ago, costs can be community based and heavily influenced by factors that are not directly obvious. Still, these issues arguably point to larger deficiencies, trends, and a communication breakdown.

One potential solution to the problem of skyrocketing costs is personalized medicine. Drawing on multiple factors of an individual’s history and genetic composition, personalized medicine theoretically is designed to empower patients to take control of their health care in ways never before imagined. Skeptics of this approach though are numerous, pointing out the complexity of the system and the challenges to individuals designing their care. The debate around this topic is sure to intensify in coming years.

For now, as the reform bill moves closer to approval, the impending inaction on this area of the problem stands out and is worrisome. It will take a concerted effort by all stakeholders to make the next big shift. Hopefully, this bill will start the ball rolling and lead to greater change down the road. For now, we’ll just have to keep waiting for our left turn.

PM&R (also called physiatry) is a field often overlooked in medicine. For those who are not familiar with it, it covers a broad spectrum of conditions including: chronic pain, spinal cord injury, traumatic brain injury, stroke, joint replacement, multiple sclerosis, Parkinson’s, amputees, burn and cancer, women’s health, cardiac and pulmonary, and electrodiagnostic medicine. It also incorporates holistic approaches perhaps more than any other field, with many physiatrists receiving training in acupuncture and other alternative medical techniques. Because patients seek physiatrists’ care only after their acute illnesses are managed, the field does not garner the attention that typically goes to emergency care, cardiology, orthopedics, or any number of other more high-profile specialties. However, for those who have ever required rehabilitation, they will tell you first-hand how critical it is. PM&R is the medicine of functional ability, and just as importantly, how patients transition into the community. With offerings that range from physical and occupational therapy, to speech, vocational, and swallow therapy, PM&R is there to assist the disabled in the true sense of the word. It is a model within medicine because it thrives on a multi-disciplinary approach which always considers multiple aspects of a patient’s well-being. While other specialties do their work in “teams”, their approach does not entail the sort of all-encompassing view physiatrists adopt.

But that is where the discussion gets skewed. Here is a chief editor of a PM&R journal pointing out that monitoring patients’ health and wellness may be a niche market for clinicians. His sentiment, while accurate, is surprising on many levels. Aren’t all physicians supposed to be looking out for patients’ well-being already? Can wellness be a niche when the system as a whole should have a dedicated framework for approaching this issue? Unfortunately, medical care in the US focuses almost exclusively on disease management and more recently on prevention. There is in fact very little focus on wellness or well-being.

Surprising? It shouldn’t be. Despite the tremendous opportunity our health care system offers, critics continuously point out the poor outcomes data we churn out annually. Additionally, for those who have followed the discussion surrounding well-being in our other postings, this information should resonate clearly. It is not only employers who are faced with a dearth of understanding of what constitutes well-being, but providers as well. There is very little in medical school training about notions of well-being and how it might impact medical care. Patient satisfaction for example, which has consistently been shown to correlate highly with multiple aspects of patient outcomes, is not mentioned at all during training. And while hospitals have instituted wellness programs for their employees to stay aligned with employers in other industries, nearly all have ignored doing the same for their chief customer: patients.

A recent article in The Washington Post (Lovenheim, 11/10/09) discusses how many medical schools are changing their focus. Instead of anatomy, students now take classes on the physician/patient relationship, communicating with patients, and social and cultural issues in health care. George Washington University students were brought to Capitol Hill to learn more about health policy, and Johns Hopkins is revamping its curriculum based on the imminent growth of personalized medicine. Medical schools are trying to keep pace, as are some hospitals. A national licensing exam was instituted a few years ago that requires medical students to examine patient actors to assess communication skills and the Accreditation Council for Graduate Medical Education has included communication and patient care as two of the six core competencies of residency training.  But is this shift enough?

The notion of well-being permeates many different levels of our society and arguably has a profound impact on health outcomes. By defining what well-being means and understanding its role in health care especially, we may just be able to drive dramatic effects on patient care. While the editor of the PM&R journal has pointed out a tremendous niche for clinicians, we can only hope that it is quickly over-saturated.