mie2015 workshop-adherence engaging-publicized

PowerPoint Presentation

MIE 2015 Workshop WS13May 28th 2015 4:45pm - 6:15pm Room Frankfurt

Chohreh Partovian, MD PhD (IBM T.J. Watson Research Center, USA)

Pei-Yun Sabrina Hsueh, PhDReview of gap analysis from big data to small patient-generated data (IBM T.J. Watson Research, USA)

Michael Marschollek Prof. Dr. med Dr. Ing(Director of Hanover Medical School, Peter L. Reichertz Institute for Medical Informatics)

Fernando Martin Sanchez, PhD(Director, Healthcare and Biomedical Informatics Center, University of Melbourne, Melbourne, Australia.)

Addressing Patient Adherence Issues by Engaging Enabling Technologies

Addressing Patient Adherence Issues by Engaging Enabling Technologies1

Agenda 4:45-5:00pm Opening RemarkPei-Yun Sabrina Hsueh: A view from big data to small data (IBM T.J. Watson Research) 5:00-6:00pm Presentations / interactive Q&A Chohreh Partovian: physicians POV on adherence management using technology (IBM T.J. Watson Research Center)Michael Marschollek: examples of adherence management via patient-generated information (Hanover Medical School)Fernando Martin Sanchez: an update of self-quantifiable movement enables and imminent challenges (University of Melbourne)6:00-6:15pm Workshop discussion/audience Q&A


Addressing Patient Adherence Issues by Engaging Enabling TechnologiesPei-Yun (Sabrina) Hsueh, PhDWellness Analytics LeadGlobal Technology Outlook Healthcare Topic co-LeadHealthcare Informatics PIC co-Chair Health Informatics Research Group IBM T. J. Watson Research Center

Research focus: Insight-driven Healthcare service design, Patient-generation info from wearables and biosensor devices/implants, Personalization analytics framework for lifestyle intervention, Patient engagement & Adherence risk mitigation

Opening Remark


Addressing Patient Adherence Issues by Engaging Enabling TechnologiesA perfect storm awaits..Healthcare Landscape Shift driven by Patient-generated information



Apple iOS 8 HealthKit

Samsung sHealthThe mHealth Data Platform Race!

Google Fit



Recap from MIE 2014: Gaps observed in the use of Patient-Generated Data in Personalized Service DesignQ: How to re-create healthcare service and user experience through Patient-generated data from non-clinical settings?

30%10%60%

Endogenous Personal GenomicsCare Delivery Clinical CareExogenous (Behavior, environment, social)

MobileFRR

Personalized HealthcareOutcome-based ModelOutcome-driven service models that can account for exogenous data (60% of healthcare determinants) are crucial to effective healthcare.

Unreliable detection of inflection points, habit formation cycles and assessments of treatment efficacyReliable means for providing granular patient understanding in daily contexts.

Not an imagined problem! (Otsuka/Proteus/LLoyds, J&J Alz early detection, Samsung app/platform, Apple HealthKit/ResearchKit/Watch, etc.)


Addressing Patient Adherence Issues by Engaging Enabling TechnologiesAlzheimers cost US $203 billion in 2013 and $1.2 trillion in 2050

Scenario definition: Pain management/dementia/cognitive decline testing (clinical home monitoring) Sensor/platform COTS survey (key insights, challenges in energy harvesting technology) and experiment Device connectivity, IBM software stack/platform review and trial Embedded analytics: personalization analytics w/ intra-individual variability and multimodal validation Thought leadership building on empowering personalized health services with patient-generated information 2014 MIE workshop (Sep 2, 2014) (the biggest European medical informatics annual conference) Speakers from Hannover, Melbourne Medical School and IBM Research (Watson, Haifa, Australia), discussions spanning from big data to monitoring standard to multiple clinical requirements to service models (both physicians and service providers POV)Continuing validating approaches with client teams: Vignet/Curam (pain management), Otsuka (mental health)

By next year, about 45 percent of the U.S. populationwill be over 50 including Boomers and the previous generation

For healthcare, thats a $20 billion+ market over the next three years, according toParks Associates. Its such an inviting market that AARP and UnitedHealthcare launchedThe Longevity Networkthis week as a hub for digital health ideas targeted at the 50+ market in general. Suggested categories which target Boomers now and in their coming years include medication management, aging with vitality, vital-sign monitoring, care navigation, emergency detection and response, physical fitness, diet and nutrition, social engagement, and behavioral/emotional health.

