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Patient-Centered Medicine and Health Reform

Apr 8, 2013, 9:00 AM, Posted by Benjamin Roman

Benjamin Roman, MD, is a Robert Wood Johnson Foundation (RWJF) Clinical Scholar in residence at the University of Pennsylvania and a senior fellow at the Leonard Davis Institute of Health Economics. This is part of a series of essays, reprinted from the Leonard Davis Institute of Health Economics’ eMagazine, in which scholars who attended the recent AcademyHealth National Health Policy Conference reflect on the experience.

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The term “patient-centered" has become something of a mantra in the nation’s current health reform efforts. There’s widespread agreement—at least in theory—that putting the patient at the center of everything is important but, as demonstrated in discussions at the recent AcademyHealth National Health Policy Conference, there is no exact blueprint for how to accomplish that.

Patient-centeredness means many things to many different people, but at its core are issues of shared decision-making and balancing how much the patient should really be in the driver’s seat. Patients want more information, but too much is overwhelming. They want to be nudged to do the right thing for their health, but not nagged. They want to choose health care wisely, but they don’t necessarily want less. Doctors want to involve patients in decision-making but don’t know how, or what evidence to use for the discussion.

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Heritage Open mHealth Challenge: Searching for a Sum Greater Than Its Parts

Mar 4, 2013, 3:14 PM, Posted by Christine Nieves

Christine Nieves Christine Nieves

“Smart” phones are rapidly becoming ubiquitous; almost half of all American adults own one. Every one of those phones has the potential to be a health companion for its owner, providing reminders about pills to take or tips about healthier foods to eat. Phones can also collect valuable health data—such as the quality of the air we breathe or the number of steps we walk. For people with a chronic disease such as diabetes, a smart phone can track the kinds of meals that spike their blood sugar or the side effects of their medications; it can even relay that information back to a doctor, who can then help patients better manage their health.

To date, the major tool for harnessing the power of mobile technology has been the app. Just like there are apps for weather, news, or restaurant reviews, there are apps for health. They can do amazing things, from measuring and monitoring, to imaging and predicting. But, there aren’t just a handful of them—there are thousands! And, that’s where the Heritage Open mHealth Challenge comes in.

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Active Transportation Gets a New App

Dec 28, 2012, 2:16 PM

New York City’s new schedule app for several of the city’s subway lines joins similar apps and online schedules introduced in cities around the U.S. that can help people more accurately plan their travel timetables --and maybe even get in some exercise. Transportation planners say that giving easily accessible and real time bus and subway schedules can increase public transportation use because it allows a traveler to accurately plan the time it takes for a trip.

San Francisco has had an app similar to the one just introduced in New York since 2008, according to a recent story in the Wall Street Journal. And other cities provide travel information online and accessible by smartphone. According to the American Public Transportation Association, real time information is one reason for a growth of almost 3 percent in public transportation use in the U.S. during 2012. Cost savings is another reason people are switching to public transportation, according to APTA, which calculated that public transit users saved about $800 during the month of December compared to the cost of owning and using a car. APTA calculated full year savings for the last year at close to $10,000.

And unless there’s a bus or subway stop right in front of the house, public transportation often adds physical exercise for its users. The closest public transportation stop for many NewPublicHealth staffers, for example, can add 1,000 steps of walking each day.

Bonus Link: Read a NewPublicHealth interview with Wendy Spencer, CEO of the Corporation for National and Community Service. Spencer gave up her car when she took the job at CNCS and moved from Florida to Washington, D.C. and now walks to work and meetings.

This commentary originally appeared on the RWJF New Public Health blog.

Pioneer Grantee Open mHealth Showcases Work at mHealth Summit 2012

Dec 18, 2012, 9:39 AM, Posted by Pioneer Blog Team

On December 3-5, 2012, Pioneer grantee Open mHealth spread the word about their work at the annual mHealth Summit in Washington, D.C. by hosting a panel session and engaging attendees at RWJF’s exhibit booth. Follow along with this Storify chronicling Open mHealth’s activities at the summit, and learn why their work to integrate apps through an open architecture is what’s next in mHealth.

 

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Open mHealth: Making Sense of Mobile Health Data

Nov 28, 2012, 10:10 AM, Posted by Pioneer Blog Team

David Haddad David Haddad

By David Haddad, program manager of Open mHealth

Next week, Pioneer grantee Open mHealth will showcase its work during the 2012 mHealth Summit in Washington, D.C. at a panel with co-founder Deborah Estrin on Monday and an “Open mHealth” special session on Tuesday.

What Is an Open Architecture?

Open architecture is software with source code that is freely available to developers to promote cooperation and interoperability (as opposed to proprietary and copyrighted software). This means developers can more quickly and effectively work together to create optimized mHealth applications.

What Is Open mHealth, and Why Is It Important?

