Pioneering Ideas Blog Team members, grantees, and guests discuss breakthrough ideas that will allow us to move toward solving challenges in health care. Mon, 20 Oct 2014 09:00:00 -0400 en-us Copyright 2000- 2014 RWJF (RWJF) <![CDATA[RWJF Pioneering Ideas Podcast: Episode 6 | What if? Shifting Perspectives to Change the World]]>

Please note that this podcast player might not work in some versions of Internet Explorer. Please view this page in another browser, such as Chrome, Firefox or Safari. You may also access the episode via SoundCloud.

RWJF's Pioneering Ideas Podcast is on iTunes! Don’t miss an episode—click to subscribe.

Welcome to the sixth episode of RWJF’s Pioneering Ideas podcast, where we explore cutting edge ideas and emerging trends that can help build a Culture of Health. Your host is Lori Melichar, director at the foundation.

Ideas Explored in This Episode

Sharing Health Care Providers’ Notes (3:08) OpenNotesTom Delbanco and Jan Walker talk with RWJF’s Emmy Ganos about why they decided getting health care providers to share their notes with patients was an essential innovation–and where their work is headed next. Here’s a hint: what if the  3 million patients who now have easy access to their clinician’s notes could co-write notes with their providers?

Rethinking How We Solve Poverty (20:27) Kirsten Lodal, founder and CEO of LIFT, talks with RWJF’s Susan Mende and shares some simple ideas with the potential to revolutionize our approach to helping people achieve economic stability and well being. In a thought-provoking conversation, Lodal connects the dots between improving the well being of those living in poverty and building a Culture of Health.

A Historian’s Take on Building a Culture of Health (27:58) – Princeton historian Keith Wailoo and RWJF’s Steve Downs discuss how deeply held cultural narratives influence our perceptions of health, and how today’s “wild ideas” are often tomorrow’s cutting edge innovations.

Sound bites

...On opening up health care providers’ notes and what’s next:

“What I would like to do is spread the responsibility for health beyond the health care system. The health care system is good; I hope that it gets better, but there are so many other parts of our lives that contribute to our well being.” – Jan Walker, OpenNotes 

“It will be a very different world in the future. And we do think that OpenNotes is kind of giving people a peek into it. It's a first glimmer that this kind of transparency, this kind of approach to things, while it's passive now, it just opens up an enormous amount of possibilities for the future. And that's what really excites us.” – Tom Delbanco, OpenNotes

...On rethinking how we solve poverty:

“People's lives are like rivers... they flowed before coming into contact with us, and they will flow after having contact with us. And so the opportunity that we have, the privilege that we have is of most positively affecting the trajectory and the velocity of that flow. But if we forget that–if we get too swept up in having to own everything that happens in a person's life–then we won't build the best solutions, because we won't build solutions that provide people with the support they need to navigate the flow of that river over the long term.” – Kirsten Lodal, LIFT

...A historian’s take on building a Culture of Health: 

“Our concern with aggregate trends is an important one in tracing the shifting demographics of health in our country, but to understand what health actually means involves actually putting the data aside and thinking about lives and thinking about individuals and thinking about what these trends mean on an individual level.”– Keith Wailoo, Princeton University

Your Turn

Now that you’ve listened – talk about it! Did anything you heard today get you thinking in new ways about how you can help build a Culture of Health? Do you have a cutting-edge idea you’d like to discuss? Comment below or tweet at me at @lorimelichar, or consider submitting a proposal. Be sure to keep the conversation and explorations going at #RWJFpodcast.

Learn More About These Topics

Tom Delbanco, Jan Walker and OpenNotes

Kirsten Lodal and LIFT

Keith Wailoo

And One More!

  • As Lori mentioned, six communities received a $25,000 cash prize in recognition of their accomplishments in leading some of the nation’s most innovative efforts to build a Culture of Health in their community. Learn more about our Culture of Health Prize winners.

Explore Past Episodes

Listen to past episodes of the RWJF Pioneering Ideas podcast, where we explore topics like conspiracy theories, the science of choosing and hacking hospital supply closets to improve patient care.

Mon, 20 Oct 2014 09:00:00 -0400 Pioneer Blog Team Patient-centered care Social determinants of health Access and barriers to care Pioneer What's Next Health Pioneering Ideas Podcast <![CDATA[Open mHealth Announces Linq]]>
Linq from grantee OpenMHealth
Mon, 8 Sep 2014 13:58:00 -0400 Pioneer Blog Team Open sourcing Mobile health/mhealth Data Pioneer <![CDATA[What's Next Health: Jammed Up: Is Too Much Choice Bad for Our Health?]]>
Too Many Choices

Each month, What’s Next Health talks with leading thinkers about the future of health and health care. Recently, we talked with Sheena Iyengar, Inaugural S.T. Lee Professor of Business at Columbia University, about navigating the thousands of choices we make daily – and the stress that comes with making so many decisions. In this post, RWJF Director Lori Melichar reflects on Sheena's visit to the Foundation.

Each of us makes choices constantly and those choices reverberate across other aspects of our lives. By choosing to read this blog, you’ve chosen to place something else on hold.

Depending on the time of day you read this, you have likely made hundreds of distinct choices today...from choosing to hit snooze one...or two, or three times, to choosing what to eat for breakfast, where to park and whether to take the stairs or the elevator in your office or home.

I don't have to tell you that so many of the choices you have made in the last 24 hours already will affect your health, your bodies (those of you who had green smoothies for breakfast are probably feeling a little better than those who, like me, had a muffin), as well as your mental health (how many of you, like me, are regretting your decision to stay up to watch another episode of The Americans instead of getting eight hours of sleep?). Many of the choices you make are simple, but many are extremely complex. 

The emerging science that helps us understand why we make the choices we do—and how to influence those choices—is equally complex.


Recently, we had one of the country’s leading experts on choice visit us for a day as part of our What’s Next Health series.

Dr. Sheena Iyengar is the inaugural S.T. Lee Professor of Business at Columbia Business School. Through reading her book, The Art of Choosing, and spending the day with her at the Foundation, she challenged many of my preconceived notions about choice, specifically how choice impacts our health.  

Sheena asks and answers fascinating questions – Is the desire for choice innate or created by culture? How much control do we really have over our choices? And how much control do we want—or should we have over our choices?  

In fact, she asks so many good questions, that it was really difficult for me to choose a focus for this blog post!

So maybe I’ll procrastinate with lunch... a peanut butter and jelly sandwich....what could be simpler than that?

The picture above is from a mid-morning snack buffet I encountered at a recent conference. It was early in the day, but I already had a lot on my mind – How should I spend the break time? Emailing? Calling the office? Networking? Exercising? Figuring out elementary “afterschool” activities for my kids for next fall?  

Taking a snack break did not make things easier. Though I entered the line having made the decision of what I wanted for a snack (peanut butter and jelly), now I was being asked to make two more decisions. What kind of jelly? What kind of peanut butter?

Some of you are familiar with the concept of decision fatigue—when the number and/or complexity of the decisions you make earlier in a day affect the quality of the decisions you make later in the day.

Here, I was being asked to allocate precious bandwidth to the activity of selecting between mango passion fruit and strawberry jam, and between almond cashew butter and coffee pecan butter? Are you kidding me?

My look of bewilderment and frustration caught the attention of the woman manning the station. With a knowing nod, she made a simple suggestion: “You’ll like the almond cashew butter.”

A wave of relief came over me. There was no reason for me to think that this woman had any idea what I would like or what I would prefer. But I followed her advice—skipping the jelly all together. I got my sandwich and got on with my life, on to more consequential decisions.

So is decision fatigue inevitable? If so, what does this mean for our health?

Sheena suggests that fatigue does not have to be a fait accompli for busy days. In fact, many times it is not in our own best interest for us to make the decisions that affect our lives—ourselves. For one, we often make the wrong decision. But even in cases where we ended up making the RIGHT choice, the stress of the decision may not be worth the control we experienced. 

In one of her studies, she examined the role of choice in retirement accounts.  When people were given more choices of funds to invest in they actually either opted to participate less (meaning they didn’t save at all) or they just opted to put all their eggs in one basket in the form of money market funds (a less than ideal selection).  So in this case, it was clear that more choice was adverse in making better choices.

We often talk about making the healthy choice the easy choice. But rarely do we talk about how to make the act of choosing easier. How can we help take choices off someone’s plate? When can we take them off our own? How do we better time our choices so they don’t fall victim to decision fatigue? And when does too much choice ironically become unhealthy?

And when it comes to decisions about our health, is more choice always healthier? Choice and information is certainly empowering but, despite the best of intentions, can it sometimes become paralyzing?

I’m going to ask you to decide.

Visit What’s Next Health to watch a conversation with Lori Melichar and Sheena Iyengar and view an infographic about the art of choosing.

Thu, 4 Sep 2014 14:28:00 -0400 Lori Melichar Behavioral economics Behavior change Pioneer What's Next Health <![CDATA[Patient Privacy: The Elephant in the Room]]>
Albert Shar / RWJF

Albert Shar, managing principle at QERT and former Robert Wood Johnson Foundation vice president and senior program officer reflects on lessons learned from the RWJF-funded project, “Testing a system of establishing voluntary patient identification across multiple health care records to improve outcomes and reduce costs” (Shar is a guest blogger. His opinions are not necessarily those of the Robert Wood Johnson Foundation).

When it comes to improving patient safety, patient privacy is the elephant in the room.

Virtually every developed country except the United States has a method for identifying patients.  Misidentification of patients is not only costly and inefficient—it’s also dangerous.  According to data from the Institute of Medicine and the Joint Commission, in the U.S., nearly 60 percent of the 200,000 deaths per year caused by medical errors are cases of mistaken identity.