FRR focus characterize & prototype condition-sensor-service combinations for cognitive health to develop a portfolio of outcome-oriented human services that can also be adapted for chronic care management

Its Data. Big Data!Its also not just Big Data!1240 PB

1800 PB

6800 PB(annual)

Clinical:Episodic; care pathways in controlled settings Genomic: Mostly static data, but critical for personalized medicine Exogenous data (behavioral, social, environmental)Social and behavioral phenotypes + Exposome informatics Exogenous Data Growing Fast !NOISY, LARGE VOLUME, UNCONTROLLEDNeed minimum description & quality control



Turning big data to actionable small data

1990Empirical MedicineIntuitive MedicinePersonalized Service

Personalized service (Individualized Calibration)

Knowledge-driven Guideline Precision MedicineDegree of personalization

Degree of collaboration (data dimension)Data-Driven Evidence

Century of behavior changeHypothesis Modeling

++


Addressing Patient Adherence Issues by Engaging Enabling TechnologiesSmall data connects people with timely, meaningful insights, derived from big data or local data sources, organized and packaged often visually to be accessible, understandable, and actionable for everyday tasks8

IBM Confidential9

Recap from MIE 2014: Gaps observed in the use of Patient-Generated Data in Personalized Service DesignThe lack of reliable means to capture granular patient-generated data in non-clinical settings (users daily life contexts)Leads to unreliable detection of inflection points, habit formation cycles and assessments of treatment efficacy. Need for a framework to integrate analytical insights with feasible service models. Progress impeded by the lack of modular design and data standardization in existing healthcare systems

Customer/PatientAdherenceTheme#1Theme#2

Theme#3

Personalization for risk stratification(from population to individual evidence)Personalization for in-context recommendation (from disease-centric to patient-centric)Personalization for adherence risk mitigation (from status-insensitive to status-sensitive)


Addressing Patient Adherence Issues by Engaging Enabling TechnologiesMore questions to think & Suggestions on next step? Do provider beliefs and support of these technologies and approaches affect patient usage?Will patient interactive reported data improve provider and patient communications, reduce risks and increase early interventions? Can adherence to care plans for patients with chronic health conditions be increased through technology-mediated techniques? Can analytics based on patient characteristics and adherence behavior be used to identify patients at risk for adverse health events, as well as identify model adherers who are more effective than the average patient at remaining healthy? Can dynamically configured software improve health outcomes for the patient and help control costs?How will real time patient reported data shift communications, culture, care processes and the patient provider partnership? A follow-up workshop/panel with a more focused area wherein filling in the gap has been perceived as priority MIE 2015


Addressing Patient Adherence Issues by Engaging Enabling TechnologiesMIE 2015 Focus Area: Adherence risk mitigation opportunities

Less than 50% of patients adhere to clinical recommendations20 to 30% of prescriptions are never filled - 194,500 deaths a year and an additional 125 billion (EU) 69% of adverse event-related hospital admissions, $100-$290 billion annually (US) $30 - $594 billion dollars annually (global)UK, France and Belgium have started including pharmacists as a mean to gather additional information on patient adherence How to bring patients and clinicians into the loop for evidence-based conversation?