Nine out of 10 people on the planet own a cell phone—making it more common than owning a car, radio, or television. Mobile health (mHealth) apps are increasingly popular—with one in five smartphone users having a health app. We can use apps on our phones to help us stay healthy. Apps like epocrates allow us to find health information and learn about medicine; other apps can help us collect and share data about our health with our health care providers.

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Open mHealth is headed to the mHealth Summit!

Nov 26, 2012, 10:18 AM, Posted by Pioneer Blog Team

By the Open mHealth team

Note: This was cross-posted from the Open mHealth blog.

Open mHealth is proud to announce that we’re going to the 2012 mHealth Summit on December 3-5, in Washington, D.C. We’re going to be showcasing the power of integration using an open architecture across two disease domains—type 1 Diabetes and post-traumatic Stress disorder (PTSD). We’ll be co-hosting a booth with the Robert Wood Johnson Foundation and 12 different technical partners, which represents a new level of collaboration in mHealth.

We’ve partnered with, and will be featuring, at the Summit: Alex Freeman (a patient with type 1 diabetes), Brian Venerick (a veteran with PTSD), Bodymedia, Runkeeper, Greendot Diabetes, Entra, Qualcomm Life’s 2Net, the Interaction Design Lab at Cornell University, Kaiser Permanente, Intel, Microsoft’s Health Vault, Ginger.ioVeteran Affairs’ National Center for PTSD, and Ohmage.

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Ending Violence: IOM Announces App Challenge Winners

Nov 19, 2012, 1:15 PM

file IOM Ending Violence @ Home App Challenge winner, Wisdom of the Children

The Institute of Medicine and the Avon Foundation for Women issued the “Ending Violence @ Home App Challenge” to encourage powerful communication through technologies such as social media and mobile apps to help end worldwide suffering caused by domestic violence.  Four winners of the App challenge were chosen from 19 submissions that came in from across nine countries. The four were chosen based on their innovation, design, potential impact, and ability to integrate evidence-based information and usability in different settings. IOM President Harvey Fineberg stated in a release, “I am very impressed with the level of creativity demonstrated by the winning products, which can make a real difference to abused individuals.”  

The top prize of $10,000 was awarded to Wisdom of the Children (Çocuktan Al Haberi), a Turkish group that developed a website to encourage individuals to see that change can start with a simple shift in how we talk to each other. The website encourages families to take old Turkish expressions that condone violence and reinforce traditional gender norms, and turn them into more positive sayings. For example, the traditional saying from the region, “don't spare a baby from your wife's belly and rod from her back,” was changed to “don't spare soup from a women's belly and sunscreen from her back.” Web visitors are encouraged to create their own new, positive, health-reinforcing sayings with their children.

>>Read more about the app challenge.

This commentary originally appeared on the RWJF New Public Health blog.

Hurricane Sandy: We Don't Have the Luxury to Wait for a Storm to Be Prepared

Oct 29, 2012, 10:55 AM

While much of the East Coast already has strong enough winds and rain to make going outdoors foolhardy for you and for the first responders who would have to come after you, there are online and online and at home preparations, such as grouping your freezer foods as close together as possible, which may make them stay cold and safe to eat longer, if the power goes out. See more food safety tips for during and after a storm here.

Asked about the impending severe storm headed for the East Coast today, Adewale Troutman, MD, MPH, who will be elected president of the American Public Health Association later this week, said that while news and information on the storm sprang up just days ago, public health, as always, is ready. “We in public health don’t have the luxury of waiting for a storm to hit to become prepared; we stand ready every single day,” said Dr. Troutman. 

NewPublicHealth looked at several new social media tools from public health departments and agencies that can offer vital help before, during and after the storm:

The Red Cross has also introduced free Hurricane and First Aid apps for mobile devices. The Hurricane App keeps people up to date with weather alerts, locations of Red Cross shelters, and features a toolkit with a flashlight, strobe light and alarm. The "I'm Safe" button lets someone use social media sites to tell family and friends they are okay, and can be used as a Spanish language app by setting a smart phone to Spanish before downloading.  The First Aid app includes expert advice for everyday emergencies. The apps can be found in the Apple App Store and the Google Play Store for Android by searching for American Red Cross.

Finally, Google has launched some interactive maps to help people navigate the storm, which includes tracking and public alerts such as evacuation notices and locations of shelters. Once power outages occur, these may be more useful for people beyond the storm’s track, but could be used to share information such as shelter locations by phone or text, so here’s a reminder to those in the storm’s path to charge up cell phones ahead of power failures. Check your battery operated radio. Some newer models include a cell phone charger.

>>Bonus Link: Read a post on NewPublicHealth about the increasing use of social media by Americans during emergencies. 

This commentary originally appeared on the RWJF New Public Health blog.

Many Colleges Banning Smoking on Campus

Oct 3, 2012, 2:25 PM

Public health experts hope high school juniors and seniors will add another question to their list as they begin to visit colleges this year: is the campus smoke free?