Not only do universal patient identification systems help reduce medical errors, but they also support better care coordination and prevent duplication of services. Why doesn’t the U.S. have such a system?  A major reason has to do with concerns around patient privacy and confidentiality. 

Although the Health Insurance Portability and Accountability Act (HIPAA) included a provision for universal patient identification, it was amended to not only remove that provision but also to forbid any government-funded research on universal identification until such time that patient confidentiality could be guaranteed.

A report released earlier this year by the Office of the National Coordinator for Health Information Technology (ONC) provides an environmental scan of the issues surrounding patient identification and matching, but does not propose a specific course of action.

As I see it, everyone agrees that patient privacy and confidentiality are paramount, but no one wants to go on record claiming to have the answer.  According to one report, 29.3 million patient health records have been compromised in a HIPAA data breach since 2009. There is a lot of fear around this issue.

So we remain at an impasse, unable to make meaningful progress on a universal patient identification system and unwilling to address patient privacy issues in a meaningful way.

Testing a Voluntary Health Identification System

The Voluntary Universal Health Identification (VUHID) Demonstration Project represented an attempt to break this impasse.  The basic concept was pretty simple:  Instead of purporting to have a “fool-proof” system, what if you explained the risks and benefits of universal identification to patients and let them decide? A kind of informed consent, if you will, with the assurance of an instantaneous response in the event of a data breach.

In 2011, RWJF funded the Western Health Information Network (WHIN), a health information exchange based in Long Beach, CA, to test a voluntary system of implementing reliable patient identifiers with a firm called Global Patient Identifiers, Inc. (GPII), of Tucson, AZ.  GPII had already developed a voluntary universal health ID system, following the ASTM Standard for a VUHID, which it believed was technologically capable of protecting patient privacy and confidentiality, and WHIN was eager to test it.

It seemed perfect.

But things did not go as planned.  WHIN had hoped to enroll about 1,000 patients, but wound up with only a few hundred instead.  In addition, not all the providers participating in the project had the technological capacity to fully implement universal patient ID.  Two of the three project sites were not far enough along with their own electronic health record (EHR) systems to implement the VUHID as designed.  Most significantly, and unrelated to the project, WHIN went bankrupt before the yearlong demonstration could be completed. 

Nevertheless, we learned several important—and surprising—lessons from the VUHID demonstration.

First, to our surprise, we discovered that patients were quite open to enrolling in a universal health ID system when the pros and cons were explained to them.  Patient resistance was not an issue.

Second, the technology is here.  We can do this.

So the two things we anticipated would be our biggest challenges were not.

The things we didn’t anticipate—such as lack of communication between the project partners—proved to be the greatest challenges. In a project like this, everyone needs to be on the same page.

The other major challenge was sustainability. We never gained a full understanding of the transaction costs involved in using the VUHID, and we didn’t figure out a way for the VUHID to generate revenue.

I thought that if we demonstrated that we could enroll patients and that the technology worked, we would convince the world that we had resolved the privacy and confidentiality issues around universal patient identification. The truth is that it’s more complicated than that.

I am now convinced that in order to move forward, we need a neutral, respected convener to bring together all the parties with an interest in universal patient identification, including government, insurers, patient advocates, and providers. We need to acknowledge issues of patient privacy and we need to have a conversation where all points of view are respected and that achieves a common vision.

This is not an easy conversation to have, because we’re all afraid of this elephant. Patient privacy and confidentiality are important, and they must be protected.  But we will never tame the elephant as long as we keep trying to avoid it.

It is time to reach out and touch the elephant.

For additional details about what we learned from this grant, click here.


Mon, 25 Aug 2014 12:30:00 -0400 Al Shar Health records/electronic health records Patients Patient safety and outcomes Data Pioneer <![CDATA[Exploring Citizen Science]]>
Christine Nieves / RWJF Christine Nieves, program associate

I remember the distinct feeling of learning about Foldit. It was a mixture of awe and hope for the potential breakthrough contributions a citizen can make towards science (without needing a PhD!). Foldit is an online puzzle video game about protein folding. In 2011, Foldit users decoded an AIDS protein that had been a mystery to researchers for 15 years. The gamers accomplished it in 3 weeks. When I learned this, it suddenly hit me; if we, society, systematically harness the curiosity of citizens, we could do so much!

This is the spirit behind our recent exploration to learn more about how citizen scientists are addressing some of the most pressing problems in health and health care.

Health-related citizen science projects encompass a wide gamut of areas ranging from oncology and epidemiology to more social aspects such as community health and health care delivery. Citizen participation ranges from game play, with projects like Foldit, to data collection using mobile phones and other devices, such as in the noise pollution research project Sound Around You, and data generation using sampling kits or completing surveys, as with Flu Near You. Other projects, such as FightMalaria@Home simply ask individuals to donate their computer’s processing power.

Through “Exploring a Culture of Health: A Citizen Science Series,” a blog series produced by SciStarter—a place to find and participate in citizen science projects—and Discover Magazine, we have spotlighted some of the ways our grantees are working to improve health, from making doctor visits more effective to boosting the health of whole communities. I hope readers of this series will share their own thoughts and ideas about how citizen scientists can get involved and help advance these efforts.

Check out the latest blog posts and join the conversation on social media using the hashtag #citsci:

Thu, 31 Jul 2014 11:34:00 -0400 Christine Nieves Patient-centered care Data Pioneer Blog - Pioneering Ideas <![CDATA[RWJF Pioneering Ideas Podcast: Episode 5 | Conspiracy Theories, Microbiomes & More]]>

Please note that this podcast player might not work in some versions of Internet Explorer. Please view this page in another browser, such as Chrome, Firefox or Safari. You may also access the episode via SoundCloud.

Welcome to the fifth episode of RWJF’s Pioneering Ideas podcast, where we explore cutting edge ideas and emerging trends that can help build a Culture of Health. Your host is Lori Melichar, director at the foundation.

Ideas Explored in This Episode

Conspiracy Theories (1:44) – What in the world can belief in conspiracy theories tell us about health and health care? A lot, as you’ll hear in this fascinating conversation between RWJF’s Brian Quinn and University of Chicago political scientist and RWJF grantee Eric Oliver. For more on this story, see this blog post from Brian; and don’t miss The Onion’s send-up of Eric’s research.

How Can We Measure a Culture of Health? (18:45) – Alonzo Plough, our Chief Science Officer and Vice President of Research, Evaluation and Learning riffs on the challenges and opportunities when it comes to measuring culture change.

Microbiomes and Design (26:25) – We sit down with microbiome scientist Jessica Green to hear the results of her latest research at the intersection of biology and environmental design. Explore early ideas about the huge ways tiny microbes might one day help create a healthier world. To learn more visit, a rich website of the Alfred P. Sloan Foundation’s Microbiology of the Built Environment program led by Jonathan Eisen.

Exploring Sleep Health (32:25) – Harvard economist Sendhil Mullinaithan, author of Scarcity: Why Having Too Little Means So Much, talks about the importance of getting more people to recognize the ripple effect of sleep on our mental and physical wellbeing.

Connect About This Episode

Visit Lori Melichar's Culture of Health blog post to read more about understanding the root causes of sleep health and to weigh in on the issue. Tell us: If you are a sleep champion, what are your secrets? Why do you think we aren't getting enough sleep?


...On measuring a Culture of Health:

“We're trying to come up with measures that address things that really have to change, maybe measures that indicate as a nation that we're going to have to have some disruptive models to move the status quo if we're going to get to a Culture of Health.” – Alonzo Plough, VP, Research, Evaluation and Learning and Chief Science Officer, RWJF

...On respecting indigenous belief systems:

“How we approach people and try to improve cultures of health has to be, in some ways, sensitive to an indigenous belief system that’s already there. And that's not going to be uniform across the country by any stretch of the imagination.” – Eric Oliver, University of Chicago political scientist and RWJF grantee

...On designing environments that promote health:

“Is it possible to use our personal effects like our cell phones to understand when and where we're picking up microbes that are good for human health and well being? And is it possible to design or engineer the built environment in such a way that it can foster wellness?” – Jessica Green

...On the instant gratification of sleep:

“If I eat a donut, I get benefits today, but the costs are small and years from now--maybe months from now if I put on some weight and I don't look good. But sleep, the benefits are now... the costs are literally in twelve hours.” – Sendhil Mullinaithan, Harvard economist and author

Your Turn

Now that you’ve listened – talk about it!

Did anything you heard today get you thinking in new ways about how you can help build a Culture of Health? Do you have a cutting-edge idea you’d like to discuss? Comment below or tweet at me at @Lorimelichar, or consider submitting a proposal.

And be sure to keep the conversation and explorations going at #rwjfpodcast”

Conversations from the Archives

Listen to past episodes of the Pioneering Ideas podcast, where we explore topics like the science of choosing, hacking hospital supply closets to improve patient care and the power of the placebo effect. 



Wed, 30 Jul 2014 12:00:00 -0400 Pioneer Blog Team Public health Behavior change Environmental health Pioneer Pioneering Ideas Podcast <![CDATA[What's Next Health: A Primer On Epigenetics]]>
Randy Jirtle Photo courtesy of Duke University Medical Center

Each month, What’s Next Health talks with leading thinkers with big ideas about the future of health and health care. Nancy Barrand, RWJF’s senior adviser for program development, hosted Randy Jirtle, senior scientist at the University of Wisconsin-Madison McArdle Laboratory, for a fascinating discussion about his work in epigenetics. Randy’s pioneering work in this field holds far-reaching implications for understanding and addressing the interplay between our genes and our environment. Randy answered follow up questions from Nancy to help lay out the basics behind epigenetics and what it might mean for our work moving forward. (Randy’s opinions are not necessarily those of the Robert Wood Johnson Foundation.)