Addressing Patient Adherence Issues by Engaging Enabling TechnologiesPatients nonadherence to care plans and medications is a common problem and has been posing tremendous challenges to providers for years. It has been contended to incur high healthcare costs globally, in the range of $30 - $594 billion dollars annually [1]. In the EU alone, nonadherence accounts for 194,500 deaths a year and an additional 125 billion Euros in cost. [2]. In the US, it has been esimtated to account for 69% of adverse event-related hospital admissions and $100 billion to $290 billion annually in terms of excessive hospitalizations and avoidable medical spending [3]. Non-adherence is especially insidious in the case of chronic care, where less than 50% of patients adhere to clinical recommendations and 20 to 30% of prescriptions are never filled [4]. 11

12Key Challenges in Adherence Risk MitigationExisting systems lack of capabilities to account for case history has resulted in not being able to differentiate urgent cases. Care coordinators have to handle all case exceptions equally; this is a costly process given the sheer number of guideline violations per day.


Addressing Patient Adherence Issues by Engaging Enabling Technologies12Wellness outside of clinical settings, need to be individualized increased relevance, ownership Adherence critical issue impacting efficiency of healthcare deliveryPersonalization of treatment plans to help improve relevance and ability to monitor to facilitate adapatation - core part of our portfolio.

A typical hospital network contains 30 40 independent systems, often with their own proprietary Clinical Data Repository (CDR)The ideal is a common repository, with a common interface and access. The reality is there are a lot of applications, with their own repositories. It makes it difficult for administrators to do their daily work. Not having common and delegated access contributes to slower patient processing, increased administrative costs such as front desk and call centers costs, and often a lack of real-time insight into overall healthcare analytics.

How do you proactively leverage patient data (individual, population) and guidelines into actionable insights based on risk and disease progression?

RiskStratificationUser-Centered ServicePersonalizationMonitoringHow do you generate a specific personalized plan?how do you monitor effectiveness, Adherence risk and adaptation points?13

Theme#1Theme#2Theme#313


Addressing Patient Adherence Issues by Engaging Enabling TechnologiesSlide 14What factors are characteristic of current adherence behavior?Adherence Outcome Measure

Control Variables (Demographics)AgeGender

Patient characteristicsSocioeconomic, Location, BenefitsHealth/wellness statusPast adherence behavior

Utilization profileDrug utilizationDrug delivery channelDrug costHealthcare utilization in the previous yearPsycho-active clinical care

Professional characteristicsProfessional responsibilityStress & Sense of Control FactorsRoutine Disruption Factors

Medication/Disease managementMedication Access Factors (Impact of retail/mail order, days supply by doctor behavior)Medication Management Burden (in observation window)Disease Management Factors (in look-back period): Charlsen Index, Secondary prevention criteria


Addressing Patient Adherence Issues by Engaging Enabling TechnologiesH?

Context-based Wellness/health Services ~ tracking the data value chain 15

Insight-driven health/wellness services

ClinicalproviderPayerAffinityServicesPersonGenerated

Billing data

Lab data

Imaging data

Inpatient EMR data

Outpatient EMR data

Claims Data

HIE Data

External pharmacy data

Geno -mics Data

Exercise assessment data

Retailer (Food, trainer, etc)

Environmental data

Wearables psychological

Patient reported symptom dataFamily and Lifestyle dataWearables physiological

User preferences/implied habitsPatient reported outcome dataRisk stratification, intervention assignment

Intervention efficacy & disease progression

Personal Health tracking

Lifestyle baselining (without self-efficacy context)


Addressing Patient Adherence Issues by Engaging Enabling TechnologiesTo better understand the value progression of data in healthcare, here is a representation of who benefits from what kinds of data. Notice that the current systems (EMR, claims,..) are geared towards satisfying (partially) the interests of very few stakeholders. More importantly, they tend to be more episodic in nature and focus on healthcare delivery at point of care and/or managing the money-flow of the care. As the data gets augmented with those generated outside of these systems, the value for stakeholders keep increasing and more stakeholders emerge as potential beneficiaries. This trend is unmistakable in healthcare where insights-as-a-service has become the North Star for most incumbents (Cerner, Optum,..). However, further gradations will emerge in this field. Insights derived by owned data may be easier to achieve, but limited in value compared to insights derived with data from second party or even third party providers. Regardless of the progression of the insights value capture methods, it is important to reiterate the need to insert IBM in the dataflow and facilitate concepts such as data-as-a-service or data marketplace to build our ecosystems.