According to the Tobacco-Free College Campus Initiative—launched last month at the University of Michigan by the Department of Health and Human Services along with private, public and education partners—about 17 percent of colleges and universities in the United States already have tobacco-free (no form of tobacco allowed) or smoke-free (no cigarettes allowed) policies, and more schools are moving toward such policies.

Cynthia Hallett, executive director of Americans for Nonsmokers’ Rights in Berkeley, Calif., says the trend toward eliminating smoking on college campuses began in the early 2000s. Before then, says Hallett, skepticism over student and faculty interest may have kept the schools from initiating policies against smoking. “With so many campuses now [outlawing smoking] and the growing number of resources available, such as model policies and guidelines for implementation and enforcement, it is becoming much easier for colleges and universities to initiate smoke- and tobacco-free policies,” Hallett says.

Hallett says effective arguments to push colleges toward tobacco-free campuses include:

  • Tobacco use initiation peaks from 18 to 25 years of age. College attendance could be a turning point in choosing not to use tobacco.
  • According to a recent report from the U.S. Surgeon General, about 25 percent of full-time college students aged 18 to 22 years old were current smokers in 2010.
  • The number of smokers who initiated smoking after age 18 increased from 600,000 in 2002 to 1 million in 2010.   
  • Progression from occasional to daily smoking almost always occurs by age 26, and curbing tobacco influence on campuses could prevent a new cohort of lifetime smokers.

Recent campus initiatives to help students stop or never start smoking include:

  • The University of Kentucky has an aggressive tobacco-free policy, which was implemented in 2009. Current efforts focus on educating new students about the policy each year and using innovative approaches to smoking cessation including mobile apps. The university also has faculty and students who are part of the Tobacco-Free Take Action volunteer group, who approach smokers and request they put out their cigarette, and also offer resources to help the smoker quit.
  • Harrisburg University of Science and Technology in Pennsylvania, only seven years old, has always been smoke free and its age gives it an edge over many other universities in that respect, according to a university spokesman.
  • City Colleges of Chicago, which has 120,000 students, implemented a 100-percent tobacco-free policy across its seven campuses last month. The policy includes offering students a smoking cessation program called “Courage to Quit.” The college system conducted a survey that found that 85 percent of students, faculty and staff respondents believe a tobacco-free policy would improve health for staff and students. The policy is the first component in City Colleges’ overall Healthy Campus initiative, which will also include healthy and affordable food choices, green initiatives and healthy activities.
  • In January 2012, University of California President Mark Yudof announced that all 10 University of California campuses would become smoke-free as of January 2014. University Student Health Services offers an individual tobacco cessation program that helps students identify triggers, reasons for quitting, and barriers to quitting as well as a variety of quitting techniques.

>>Bonus Link: Americans for Nonsmokers’ Rights maintains a list of colleges and universities with smoke-free policies. 

This commentary originally appeared on the RWJF New Public Health blog.

Health Datapalooza 2012: Challengeology

Jun 11, 2012, 7:38 PM, Posted by NewPublicHealth

The Health Data Initiative Forum (also known as the “Health Datapalooza”) focused on critical opportunities for using health data -- as well as the growing practice of “challengeology.” Challenge competitions have been used widely by government and private sector, in part to find new opportunities to make use of recently released heath data.

Prizes are typically in the hundreds to thousands, but can soar higher. The top winner in a Robert Wood Johnson Foundation challenge, announced at the Forum, was $100,000. The challenge required participating teams to create applications that would allow consumers to access and use comparative information about the quality of care provided in various regions of the country. Data for the apps came from Aligning Forces for Quality (AFQ), a Foundation initiative based at the George Washington University Medical Center School of Public Health and Health Services. AFQ focuses on improving the quality of health care in sixteen communities nationwide.

The $100,000 winner was the Symcat app, which used the AFQ metrics to allow users to find quality care personalized to their own medical needs. The creators are medical students from Johns Hopkins and web developers.

Mike Lydon,Chief Technology Officer, of TopCoder, a software development competitive community, said the biggest impact of challenges is the success of an individual challenge to “open up eyes in organizations about the availability of other ways to get things done.” That gets people motivated, said Lydon, “and gets the train rolling.”

Panelists and participants focused a great deal on “challenges 2.0” , on how to put the apps or ideas generated by a challenge into play because too often an app or idea developer is left with a good idea but not enough funding or expertise to put the concept into practice. Indu Subaiya, MD, MBA, CEO and Co-Founder of Health 2.0, says collaborations can be very effective, including partnering idea generators and web designers. Subaiya also said very recently some companies have begun attending challenge conferences and approached winners to help them with commercialization. “They’re thinking ahead on how to harness the research created,” said Subaiya.

New approaches for challenges included a reduced reliance on apps, since they can be expensive to commercialize, and instead to embrace the idea that new approaches or concepts can be equally useful.

This commentary originally appeared on the RWJF New Public Health blog.