Nancy Barrand: What is epigenetics?

Randy Jirtle: Epigenetics simply means above the genetics, and it refers to the study of heritable changes in gene function that occur without a change in the DNA sequence. So we now know that chemical modifications of the DNA, and the histones the DNA wraps around, actually determine whether genes are functional or not functional. These chemical modifications can be caused by environmental factors that we are exposed to, such as the nutrients we eat—or those our mother ate—or stress at critical junctures in our development.

Understanding how a single epigenetic change can totally disrupt the action or expression of a gene is providing us for the first time with information that will ultimately allow people to prevent diseases and conditions from ever happening, rather than just treating them after they occur.


When talking about epigenetics in the context of genetics, you often make the comparison to software and hardware. What do you mean by this?

Even though each cell in our body has the same genome, our body has around 250 different cell types (e.g. liver cells, skin cells, and brain cells) because they were programmed during early development to function differently. Therefore, the repertoire of functional genes varies between cell types. So in other words, cells can be thought of as being programmable computers with the DNA being comparable to the hardware of the computer, and the epigenome, the software that tells the computer when, where, and how to work.

Not to mix metaphors, but another way to look at this is to think of writing systems and reading systems—your DNA is something that has been written—a book or a paper. However, just because something has been written, doesn’t mean it will be read. So what you have inherited, your marked DNA, may or may not be read depending on changes to your epigenome. The “reading” is where gene development and expression can be altered through environmental and behavioral changes.

What can cause our gene expression to change during our lifetime, and are there times when it is more susceptible to change?

The epigenome is vulnerable to change throughout life, but early development, puberty, and old age are stages of life that are particularly susceptible. This malleability of the epigenome means we can either increase or decrease our risk to disease by altering our environment and behavior.

The epigenome is most susceptible to environmentally induced changes during early embryogenesis, right after conception. It is at this period of development that the epigenetic cellular differentiation programs are established in cells. Consequently, programming abnormalities that occur at this time will be present in basically all cells in the body throughout life. We have shown that maternal diet during pregnancy directly affects the ability to program the epigenome in the offspring, resulting in altered disease susceptibility in adulthood.

Although the epigenome is vulnerable to change throughout life, the ability to maintain its fidelity becomes increasingly compromised with age. This may be one reason why cancer is more prevalent in older people, and we now realize that cancer is both a genetic and epigenetic disease.

Maternal behavior and abuse during childhood can modify the epigenetic programming of the brain. There is accumulating evidence that even post traumatic stress disorder may have an epigenetic component to its etiology, and that compounds that alter the epigenome may be useful in its treatment. The epigenome is also susceptible to environmental modification during the rapid cell growth and development that occurs, for example, in the breast during puberty.

The interest in epigenetics is growing substantially and other fields of science are recognizing the importance of epigenetics to their work. You suggest that epigenetics might ultimately become the organizing system that ties together hard science with social science. This is an intriguing possibility. Can you say more?

It’s true. The field of epigenetics is growing exponentially with the number of papers published in this field doubling about every three years—a rate that is three times that for science in general. This has occurred, in part, because increasing numbers of scientists from other disciplines, such as epidemiology, neurobiology, psychiatry, psychology, and the social sciences, are realizing the critical importance of environmental epigenomics in human health and disease. Consequently, over 12,000 papers were published this past year in epigenetics, many of which described the social and behavioral aspects of epigenetic programming.

The large-scale human studies that will be required in the future to more clearly define the role of epigenetics in human well being will require teams of scientists comprised of neurobiologists, geneticists, and toxicologists interacting closely with epidemiologists, nutritionists, psychologists, and social biologists.

Both current interest and future needs point to the same end point. Epigenetics isn’t simply influencing the way we study biology—it is in fact becoming biology. That is the beauty of epigenetics. It is inseparable from the study of life.

To learn more, visit What’s Next Health to watch a conversation with Randy and RWJF's Nancy Barrand and view an infographic inspired by Randy’s pioneering work in epigenetics and genome imprinting. For more information about epigenetics research and the studies mentioned in this Q&A, please visit 

Wed, 16 Jul 2014 09:00:00 -0400 Nancy Barrand Genetics Early intervention Childhood obesity What's Next Health <![CDATA[Meet the MCAT Competition Winners]]>
Khan Academy MCAT competition video

Rishi Desai, Medical Partnership Program Lead at Khan Academy, works to help Khan Academy connect people to quality information about health and medicine. He is currently a pediatric infectious disease physician, and previously spent two years as an EIS officer with the Centers for Disease Control and Prevention (CDC).

By Rishi Desai

About two months ago we launched two competitions to find talented individuals that could help us by making videos, creating questions, or writing articles for the 2015 Medical College Admission Test (MCAT). The 2015 MCAT is different from the previous MCAT exam because it will include new content in areas like psychology and sociology. To help students get ready for this new exam, Khan Academy has partnered up with the Robert Wood Johnson Foundation and the Association of American Medical Colleges, and so far we have put together a collection of 500 videos and 600 practice MCAT questions.

The competitions were a tremendous success and we found 12 video competition winners and 20 question and article writing competition winners.

Meet our winners and learn about why they decided to participate in the competition. 


Wed, 9 Jul 2014 12:00:00 -0400 Pioneer Blog Team Education and training Medical schools <![CDATA[Personal Health Data Goes to the Doctor]]>
Open mHealth Logo

Since the advent of the stethoscope, information-gathering technology has been helping doctors and other medical professionals improve patient health. Over the past decade, RWJF has funded a series of projects that suggest helping patients track and share data with their clinicians can strengthen the patient-clinician partnership and improve health outcomes. It makes sense that giving clinicians access to patient-tracked health data can improve the health of individuals and communities. As simple as the concept may sound, though, unlocking personal health data for clinical purposes has proven quite challenging. 

Individuals can now use health apps on their smartphones to track almost anything—from activity to sleep, heart rate to mood. There are a number of barriers to fully leveraging these apps to improve care, and one of them is data integration. There is still no practical way to use these data to improve care. Most data generated by new apps and devices are not designed to align with existing clinical data types, making it very difficult for health providers to use and trust them in a clinical setting. Furthermore, most apps export their data in proprietary formats and servers, making it difficult to access, combine and make sense of data. For example, it is critically important for a clinician to know whether a blood glucose reading was taken in the morning or evening, if a weight reading was manual or automatic, and if sleep data came from a wearable device or a sleep journaling app. These barriers have kept most personal health data in silos, out of the clinical picture.

RWJF has been working to address this challenge since 2006, when we funded Project HealthDesign, one of the first efforts to explore how personal health data could involve individuals in their own health care. The resulting studies showed great potential—patients were able to work with physicians to successfully manage conditions ranging from Crohn’s disease to obesity. By tracking and sharing observations of daily living (ODLs) with their providers, patients reported feeling supported and engaged, and their health outcomes improved.

To continue breaking down the data barriers between clinicians and their patients, the Foundation invested in Open mHealth, a nonprofit startup that has developed an open API framework designed to help bring personal, digital health data into the clinical setting. App developers can use this open architecture to build apps that create clinically relevant, actionable data streams. The data schemas embedded in the architecture serve as a ‘universal dictionary’ for mobile health (mHealth) data, enabling integration between different types of data from multiple sources. By aligning the way that data is written and read with existing clinical data standards (e.g. LOINC and SNOMED), and designing the use of data into the clinical workflow, Open mHealth tools will allow users to share their health observations in a way that’s useful to clinicians.

We invested in Open mHealth in September 2011 and have recently extended our commitment, providing an additional $1.48 million grant to strengthen these tools and drive adoption among health app developers. RWJF has also set up a challenge grant to match donations made to Open mHealth by other funders. From now until January 2016, RWJF will match funding on a one-to-one basis for up to an additional $575,000.

We envision a near future where patients can share activity-tracking or calorie-counting app data with their providers and providers can incorporate that information into their patient care regardless of the device or app a patient is using. There are still a number of non-technical barriers to personal health data integration, but Open mHealth is working to remove one major technical one. By enabling an open flow of data into the clinical workflow, the Open mHealth ecosystem will allow a more comprehensive view of a patient’s health status—arming clinicians with the insights to deliver on the full promise of personalized preventive care.

Wed, 9 Jul 2014 09:15:00 -0400 Steve Downs Open sourcing Mobile health/mhealth Data Pioneer <![CDATA[New Microbiome Health Research Puts the ‘Cell’ Back in Cell Phone]]>
WNH Jessica Green infographic

What’s Next Health guest Jessica Green, founding director of the BioBE (Biology and the Built Environment Center), visited RWJF last year to discuss the health implications of the microbiome—the invisible collection of bacteria, viruses, fungi, and archaea that live on, in and all around us. Watch Jessica’s What's Next Health interview to learn more about microbiomes in the built environment and how that knowledge can be used to design spaces and buildings to create a healthier, more sustainable world.

During her visit, Jessica led an educational workshop where staff swabbed their fingers and mobile phones to learn about the relationship between the microscopic communities living on both. The findings from that educational workshop turned out to be quite interesting, and ultimately led to a study published today in the journal PeerJ. Senior Program Officer Deborah Bae caught up with Jessica to learn more about her research.

Deborah: When we hear the term microbe, many of us think about germs that cause disease. So what is the microbiome, and why is it important in promoting health?

Jessica: Twenty years ago, when I was an environmental engineering student, I learned that microbes were pollutants or contaminants, and were something that you wanted to eliminate, particularly in the indoor environment. And we know from history that being in a very unclean, unsanitary environment kills people. What we’ve learned more recently is that for every human cell, we have up to ten bacterial cells and even more viruses living on the human body. There's a rising consensus that aspects of this microbiome can be beneficial to human health. Some of these microorganisms help our immune system function, ward off pathogens and infections, and microbes in our gut may be even linked to the way that we think and feel.