The light green box (User preferences) is potentially a significant differentiator that leverage IBM strengths in analytics disease progression, similarity, behavior modeling.

This could also form the basis of how we define our services. In a later chart we expand on our invest-harvest strategy. IBM will need to quickly decide on forming strategic alliances where we give some of the infrastructure and analytics to help us secure a position in the data flow to then position ourselves for significant monetization opportunities in the insights business15







Addressing Patient Adherence Issues by Engaging Enabling Technologies16

Ambient and Wearable Sensor Systems improving patient adherence?

Some example studiesDiscussion

Michael Marschollek (Peter L. Reichertz Inst. for Med. Informatics at Hannover Medical School, GER)

Personalized Healthcare and Adherence: Issues and challengesThe NATARS studyAmbient sensors (retrofitted) in homes and wearableslong-term mobility and activity monitoring of patients who recover from mobility-impairing bone fractures24 patients (recruitment: some 400), each 3 monthsPrimary outcomes: acceptance, feasibilitySecondary: relationship sensor data clinical outcome

Personalized Healthcare and Adherence: Issues and challengesdevices used19inexpensive, backfitting possible, wireless

home automation sensorsbase station (data collection)

wearable accelerometerpower meters

Personalized Healthcare and Adherence: Issues and challengesExample: motion sensors in bathroom, kitchen20

Personalized Healthcare and Adherence: Issues and challengesoutcomeTechnical feasibilityGood acceptance, once installedFirst hints on relationships btw. clinical outcome and sensor data

Marschollek M, et al. Inform Health Soc Care, 2014; 39(34): 262271

Personalized Healthcare and Adherence: Issues and challengesClinical outcome and sensor data

Personalized Healthcare and Adherence: Issues and challengespromoting physical activity in childrenmultitude of projects, e.g. Plischke et al, 2008, Stud Health Technol Inform, cyberMarathon study, wearable sensor data feedbackresults:change in BMI over a year in intervention group+11.4% daily physical activity MET level

23

Personalized Healthcare and Adherence: Issues and challengesAGT Rehab study

Personalized Healthcare and Adherence: Issues and challengesPoint-of-Care study Remote monitoring of liver transplant childrenPoint-of-care blood testingDecision support and communication for parents, doctors

Marschollek et al., ESPGHAN 2013

Personalized Healthcare and Adherence: Issues and challenges

parents view

physicians view

Personalized Healthcare and Adherence: Issues and challengesPOC study results (excerpt)Home monitoring following liver transplantation isfeasible and is accepted by parents and physicians.Cons:time consuming (physisican), expensivetwo POC devices were damaged despite trainingpossible interference of communication with local health care provider (patient may fall in-between responsibilities)Pros:data securely transmitted one infection alarm was generated successfullyenabled timely diagnosis and anti-viral treatmentgood parent satisfaction, acceptance

It was so soothing to have it here and know that everything is ok with our son. It really helps people in our situation and gives them security. Thank you for letting us use it!

Personalized Healthcare and Adherence: Issues and challengesQuestionsDoprovider beliefs and supportof these technologies and approaches affect patient usage?Willpatient interactive reported dataimprove provider and patient communications, reduce risks and increase early interventions?Canadherence to care plansfor patients with chronic health conditions be increased through technology-mediated techniques?Cananalyticsbased on patient characteristics and adherence behavior be used toidentify patients at riskfor adverse health events, as well as identify model adherers who are more effective than the average patient at remaining healthy?Candynamically configuredsoftware improve health outcomesfor the patient and help control costs?How will real time patient reported data shift communications, culture, care processes and the patient provider partnership?

YES

YES, maybeYES

Maybe

YES

subtantially

Personalized Healthcare and Adherence: Issues and challengesButLack of data integration in HIS (semantics?)Lots of data = lots of information? > analytic gapIssues of data qualityAdherence only in case of clear benefit (e.g. POC study), potentially strong study bias?







Personalized Healthcare and Adherence: Issues and challenges30

QuestionsDoprovider beliefs and supportof these technologies and approaches affect patient usage?Willpatient interactive reported dataimprove provider and patient communications, reduce risks and increase early interventions?Canadherence to care plansfor patients with chronic health conditions be increased through technology-mediated techniques?Cananalyticsbased on patient characteristics and adherence behavior be used toidentify patients at riskfor adverse health events, as well as identify model adherers who are more effective than the average patient at remaining healthy?Candynamically configuredsoftware improve health outcomesfor the patient and help control costs?How will real time patient reported data shift communications, culture, care processes and the patient provider partnership?

YES

YES, maybeYES

Maybe

YES

subtantially


The problem-centered interviewing and treatment The Doc Martin Approach

SymptomsPast medical historyDemographicsClinical ExaminationDiagnostic Tests: Lab, Imaging...DiagnosisTreatment

Recommendations for behavioral and lifestyle changeMedications

Patient DATA

Physician OrderDecision Making Process

???

Personalized Healthcare and Adherence: Issues and challengesAdherence is a key mediator between medical practice and patient outcomesFor every 100prescriptions written50-70go to a pharmacy

48-66come out of the pharmacy

25-30are taken properly

15-20are refiled as prescribed


Personalized Healthcare and Adherence: Issues and challengesFive interacting dimensions of Adherence

Low literacy - Language barrierLack of insight into illnessBelief medications are harmful or not importantLack of belief in benefit of treatmentFear of medication side effectsForgetfulnessTired of taking medications

Anger, stress, anxietySubstance abuse, psychiatric disease, Depression

Complexity of medication regimenInconvenience of medication regimen

Inadequate follow-up / discharge planningBarriers of access to careCost of medicationsProviders inadequate techniques, theory, and relationship skills, failing to assess the patients needsnot sharing decision making with patients

Personalized Healthcare and Adherence: Issues and challengesHow to promote maintained health behavior change?

Personalized Healthcare and Adherence: Issues and challengesSelf determination theory suggests the need for fostering Autonomyintentional change as opposed to societal, developmental, or imposed changeIntrinsic motivation or well-internalized extrinsic motivationautonomously motivated people are more engaged, persistent, and efficacious

Personalized Healthcare and Adherence: Issues and challengesHow to promote autonomyCreating conditions for internalization of the recommendations Refraining from pressuring to think, feel, or behave in particular ways via coercion or seductionTaking interest in the barriers to change and their motivations behind itAcknowledging their internal frame of reference and Respecting their choicesEncouraging them to explore and to make choices about how to behave

Providing guidance and supportProviding relevant information in a dispassionate way, Translating the information Scaffolding the presentation of facts to facilitate more reflective lifestyle choices

leaving them alone to decide and act for themselves being permissive or neglectful

ControlAutonomyIndependenceDependenceExternal influence and individual commitment

Personalized Healthcare and Adherence: Issues and challengesPatient-centered interviewing and treatment An integrated (biopsychosocial) approach to clinical reasoning and patient care

Personalized Healthcare and Adherence: Issues and challengesCan technology-enabled patient-generated data help the provider-patient duo to better manage adherence?