That leads me to think about all the articles saying we need to disinfect everything. People have this misperception that microbiomes—and the more colloquial term, germs—are everywhere, and that germs are bad. Could this push to sterilize everything be killing off good germs and actually not promoting health?

People are beginning to wonder if overusing antibiotics and over-cleaning the built environment and ourselves is removing microbes that are really important to our health. Given that we can’t live in a sterile environment, and probably wouldn’t want to anyway, how can we manage the environments that we live in to promote the growth of microbes that foster health and well-being?

Your recently published study found that our cell phones actually reflect our human microbiome. What inspired you to do this project?

I've been interested in microbiome research for nearly a decade, so I've studied microbes in marine environments, in terrestrial environments, and more recently, I've been interested in the built environment microbiome, the complex microbial communities found in buildings. I've also been thinking about this concept of the “personal microbiome” that's associated with your personal effects. I don't know about you, but I take my phone with me wherever I go, and when I was visiting the Robert Wood Johnson Foundation I really got interested in the concept of using a personal effect like your phone to be able to measure the complex bacterial communities that are on us all the time. I've been trying to think of ways to survey individuals in a non-invasive way. I could imagine using our personal effects as a sensor in health care settings to understand the source and spread of different groups of microbes, for example. Or at much larger scales, using bio-sensors combined with public health data to help us understand how different urban planning decisions­­—for example, comparing green spaces with a concrete-laden environment—relate to the health of people living in those neighborhoods.

Can you walk us through what you did and help us understand some of the findings?

So, I held a workshop that taught everyone how to collect their own microbiome samples using something like a Q-tip to swab their hands and phones. Then we took those samples to my lab and identified the different types of bacteria using standard DNA sequencing technology. And we discovered that the phone microbiome is really diverse. There are thousands of different types of bacteria on our phones, and there’s a significant amount of overlap between what's found on your phone and what's on your fingers. So if you consider all of the different types of bacteria found on an individual’s phone and those on their hand, we found about a 20% overlap in the types of microbes that they shared. And the last thing we found was that you share more bacteria with your own phone than with anyone else's phone. So that makes your phone biologically identifiable as yours.

At RWJF we talk about health happening where you live, work, learn and play. So how does our human microbiome interact with our health and our environment?

We're definitely still in the really early stages of understanding how the human microbiome influences our health. We know that we pick up microbes from our mothers when we're born; we know that we exchange microbes with people that we come into direct physical contact with. It's reasonable to assume that we pick up microbes from the built environment, as well. And my long-term vision is to really understand the nature of picking up microbes from our surrounding environment and how this exposure affects our health. This study could be a first step in learning if it’s possible to use personal effects like our cell phones to understand when and where we're picking up microbes that are good for human well-being. And if it’s possible to design or engineer the built environment in such a way that it can foster wellness.

Part of the reason we're so interested in your work is because you're trying to marry engineering with microbiology, ecology and design. And I love this question of how we can design the indoor environment to promote beneficial microbes and inhibit harmful ones. Can you talk about signs of progress that you're seeing in this direction?

We've made a lot of progress in this area in the last five years, in part because of the vision of Paula Olsiewski at the Alfred P. Sloan Foundation and their Microbiology of the Built Environment program. When I first started working with the Sloan Foundation, the questions that we wanted to answer were very basic. For example, do the choices that engineers and designers make about the indoor environment have an effect on the types and distributions of microbes indoors? And the resounding answer was yes. So we know that the choices engineers make about ventilation impact what kinds of microbes are airborne inside. We know that the choices designers make about the types of materials used indoors will impact the kinds of microbial communities that we have inside. So the next step is really to link this innovative work that's relating design and indoor microbial ecology, to health. And I think that there are a lot of ways to approach that grand challenge.  

To learn more about Jessica’s ideas and her conversation with Deborah, listen to the fifth episode of the Pioneering Ideas podcast below.

Tue, 24 Jun 2014 12:13:00 -0400 Deborah Bae Public health Built environment Environmental health Pioneer <![CDATA[Big Strides in Community-Level Interventions at Health Datapalooza]]>
Paul Tarini, Susan Dentzer, Dwayne Spradlin, Greg Downing, and David Vockell discuss harnessing data for health on an RWJF First Friday Hangout

As co-chair of the Community Track at this year’s Health Datapalooza conference, I was impressed by the strong sense of purpose I felt among the attendees. The conversation has clearly moved from the abstract concepts of gathering and accessing data, to how we can use that data to solve real-world challenges. The launch of a new network to bring together researchers, scientists and companies and accelerate research using personal health data, led by the Health Data Exploration project with funding from the Robert Wood Johnson Foundation, was one of many efforts designed to directly improve our understanding of health through the wise use of data.

The momentum is coming from widespread reports of successful programs, from research showing improved clinical outcomes to communities solving health issues with these new tools. In Chicago, for example, the Department of Public Health has developed a clever way to target their food safety inspections. Working with a hacker collective, the department developed a system for scraping local Twitter feeds for terms that correlate with foodborne illness. Then they direct message those folks, asking victims of food poisoning to fill out a form that helps the department target its inspections.

It can take years for official public health data to be released, and by that point, it’s no longer useful. At Datapalooza, there was a wealth of discussion about “guerrilla style” data gathering to help officials and community members make better, more timely decisions. In Boston they are addressing the problem of drug overdoses, using rapid data harvesting to target resources in real time. Realizing that 911 was called in more than 90% of overdoses, the city’s Department of Public Health began asking ambulance drivers to report the locations of drug-related emergencies. Is the data messy? Yes, but it’s good enough to help address immediate health threats by identifying clusters of overdoses and responding in real time with public education campaigns and undercover drug buys that result in being able to analyze these drugs.

There was also a recognition that using data to improve community health needs to be done not only at the community level, but in partnership with the communities. In particular, these neighborhood-level groups need granular and timely data presented in ways that are accessible and acceptable to the folks who live there.

The Kate B. Reynolds Charitable Trust’s Healthy Places NC initiative is a great example of this. They are listening to the needs of rural counties in North Carolina with major health disparities, and using data to bring people together around solutions. In one county, for example, many of the patients using the emergency room would have been better served at a primary care facility. The solution they came up with—building a health clinic right across the hall from the ER—was a success because it came from the community and was supported by strong data analysis.

Going forward, there is a real need to expand the capacity of organizations across the country to use these types of tools in order to build a Culture of Health. We need more people who are fluent in data analytics leveraging these insights across disciplines, boundaries and perspectives. For instance, what role could health data play in other civic planning efforts, such as designing transportation systems?

Let me know how you think health data might bring about positive changes in your community in the comments. 

Tue, 10 Jun 2014 14:38:00 -0400 Paul Tarini Data Health IT Pioneer Health Datapalooza <![CDATA[Another Step Toward Open Health Education]]>
Osmosis Logo Image credit: Knowledge Diffusion

This post was originally published on The Health Care Blog by Shiv Gaglani, Ryan Haynes, and Michael Painter, MD.

Earlier this month Shiv and Ryan published a piece in the Annals of Internal Medicine, entitled What Can Medical Education Learn from Facebook and Netflix? We chose the title because, as medical students, we realized the tools our classmates are using to socialize and watch TV use more sophisticated algorithms than the tools we use to learn medicine.

What if the same mechanisms that Facebook and Netflix use—such as machine learning-based recommender systems, crowdsourcing, and intuitive interfaces—could transform how we educate our health care professionals? For example, just as Amazon recommends products based on other items that customers have bought, we believe that supplementary resources such as questions, videos, images, mnemonics, references, and even real-life patient cases could be automatically recommended based on what students and professionals are learning in the classroom or seeing in the clinic. That is one of the premises behind Osmosis, the flagship educational platform of Knowledge Diffusion, Shiv’s and Ryan’s startup. Osmosis uses data analytics and machine learning to deliver the best medical content to those trying to learn it, as efficiently as possible for the learner. Since its launch in August, Osmosis has delivered over two million questions to more than 10,000 medical students around the world using a novel push notification system that syncs to student curricular schedules.

Osmosis is aggregating medical school curricula and extracurricular resources as well as generating a tremendous amount of data on student performance. The program uses adaptive algorithms and an intuitive interface to provide the best, most useful customized content to those trying to learn. However, as Ryan and Shiv conclude in their Annals article, data can only take us so far. Anyone who has received a baffling Netflix or Amazon recommendation can likely relate to that problem. Ultimately Osmosis will need an even larger database of curated and validated open educational resources (OER) to create a truly useful health education platform, for both clinicians and patients.

To help take this work to the next level, Robert Wood Johnson Foundation (RWJF) recently extended a $150,000 grant to help Osmosis make its platform accessible to all clinical students and, eventually, patients and other public users. This project will build on RWJF’s ongoing investment in reimagining medical education. As Michael says, this kind of smart online platform that enables customized, just-in-time learning could be another piece in our search for that giant leap to “free, ubiquitous and utterly fantastic health care education.”

The Osmosis content will be openly licensed under Creative Commons so that students and faculty can continuously improve upon it through the Osmosis crowdsourcing platform. Combined with our recommendation engine, this high-yield content will be made publicly available on

Members of the medical community, we need your help. We need clinicians, experts and educators like you to help contribute and review content. We’re counting on the medical community as we develop and curate practice questions, images, videos, mnemonics, and other resources in ten specific areas, from anesthesiology to surgery.  If you’re interested in helping us build this unique and potentially powerful learning tool for all, apply here.