Technologies that aim to enable real-time, adaptive management, engage and influence patients, and enhance clinicians cognitive processes

Personalized Healthcare and Adherence: Issues and challengesPatient-Generated DataHealth-related data created, recorded, gathered by/from patients to help address a health concernPatients and not providers are primarily responsible for capturing or recording these dataPatients direct the sharing or distributing of these data to providers and other stakeholdersPersonal Health Records (PHR), Interactive Web-Based Patient PortalsRemote monitoring using passive low-cost Mobile sensors, Streaming biometric data with manual or automatic download from medical devices, Geo-location tagging, question-asking systems using mobile phones to create personal profiles from questionnaires, quality of life scores and other patient-reported outcomes


Personalized Healthcare and Adherence: Issues and challengesWill patient-generated data help?Parity of information access is important to effective engagementThe fact of creating, managing, and reporting data has the potential to empower patients, to engage and activate themPatients who read their notes, collected personal health data, and maintained a record became more aware of their conditions and behaviors => felt more in control of their care, and showed increased participation Can address information gap and ensure continuity of care after discharge from hospital or between visitsLeverage untapped patient experience for shared decision making

Personalized Healthcare and Adherence: Issues and challengesProviders perception of PGDIts not just me learning about them, they are learning about themselves

They discover it because they pull it out of the data, which is much more powerful than me figuring it out and telling them

Personalized Healthcare and Adherence: Issues and challengesShared Information alone does NOT insure benefitExpanding technology use alone does not guarantee that people will become more adherentA patient having limited health literacy or low patient activation may not engage effectively in capturing and sharing PGD that require understanding and engagement


Perhaps more automated methods could help

Personalized Healthcare and Adherence: Issues and challengesUnderstanding the process of conversion from uninvolved to highly engaged patient is critical

Underlying structure of change is neither technique-oriented nor problem specific

Personalized Healthcare and Adherence: Issues and challengesThe transtheoretical model of change

a cyclical pattern of movement through specific stages of change a common set of processes of change a systematic integration of the stages and processes of change

Prochaska and DiClemento 1992

Personalized Healthcare and Adherence: Issues and challengesTranstheoretical Model: People are perceived as moving through a series of stages

stages of change represent a temporal dimension: when a particular shifts in attitudes, intentions, and behaviors occurThe more clients progressed into action early in therapy, the more successful they were in losing weight by the end of treatmentProchaska and DiClemento 1992

Personalized Healthcare and Adherence: Issues and challengesProcesses of Change: how these shifts occurCovert and overt activities and experiences that individuals engage in when they attempt to modify problem behaviorsRepeatedly identified across diverse areasThe processes used early in treatment, and the stages of change scores were the best predictors of outcome

Source: Reproduced from Prochaska, J.O. et al. (1992). In Search of How People Change. American Psychologist, 27, 11021114.

Personalized Healthcare and Adherence: Issues and challengesEfficient change depends on doing the right things (processes) at the right time (stages)10%15% of smokers are prepared for action, 30%40% are in the contemplation stage, and 50%60% are in the precontemplation stageThe amount of progress clients make following intervention tends to be a function of their pretreatment stage of change Helping people progress just one stage in a month can double the chances of participants taking action on their own in the near future

Not really thinkingAbout change nowPrecontemplation only action-oriented programs are likely to underserve, misserve, or not serve the majority of their target population.

Prochaska, DiClemente, Velicer, Rossi, & Guadagnoli, 1992


Mismatching Stage and TreatmentSome appear to rely primarily on change processes most indicated for the contemplation stageconsciousness raising, self-reevaluationwhile they are moving into the action stage. Insight alone does not necessarily bring about behavior changeOthers rely primarily on change processes most indicated for the action stagereinforcement management, stimulus control, counterconditioningwithout the requisite awareness, decision making, and readiness provided in the contemplation and preparation stages Overt action without insight is likely to lead to temporary change

Personalized Healthcare and Adherence: Issues and challengesDynamic measures of the processes and stages of change outperform static variablesFour major patterns of behavior change in a two-year longitudinal study of smokers(a) Stable patterns: remained in the same stage for the entire two years (b) Progressive patterns: linear movement from one stage to the next (c) Regressive patterns: movement to an earlier stage of change (d) Recycling patterns: two or more revolutions through the stages of change over the two-year periodProchaska, DiClemente, Velicer, Rossi, & Guadagnoli, 1992