Shiv Gaglani (@ShivGaglani) is a co-founder of Osmosis. An editor of Medgadget, he is currently an MD/MBA candidate at the Johns Hopkins School of Medicine and Harvard Business School. Ryan Haynes, PhD is a co-founder of Osmosis. He is an MD candidate at the Johns Hopkins School of Medicine.

Thu, 22 May 2014 08:00:00 -0400 Mike Painter Health education Education and training Pioneer Blog - Pioneering Ideas <![CDATA[Khan Academy MCAT Competition: Building Free, Open-Access Medical Education Resources]]>
Rishi Desai Rishi Desai, MD, MPH, Medical Lead at Khan Academy

Rishi Desai, Medical Partnership Program Lead at Khan Academy, works to help Khan Academy connect people to quality information about health and medicine. He is currently a pediatric infectious disease physician, and previously spent two years as an EIS officer with the Centers for Disease Control and Prevention (CDC).

By Rishi Desai

When I think about the new MCAT test that will launch in 2015, it brings back memories of my own late night study sessions in college. Just prior to taking the MCAT, I was enrolled in a particularly tough life sciences course at UCLA where our professor asked us to design an experiment that would “prove” that DNA was the genetic material in cells. We literally had to step into the shoes of historic researchers, think critically, and rediscover the fundamentals for ourselves. Preparing for these classes was tough, but it was worth it because I knew that it would help me understand the material on a very deep level. At Khan Academy we want to help all students truly understand the material and understand how to apply it.

Recently, we teamed up with RWJF and the Association of American Medical Colleges to build the MCAT test prep collection, a free tool available to anyone, anywhere. The idea is to allow students to learn important core health and medicine information online so that they can have meaningful learning experiences in the classroom. The MCAT is based upon foundational scientific concepts that span key areas that are relevant for pre-health students, so it’s a perfect fit for our approach.

Our first MCAT winners were absolutely fantastic, and to help grow the MCAT prep collection with even more top-notch content, we’ve just launched our second annual MCAT competition. Med students, pre-med students, professors and others are invited to submit video tutorials, passage-based quizzes, or articles. Winners will receive training from Khan Academy, and the chance to become a Khan Academy fellow.

Help Khan Academy spread the word! Here’s a video and some quizzes to give you an idea of what we’re looking for.

Wed, 14 May 2014 08:00:00 -0400 Pioneer Blog Team Education and training Medical schools Continuing education <![CDATA[RWJF Pioneering Ideas Podcast: Episode 4 | MakerNurse, Visualizing Health Data & More]]>

Please note that this podcast player might not work in some versions of Internet Explorer. Please view this page in another browser, such as Chrome, Firefox or Safari. You may also access the episode via SoundCloud.

Welcome to the fourth episode of RWJF’s Pioneering Ideas podcast, where we explore cutting edge ideas and emerging trends that can transform health and health care. Your host is Lori Melichar, director at the foundation.

TED Master Class Game designer Jane McGonigal and IDEO CEO Tim Brown join Thomas Goetz for the master class conversation at TED 2014

Ideas & Projects in This Episode

  • MakerNurse (2:38) - Nurses Kelly Reilly, Roxana Reyna, and Mary Beth Dwyer share how they hack the supplies in their hospitals’ supply closets to improve patient care. (These nurses are all involved with RWJF grantee MakerNurse, the brainchild of Jose Gomez-Marquez and Anna Young, who lead the Little Devices Lab at MIT.)
  • Alternative Marketplaces (8:59) - Grantees Terry McDonald (St. Vincent de Paul) and George Wang (SIRUM) have something in common: They’re passionate about turning other people’s trash into resources that can improve health and health care. We introduced them and invited them to have a conversation about their work.
  • Visualizing Health (19:15) - RWJF entrepreneur in residence and former WIRED editor Thomas Goetz, RWJF program officer Andrea Ducas, designer Tim Leong and the University of Michigan’s Brian Zikmund-Fisher talk about Visualizing Health ( -- how it came about, how they collaborated to make it happen, how it features agile research practices and what they hope happens next
  • Designing a Culture of Health (25:45) - Game designer Jane McGonigal and IDEO CEO Tim Brown share ideas about designing a culture of health (highlights from the master class conversation at TED 2014).


...On MakerNurses:

  • “The inventions start at the bedside. The need is always at the bedside first.” - Roxana Reyna
  • “A lot of the time spent in the world of nursing is hunting and gathering.” - Kelly Reilly
  • “I think a lot of informal workarounds are just passed down from generation to generation of nurses.” - Mary Beth Dwyer

...On creating alternative marketplaces for waste that can improve health:

  • “How we deal with our wastes, what we perceive of what we cast off, is something that has dramatic impact on community health.”- Terry McDonald
  • “We like to call ourselves the of unused medicine.” - George Wang

...On Visualizing Health:

  • “We lack data about how to present data.” - Thomas Goetz
  • “We're producing Visualizing Health as a platform under a Creative Commons encourage designers and researchers and health professionals to build on what we've done.” – Andrea Ducas
  • “I'm a big believer that constraint breeds creativity.”- Tim Leong
  • “One thing that was reinforced to us in this project is how valuable it is to think of any process in an iterative way.” - Brian Zikmund-Fisher

...On designing and building a culture of health:

  • “The biggest societal shift that I think we could make towards a culture of health is... the length of a typical standard work week.” - Jane McGonigal
  • “We have to design for human experiences, not just for an efficient healthcare system.” - Tim Brown

Your Turn

What ideas or questions did listening to this episode inspire? What are you working on that relates to one of the featured stories or themes? We’d love to hear from you.

Do you have a cutting-edge idea for advancing a Culture of Health? Learn more and submit a proposal.

Listen to Past Episodes

Check out past episodes of the Pioneering Ideas podcast, where we explore topics like the science of choosing, the radical effect of empathy on innovation and the power of the placebo effect.

Mon, 12 May 2014 08:00:00 -0400 Pioneer Blog Team Disruptive innovations Nurses Data Pioneer Pioneering Ideas Podcast <![CDATA[Discover Positive Health: New Website Launches]]>

Are you interested in the connection between physical and psychological health? Intrigued about how positive health assets may help us stay healthy and recover more quickly from illness? Looking for ways to stay up-to-speed on the latest research?

Check out the new Positive Health Research website, a valuable resource for those who are exploring the concept of positive health.

Some of the more recent research featured on the website includes:

  • A study into whether life satisfaction impacts how often someone visits the doctor
  • A study that found psychological well-being is associated with a reduced risk of hypertension

Over the past five years, the Robert Wood Johnson Foundation has funded research to help identify the health assets that produce stronger health, in collaboration with the Positive Psychology Center at the University of Pennsylvania. This new website showcases the most promising research around the concept of positive health, providing evidence that has the potential to change the way we think about health and health care.

Fri, 9 May 2014 12:25:00 -0400 Pioneer Blog Team Prevention Health promotion and disease prevention Pioneer Blog - Pioneering Ideas <![CDATA[The Case for Journeying to the Center of Our Social Networks]]>
Dr_James_Fowler James Fowler, Professor of Medical Genetics and Political Science at UCSD

James Fowler is Professor of Medical Genetics and Political Science at the University of California, San Diego. His work lies at the intersection of the natural and social sciences, with a focus on social networks, behavior, evolution, politics, genetics, and big data. Together with RWJF grantee Nicholas Christakis, Fowler wrote a book on social networks for a general audience called Connected.

By James Fowler

In recent weeks, much has been made of David Lazer’s finding that Google’s Flu Trends tracker seriously missed the mark in its measurement of flu activity for 2012-2013—and in previous years, too. For those who don’t know, Flu Trends monitors Google search behaviors to identify regions where searches related to flu-like symptoms are spiking.

In spite of Flu Trend’s notable misstep, Lazer still believes in the power of marrying health and social data. In discussing the results of his study, he has maintained Google Flu is “a terrific” idea—one that just needs some refining. I agree.

And, earlier this month, Nicholas Christakis, several other colleagues, and I—with funding from the Robert Wood Johnson Foundation—published a new method offering one such refinement. Our paper shows that, in a given social network (in this study’s case, Twitter), a sample of its most connected, central individuals can hold significant predictive power. We call this potentially powerful group of individuals a “sensor group.”

By finding and monitoring the tweets of a sensor group, we can catch—and sometimes even predict—the outbreak of contagious information early on. That detection edge could improve how we track the outbreak of disease epidemics, the rise of certain terms or phrases, or shifts in political sentiment.

Whereas Flu Trends relies on a relatively static, proprietary “dictionary” of flu-related search terms based on average Google search habits, the sensor method taps into what is really happening in social networks in real time. By drawing on language being used by a sensor group—such as mentions of an emergent symptom or a popular newly coined name for a disease—Google could gain insight into what their dictionary might be missing. Sampling both the average Googler’s behavior and that of the exceptionally connected social network user can paint a much fuller picture of whatever landscape we are interested in tracking. We can more accurately see how it looks now—and how it could look in the near future.

Our method could have implications well beyond Flu Trends, improving how we use social data for a variety of public health monitoring and intervention efforts. For example, imagine if we started talking about health issues  using the phrases sensor groups indicated real people are using—or about to start using. We could proactively customize and continue to evolve health education campaigns to ensure they remain resonant with different communities or regions.

There is more work to be done, but I am optimistic social data will continue to provide us with smart ways to improve the health of individuals and our communities.

Read coverage of James Fowler’s study in Fast Company.

Learn more about the work led by James Fowler’s collaborator Nicholas Christakis to understand how social networks influence our health and behavior. 

Mon, 5 May 2014 11:07:00 -0400 Pioneer Blog Team Networks Data Public health Pioneer Blog - Pioneering Ideas <![CDATA[Explore Opportunities and Trends at Health Datapalooza ]]>
HDP banner 022014

We’re a little over a month away from the 2014 Health Datapalooza (HDP) conference. For those of you who don’t know, HDP—an event of the Health Data Consortium, which RWJF supports—is a great venue to explore the opportunities and trends of open health data.

Trying to get a firm understanding of this space can be challenging, but HDP brings it all together. The conference has tracks focusing on the use of open data by businesses and consumers, in community and clinical settings, and for research purposes.

But the bigger opportunity I have seen is the chance to intersect and interact with people who are working in a variety of areas – that’s when the learning and networking opportunities get really powerful.

This year, I’m looking to see where data is being used to make connections across health care, public health and human services and drive integration of those different systems and help restructure them. If you have an interest in that space, please let me know by commenting below.

If you’re interested in learning more and registering to attend, visit the conference website and follow the conversation on Twitter at #hdpalooza.

Mon, 28 Apr 2014 08:00:00 -0400 Paul Tarini Data Health IT Pioneer Blog - Pioneering Ideas Health Datapalooza <![CDATA[A Conversation with the Health Data Exploration Project]]>
Person tracking their health data on a mobile device.

RWJF’s Lori Melichar and Steve Downs sat down with grantees Kevin Patrick and Jerry Sheehan who lead the Health Data Exploration project to discuss early insights from their work, shared in the recent report Personal Data for the Public Good: New Opportunities to Enrich Understanding of Individual and Population Health.”

Patrick and Sheehan are working on a team that is exploring the use of personal health data in research and how to bridge the “worlds” of individuals who track data about their own personal health, companies that develop tracking apps and devices and typically hold these data, and health researchers.

Here are highlights from their conversation:

Lori: Why are you interested in self-tracking data?

Kevin: There’s all of this personal data out there and it really presents us with an opportunity to gain insights into health that we just have not been able to gain before. If we can better measure what's happening 24/7 with people, that can really accelerate our understanding of health. Imagine physical activity data sets, sleep data sets, data sets on mood and data sets on where you live, like zip codes. Once you have all of this data, you get a more persistent view of what's really happening in someone's life.

Jerry: The juxtaposition of the various types of data that people track begin to allow you to ask more holistic questions, and look at correlations that honestly no one's looked at before because the data hasn't been cost affordable to analyze.

Lori: You surveyed over one hundred people who are already tracking their health and found considerable enthusiasm for sharing that data with researchers. How do you see those findings extrapolating to the rest of the population?

Kevin: I think the people who responded to our survey are really very representative of the future and that we’re seeing the start of a trend. With the uptake of smartphone apps and wearable devices, I really think we're onto something here. What we’re seeing are some very, very positive signs from these folks and some great insight into what is “to be.”

Jerry: And that overwhelming interest in sharing data with researchers that we saw is reinforced by a recent IOM survey that looked at people who were engaging in social networking—so another convenience sample—which found overwhelming support for data sharing with scientists or others who were doing research on a certain health condition. Even internationally, in the UK they've gone back and asked patients if they would share their health record with researchers, and the numbers are upward of 80 percent.

Steve: You also spoke with several companies that are making these apps and devices, and hold this data. What insights did you get from those interviews?

Jerry: There really did appear to be two types of companies. Companies that thought of themselves as consumer electronic device companies, who understood that they were generating data and that the data was giving their users useful interactivity input and output from a metrics standpoint, and companies that looked at themselves as data services companies. And the companies that tended to think of themselves as data services companies seemed more likely to think about their data as their intellectual property that, if shared, would somehow give someone insight with their competitive edge. The consumer electronics companies just didn't have that impression. They had concerns about how sharing data could impact their users, but they weren't against it from an intellectual property standpoint.

Lori: How did people feel about sharing their data with companies?

Kevin: We found that people were more comfortable sharing their data with companies if they felt that a university or researchers were the ones doing the research; if it wasn't just a company doing research for profit. While I think there's a useful sort of buffering role that academic researchers can provide that will reduce the friction for individuals to donate their data, I think there is also a benefit to companies for having researchers involved. If the data transfer and IP arrangements can be worked out—and that's a nontrivial matter, the whole process of working with universities is never easy—then I also think companies will begin to see and explore how this research could be useful to them from an R&D perspective.         

Steve: In the report, you talk about an emerging ecosystem of researchers, companies and individuals who are already trying to do this. Can you give us an example?

Kevin: We describe in our report an emerging ecosystem of players in this environment and it's relatively immature now, but I think there's an opportunity for it to grow and develop. That’s not to say that at the end of the day there aren't going to be some big barriers, but at least there's activity in this environment right now that's promising. One of the companies that seems to be finding a comfort with and a model for opening their data up to researchers is FitBit. Small Steps Lab basically has a preferred relationship with FitBit and their API, so when Fit Bit gets approached from researchers—and they get approached a lot—they're now able to turn to this secondary company to act as a preferred provider of their data.

Steve: My impression from reading the report is that there's an opportunity to go from these early examples where it’s challenging and feasible but difficult, to something that actually ultimately becomes routine with some concerted efforts.

Jerry: There are tremendous opportunities, but also a lot of hard work that's going to need to go into understanding where the rough edges are for individuals, researchers and companies, and what ethical issues we need to consider to make sure that when we build the necessary tools to enable this type of research, such as protocols for sharing data, that we make them thoughtful and respectful of the individual and the intent of their donation—that they are contributing personal data for the public good.

Mon, 31 Mar 2014 13:12:00 -0400 Pioneer Blog Team Data Mobile health/mhealth Health IT E-health Pioneer <![CDATA[Creating a Knowledge Map with Stanford Medical School]]>
Mike Painter, senior program officer Mike Painter, senior program officer

Why should I be in the same room with these people?

That’s one of the many smart questions participants posed at a Stanford Medical School meeting I attended last weekend.  If I had been daydreaming (I’d never do that), I might have thought the question was for me. You see, the participants were a handpicked set of national medical education experts, folks nominally from the status quo medical-education-industrial complex—the very thing we’re trying to change.

You might think that they embodied that dreaded status quo.  I’m happy to report they did not—not even close.  I’m also relieved to tell you that the question (in spite of my paranoia) wasn’t for me. Instead, it was one of many challenges these thoughtful, passionate teachers tossed at each other.

“Why are we in the room?” was a challenge to each other. Why and when should teachers be in the same room with the learners?

When you think about it, that’s actually a central question if you’re attempting to use online education to flip the medical education experience.  It’s also a brave one if you’re a teacher: justify the time you spend with your students.

Read the rest of this post on The Health Care Blog

Mon, 24 Mar 2014 13:00:00 -0400 Mike Painter Health education Patient-centered care Pioneer Blog - Pioneering Ideas <![CDATA[What's Next Health: Designing an Elegant Health Care Process]]>
Jay Parkinson, founder of Sherpaa Jay Parkinson, founder of Sherpaa

Each month, What’s Next Health talks with leading thinkers with big ideas about the future of health and health care. Recently, we talked with Jay Parkinson, founder of Sherpaa, who challenged us to consider what a more "beautifully designed" health care system might look like. As you'll read in his post below, Jay’s trying to do just that through his work at Sherpaa. (Jay’s opinions are not necessarily those of the Robert Wood Johnson Foundation.)

By Jay Parkinson

Everything great comes from an elegantly designed process. Just think of all of the experiences we love and use on a daily basis. Consider the iPhone. Apple re-imagined what a phone, or rather, a tiny computer in your pocket, could be and created a revolutionary device. Steve Jobs designed not only the interface that changed computing forever, but Tim Cook designed the manufacturing and material sourcing processes that enabled them to produce a remarkably complicated device at a relatively inexpensive price. They understood that, in order to deliver an exceptional user experience, they had to design the entire process, from the interface to the factory.

Health care was never designed. It just happened, revolving mostly around doctors’ needs and wants, in a culture that strongly believed “doctor knows best.” But our culture changed with the democratization of health information and other industries quickly evolved, raising consumers’ expectations of what health care could and should be.


Comparing the Apple Genius Bar with today’s average health care experience is laughable.

So how can health care catch up? Design an elegant health care process that enables intelligent health care delivery. Don't only design that process, but implement it. Essentially, combine the elegance and creativity of Steve Jobs with the process-driven business savvy of Tim Cook. That’s what we do every day here in my company, Sherpaa. Here’s how it works:

  • Our salaried, full-time doctors have one mission: communicate via phone or web and creatively solve our patients’ health problems, all day, every day.
  • When patients have health problems, they log in and tell us their story.
  • Our doctors then, online, ask the right questions and get a careful history, prompting them to either order lab or imaging tests, treat with a medication, watch and wait, or refer for an in-person evaluation to a doctor in the patient’s neighborhood.
  • 70% of the time, our doctors treat or solve the issue without having to refer to an in-person doctor. When we do refer, it’s always to the exact specialist the patient needs.

Does that really mean that 70% of primary care, specialist, and ER visits don’t need to happen? Does that really mean that 70% of those insurance claims should never happen? Yes, exactly. If you give patients accessible doctors at the right time to skillfully decide how best to use health care, health care is used intelligently with very little waste. In this system, everything that’s done actually needs to happen.

All of this is the result of an elegantly designed health care delivery process. But elegant processes aren’t free. So, in conjunction with this process, you must have an equally innovative business model to pay for this new process. There’s a hard fact floating around companies saddled with health care costs—health insurance premiums double every seven and a half years. Employers have a vested interest in taming those costs. And with roughly 70% of health care costs in America fronted by employers, they are the perfect innovation partner. Employers pay us to innovate their way out of rising costs through intelligent health care delivery.