Need to assess the stage of a client's readiness for change and to tailor interventions accordingly

Personalized Healthcare and Adherence: Issues and challengesProviders concerns: An information system is only as good as the information stored in itRisk of Information overloadChallenge of finding useful information in a large amount of data Quality and trustworthiness of data: need to trust that the information content is pertinent and the extra time spent worthwhileAdditional work not being reimbursedHow is it going to fit with the workflowUsabilityInteroperability between PHR and EMR

Personalized Healthcare and Adherence: Issues and challengesDesign Issues: What information?Customization may be necessary: Information needs vary across specialtiesMedication, medical history, records of past tests and treatmentsSubjective information: patients goals, values and preferences, feelings, moods, experiences, perceptions about their conditions, aspects of their lives related to their conditions, quality of life=> to better understand individual patients and provide more personalized service

Personalized Healthcare and Adherence: Issues and challengesHow the information should be presented? How easily the information can be retrieved, viewed, processedWhat thresholds are useful for timely review of received information and for automated alerting for out of range informationPresenting in a chronological manner: Timelines, CalendarsImportance of data visualization: Tables, Charts, color coding, trends over time and patternsIntegration of various types of information to identify relationships among multiple factors surrounding a patient specific behavior in order to identify triggers

Personalized Healthcare and Adherence: Issues and challengesDesign issues: What functions should be includedAbility to exchange data between EMRs and PHRs via an easy interfaceAbility to distinguish between PGD and data coming from other providers into EMRAbility to prompt patients to supply specific pieces of information during data entryAbility to filter data based on certain criteria, and to implement rules to detect conflicting data pointsFunction that would relay information directly to the care team when urgent care is needed and workflow created to respond quickly and reliably

Personalized Healthcare and Adherence: Issues and challengesPolicy, Privacy, and Liability IssuesWho is accountable for each step in handling of informationSecurity and privacy issuesPolicies guiding review and documentation of relevant information in a consistent way across organizationsReliable and trusted mechanisms for identifying and acquiring unadulterated, unambiguous, time-stamped data from known sources

Personalized Healthcare and Adherence: Issues and challengesProviders Role: Achieving high adoption impacts usefulness

Just as providers discuss and recommend medicines, lab tests, exercise, and other health-related activities, their impact on promoting patient use of PGD is likely to be important in terms of marketing the use of PGD to their patients or responding enthusiastically if their patients suggest PGD use

Personalized Healthcare and Adherence: Issues and challengesProviders Readiness to Change?Changes in workflow: The staff came to work one day and nobody knew how to do their job Richard BaronSocial relationships and communication patterns will change:Medical interns spent 12% of their times talking to patients vs. more than 40% of their time on computersPower dynamics who controls what have to be redefined and renegotiated: team work and shared decision-makingPolicy changes and realignment of incentives: Pressure to be cost-effective, outcomes and quality measurements

Personalized Healthcare and Adherence: Issues and challengesNeeds for education, creativity, and innovationUse of simulation and experiential learning to make the process of adopting the innovation (web-enabled patient reported measurement systems) easier for individual clinics to accomplish

Double Loop Learning

Personalized Healthcare and Adherence: Issues and challengesIt takes time.In 1834, speaking of the stethoscope, Times of London wrote: This diagnostic advance was not well received. That it will ever come to general use, not withstanding its value, is extremely doubtful because its beneficial application requires much time and gives a good bit of trouble both to the patient and the practitioner, because its hue and character are foreign and opposed to all our habits and associations.

The Digital doctor, Robert Wachter

Personalized Healthcare and Adherence: Issues and challengesThank you!


Thank YouMerciGrazieGraciasObrigadoDanke

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mie2015 workshop-adherence engaging-publicized

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