This is all very interesting for the early adopters—the innovative and creative companies looking to make health care awesome for their employees. But what about the rest? What about the unions, those folks on Medicaid, and companies with minimum wage workers? Well, it’s called trickle-down technology. When the iPhone came out, few people could afford it. Over time, we now have cheaper versions of iPhones and, most importantly, Google’s Android smartphones. There’s even a $25 Android smartphone soon to be released. Now, almost everyone can afford this fancy “new” technology. This will also happen with health care. Start with the innovators who can’t stand frustrating experiences and who are dying to pay for something better. Work with those folks to refine your process and make it even more elegant, build an even bigger business, and watch competitors arise. And in the not too distant future, we’ll all wake up one day to see health care transformed by a little combination of dreamers, designers, and businesspeople who couldn’t stand seeing something broken without doing something about it.

To learn more, visit What’s Next Health to watch a conversation with Jay and RWJF's Wendy Yallowitz and view an infographic inspired by Jay's ideas for reimagining what primary care should look like.

Thu, 20 Mar 2014 08:00:00 -0400 Pioneer Blog Team Primary care Cost of care Mobile health/mhealth Pioneer What's Next Health <![CDATA[RWJF Pioneering Ideas Podcast: Episode 3 | Empathy, Choice & the Next Generation of Innovators]]>

Welcome to the third episode of our podcast, where we explore cutting edge ideas and emerging trends that can transform health and health care. Your host is Lori Melichar, a director at the foundation.

Ideas in this Episode

  • The science of choosing – From TV shows to health plans, Americans have more options than ever before – and we like it. But do we really? What does our relationship with choice mean for our health, and for the health care system as a whole?
  • The radical power of empathy – What happens when a health care provider actually stops and listens to a patient? How does empathy fuel innovation?
  • The next generation of health care innovators – We hear from two students at Princeton University who are studying how to apply social entrepreneurship to address global health challenges.


  • Barry Schwartz: “When you confront people with lots of options...they're going to postpone the decision that they have to make, or they're going to make unwise decisions.”
  • Sheena Iyengar (@sheena_iyengar): “Be choosy about choosing.”
  • Rushika Fernandopulle: “A $45 iPod saved $280,000. Why didn't the system do it? Because there's no CPT billing code for ‘buy iPod from eBay.’”
  • Azza Cohen (@azzacohen): “Solutions that are good enough ideas should be able to be replicated.”
  • Justin Ziegler: “We don't need to get on a plane, we don't need to drive anywhere... the health care problems and solutions are right in our backyard.”

Related RWJF Projects

Your Turn

What do you think about what you heard? What would you like to hear more (or less) of in future episodes? Share your feedback in the comments below.

Thank you to WIRED for allowing us to include their recording of Rushika Fernandopulle’s remarks at last year’s WIRED Data Life conference. Watch an interview with Rushika at that event.

Listen to Past Episodes

Check out past episodes of the Pioneering Ideas podcast, where we explore topics like the power of the placebo effect and creating systems for behavior change.  

Tue, 11 Mar 2014 08:00:00 -0400 Pioneer Blog Team Behavior change Patient-centered care Disruptive innovations Pioneer Pioneering Ideas Podcast <![CDATA[A Toolkit for Implementing OpenNotes]]>
Open Notes_20120530_00726

In writing about OpenNotes last summer, I argued that the practice of sharing clinicians’ notes with patients had moved beyond the question of whether it was a good idea (the landmark study published in Annals of Internal Medicine was pretty clear on that) to questions of how best to implement it.  As more organizations adopt the practice, it’s clear that we’re now in a phase of implementation, and experimentation with different approaches and learning.  Tom Delbanco, MD, one of the project leads, often compares open notes to a drug -- it does have some side effects and some contraindications for some people and some circumstances -- and we all need to understand those nuances.

To make it easier for health care organizations to offer the service to their patients, the OpenNotes project team has just released a new toolkit.  The toolkit focuses on two challenges:  helping organizations make the decision to implement open notes and helping organizations with all the steps involved in implementing open notes.  It includes a slide deck that lays out the results of the study and makes the case for implementation, a video profile of how a patient and her doctor have used the practice, profiles of the implementations at the pioneering sites, FAQs for clinicians and patients, and tips for clinicians on how to write open notes.  Please check it out and tell the OpenNotes team what you think:  is it valuable? How could it be better?

In a recent perspective piece in the New England Journal of Medicine, OpenNotes study leaders Jan Walker, Jon Darer, Joann Elmore and Tom Delbanco write that they anticipate that providing open notes will become the standard of care.  With institutions like Beth Israel Deaconess Medical Center, Geisinger Health System, Cleveland Clinic, Mayo Clinic, the VA Health System and several others offering open notes, they estimate that two million people now have access to the notes their physicians write about them.  The deliberations of the HIT Policy Committee are also revealing:  while the committee declined to make the provision of open notes a requirement under Meaningful Use Stage 3, their report indicates that they gave the idea serious consideration and only held back because they felt it was too early to prescribe the method for implementing open notes.  In short, there’s an increasing sense that opening up clinician notes to patients is inevitable.  It’s our hope that the new toolkit will make it easier for all who are curious about the practice to assess the idea, sell the idea, and bring it to fruition.

Mon, 10 Mar 2014 10:00:00 -0400 Steve Downs Patient-centered care Patients Physicians Pioneer <![CDATA[Big News in Big Data: NIH Launches Largest and Most Diverse Genetics Database Ever Created]]>

Eighteen years ago this month, Big Data had a cultural coming out party when IBM's Deep Blue defeated international chess champion Gary Kasparov in a game. Gary Kasparov was a chess genius. But Deep Blue could mine the records of 700,000 grandmaster chess games and evaluate 200 million positions per second. The famously nimble Kasparov ultimately could not match the brute computing force of Deep Blue. 

This week we mark another historic milestone in Big Data history. This time, there is more at stake than bragging rights from a chess competition. 

On February 26 the National Institutes of Health (NIH) announced it had added comprehensive genetic data for a cohort of 78,000 people to its online genetics database—known as the database for Genotypes and Phenotypes (dbGaP). The transfer of data is a down payment on what is envisioned to be the largest and most diverse repository of high quality genetic data in the world.

This data donation is the product of a collaboration between Kaiser Permanente's Research Program on Genes, Environment and Health and the University of California, San Francisco (UCSF) Institute for Human Genetics. Since 2007 and with support from the Robert Wood Johnson Foundation, researchers at Kaiser Permanente have been collecting saliva samples from volunteering Kaiser Permanente members. In 2009, Kaiser Permanente and UCSF collaborated to genotype DNA from the saliva samples for more than 650,000 genetic markers per person. The genetic data was matched with each member's longitudinal electronic medical records as well as extensive survey data on their health habits and backgrounds. It was also linked to one of the world’s most comprehensive environmental databases.

If you ever wanted a big data set to study what makes a culture of health—including genes, social and environmental factors, and behavior—you would want something a lot like the biobank Kaiser and UCSF built. 

In addition to diseases and conditions traditionally associated with aging, such as cardiovascular disease, cancer and osteoarthritis, researchers worldwide can—because of this deposit—now use the dbGaP to explore the potential genetic underpinnings of other diseases, including depression, insomnia, diabetes, and certain eye diseases. Researchers will also be able to use the database to retroactively confirm or disprove studies that use data from relatively small numbers of people. The database will also serve as a source of controls that researchers can compare to individuals with different conditions that they have studied.

The genetic information for all 78,000 individual patients translates into over 55 billion bits of genetic data. Like Deep Blue calculating moves with mind-blowing speed, researchers who access the database will be able to look at millions of genetic markers at the same time. With this addition, dbGaP will save researchers time and money. In doing so, it will ultimately savelives.

Thanks to this huge data set, researchers won't have to go through the expensive and painstaking process of collecting, storing and genotyping their own bio samples. Instead, they can just extract and study volumes of valuable genetic information from their computer.

And this first transfer is just the beginning. The Kaiser Permanente RPGEH has already collected more than 200,000 genetic samples from Kaiser volunteers and are aiming to reach half-a-million samples, all with the goal of accelerating health research worldwide.

So much of the credit for this breakthrough resource goes to the research team led by Kaiser's Catherine Schaefer, PhD and UCSF's Neil Risch, PhD. Credit also goes to the 78,000 Kaiser members who volunteered their genes and medical data for the good of human health.

It is also worth remembering the role the federal government must play in supporting research that has the potential to improve health on such a massive scale. The Robert Wood Johnson Foundation may have gotten the ball rolling with an initial $8.6 million grant to start this project. It was a later $24.9 million grant from NIH to complete the work that made this historic data transfer possible. 

Just as we saw in Big Blue vs. Kasparov, Big Data has changed the game. This time, with the potential to save lives.  

Wed, 26 Feb 2014 19:21:00 -0500 Nancy Barrand Data Clinical research Aging Genetics Health records/electronic health records Environmental health Pioneer <![CDATA[What Convinces College Students to Get Flu Vaccines?]]>

What convinces college students to get flu vaccines? Read the latest in our efforts to apply behavioral economics to perplexing health and health care problems.

Almost every college student knows that getting sick while at school will have negative effects on their grades and social life. So why do so many students forgo flu vaccinations that are readily available at almost every college health center? Researchers at Swarthmore College tested three approaches to motivate students to get a flu vaccine: a financial incentive, a peer endorsement via social networks, and an email that included an audio clip of a coughing individual to convey the consequence of not getting the vaccine. The researchers found that students offered as little as $10 were twice as likely to get a flu vaccination.

Read the full story


Mon, 24 Feb 2014 08:00:00 -0500 Deborah Bae Behavior change Social sciences Health promotion and disease prevention Pioneer Blog - Pioneering Ideas <![CDATA[Entrepreneurs and Underserved Communities: StartUp Health's New Accelerator ]]>
Members of the public stand at tables at a polling center, signing in to vote and have flu vaccinations

The past few years have been marked with a surge in health care business accelerators—programs that provide support to help health care entrepreneurs develop their ideas and raise initial funding. In tracking the success of these innovation hubs, we realized something was missing.

On the complex journey of taking a health care idea to market, most entrepreneurs aren’t seeing underserved communities—the people and the providers who serve them—as target markets. The result is that health care innovations are passing by some of the communities that could benefit the most from innovation. But what if we could help entrepreneurs see these patients and their providers as a viable market? What if we could make it easier for health care businesses to design solutions for the needs of our most vulnerable populations?

With this aim in mind, RWJF has provided StartUp Health with a two-year grant, designed to bring entrepreneur-driven innovations to patients and providers in underserved communities. StartUp Health has already established itself as one of the top health care accelerators in the country. The StartUp Health Education Program for Entrepreneurs, which will launch in stages over the next two years, aims to provide entrepreneurs with the resources and contacts they’ll need to better target innovations to meet the needs of vulnerable populations.

As we look to build a culture of health, access is about more than ensuring a community has medical facilities or grocery stores with fresh vegetables. Access also means connecting communities to the next digital health innovation – and, just as importantly, connecting these digital innovators to the right customers.

Tue, 18 Feb 2014 08:00:00 -0500 Paul Tarini Medically underserved areas Social determinants of health Pioneer Blog - Pioneering Ideas <![CDATA[One Size Doesn’t Fit All: Making Incentives Stick]]>

By Emmy Ganos

I work for the country's largest foundation dedicated to health, but I have a secret. I have a huge problem staying away from my go-to comforts: macaroni and cheese, doughnuts, and most of all, the couch. I'm able to keep away from donuts most of the time, by exercising huge degrees of willpower on my way home from work each night (RIGHT PAST the Krispy Kreme). But by the time I get home, that's enough exercising for me, and I'm ready for my macaroni and my couch.

And, another secret, I barely exercise. About once a week, I walk for transportation around Philadelphia, and I walk fast. But that's the full extent of it for me. It is not uncommon for me to spend whole days on the couch -- with a great book and my cat on my lap, working on my laptop, or binge-watching HBO with my husband. I rarely exercise at work--despite free exercise classes and a free gym. 

But I know that these things are important. My dad was just diagnosed with heart failure a few months ago, and I know the single best thing I can do to keep my own heart healthy is to eat a healthy diet and to exercise. But I just can't seem to do it. On the rare days I do decide to make a change and pick up some new exercise regimen, I can never seem to stick with it for longer than a week.

Research on health behavior suggests that being offered an attractive incentive to exercise could appeal to my extrinsic motivation for long enough that intrinsic motivation will have a chance to kick in. If the right incentive helped me to make exercising a part of my routine, it would first become a habit and then just a part of my lifestyle. The trick is finding an incentive that works.

Which brings me to a new article by RWJF grantee Elizabeth Merrick and her colleagues Dominic Hodgkin and Constance Horgan, “Person-Centered Incentives for Health Behaviors.” The article describes the possibilities of customizing incentives to each individual's values and preferences as a way to make them more effective.

In my case, a very common wellness program incentive--a free gym membership--just isn't going to work. I have access to a small gym in my apartment building, a large gym at work, and free exercise classes 5 days a week. Clearly, access isn't my issue. But perhaps there is something else that would do the trick? Maybe a “jeans day” for every week that I attend the office gym at least 3 times would be the thing that works for me. (Hint to HR: I think this would actually work for me! I love wearing jeans!)

Merrick and colleagues advocate giving people the option to select from an array of incentives. And there are so many types to choose from—prizes, gift cards, discounts, gym memberships, competitions, charitable donations, and more. The people who set incentives can't possibly know what's going to work best for everyone, and tailoring incentives by providing options is a great way to convey respect for the preferences of the incentivized person, and to offer them both the dignity and control that can help to make the incentive stick.

Merrick and colleagues outline a useful framework to understand person-centered incentives, and recommend further research.  And there is much left to learn: Do person-centered incentives actually work better? How do we structure these choices? How many options is too many? What is the distribution of preferences within different populations? What types of incentives work best for what types of behaviors? I'm eager to learn what they, and our other grantees who are applying behavioral economics to health and health care problems, find in future research.

Health behaviors are complex, and so is motivation. The idea that incentives shouldn't be one-size-fits-all makes a lot of sense. I’m hopeful that more employers, health plans, businesses and others will continue to make progress in offering respectful, person-centered strategies for incentivizing healthy lifestyles.

Fri, 14 Feb 2014 09:00:00 -0500 Pioneer Blog Team Behavior change Social sciences Health policy Pioneer Blog - Pioneering Ideas <![CDATA[How Can We Help People Get More Sleep?]]>
Hairdresser Sleeping Hairdresser takes a break during work. Image courtesy of

How’d you sleep last night?

Like many Americans, I’m a mother of small children. And like many Americans, I have a full time job with a long commute, from New York City to Princeton, New Jersey. Like too many Americans, I don’t always get as much sleep as I need to do a good job as a mother or as a program officer here at the Robert Wood Johnson Foundation.

So when WNYC recently asked me to participate in a roundtable discussion about sleep with Dr. Shelby Freedman Harris and Dr. Carl W. Bazil, I hesitated; clearly, I’m no expert on the subject. But I’ve spent a large part of my career in the Foundation’s Department of Research and Evaluation, where we support research into the root causes of poor health and explore how we can accelerate improvements in health and health care. And as I thought about the studies we’ve supported over the years on behavior change and other research I’ve encountered, I realized that much of it might shed light on the national challenge of sleep deprivation.

What follows are the thoughts I shared at the WNYC panel. I’d be thrilled to hear what you think might work.

Influencing People’s Habits

At RWJF, we are increasingly realizing that, as critically important it is to produce irrefutable evidence that something is bad for us, it’s just as important–if not more important–to pay attention to how people are influenced to change their behavior.

Our health is highly dependent on what we do–not what we think or believe we should do. So the Foundation has been supporting the exploration of the cutting edge of behavior change and thinking a lot about influence.

So, when it comes to helping more Americans get a good night’s sleep, what specific behaviors are we trying to influence? For me, I know it helps when I avoid eating or drinking too late in the evening, watching too much TV, reading on backlit devices, or engaging in stressful conversations (or email exchanges) too close to bedtime.

To change the amount of sleep I get, I’d need to approach each of these micro behaviors one by one...and all together. So, how should I go about that? Here are some influence tactics we’ve learned about from work we’ve supported in recent years.

1. Leverage Social Networks

Nicholas Christakis’ work has shown that eating, exercise and smoking behaviors travel through social networks. This suggests that efforts to change the behavior of one are influenced by (and can influence) the behaviors of many.

Seeking to influence behavior by influencing others in a social network is a strategy that another of our grantees, Microclinic International, is employing. Microclinic International has shown that delivering support for healthy behaviors in and through small, close-knit networks of people in communities has led more individuals to engage in activities that prevent, instead of lead to, diabetes.

To apply what we’re learning about influence through a social network, we might turn to Facebook as a partner. What if I signaled to my friends that I was going to sleep? Might that trigger an earlier bedtime for them?

Employers and managers seeking to influence their workers to enhance their productivity by sleeping more, could take a page from the work of psychologist Betsy Paluck at Princeton University. Betsy’s work suggests that influencing the norms of influential individuals can influence the behaviors of others.  What if I sent an automatic reply to all the emails I received after 9 p.m., lamenting the fact that my colleague was sacrificing his/her health to send me a message?

2. Put Self-Tracked Data to Work

We have a mantra here at RWJF: You can’t improve what you can’t measure.

With this in mind, we’re working with CalIT2 to explore how researchers might analyze the data that people track through their personal health devices like FitBit and Nike+ FuelBands®, as well as the data they enter manually, to gain insight into public health. So much data is being compiled every day, and we’re excited about what it could reveal and how it could be used for broader social good.

These devices are getting much better at tracking sleep, not to mention factors like diet and exercise that may influence our sleep. Increasingly, we all have the potential to be citizen scientists—able to assess with relative ease what having sweets after 8 p.m. does to us, for example, or how much water keeps us hydrated without causing a trip to the bathroom in the middle of the night. Do we sleep better when we exercise? Is it better for us to exercise in the morning or the evening?

Using these devices and setting goals can help people compete with themselves...and their loved ones. Personally, I track my sleep on my FuelBand and get a sense of satisfaction when I see my average rise.

3. Apply Behavioral Economics

Finally, we’ve also been exploring the field of Behavioral Economics. Unlike traditional economics, in which I was trained, behavioral economists don’t assume that informed individuals make rational decisions. In a nutshell, behavioral economists assume that we will make the easy choice; therefore, behavioral economic interventions seek to make it easier for us to make the right decision–and harder to make the wrong decision.

A behavioral economist might tackle the micro behavior of reading on backlit devices by making it difficult to read on an iPad within an hour of bedtime. This could be done with a default setting timed fade on devices and lights—someone could have the option of reversing the fade, but if we make it taxing enough, say by throwing in a few different passwords requiring capital letters and numbers, maybe they wouldn’t go to the trouble... and could sleep better as a result.

In addition, by letting our devices make the decision to stop reading or working, we eliminate a decision we have to make each day. From what we’ve learned from Sheena Iyengar, Barry Schwartz, Sendhil Mullainathan and others who have studied the stress of choice, eliminating the need to make a conscious decision to go to bed earlier than we want to could have a ripple effect on our well being.

(Taking liberties to extrapolate on what I learned this week from Dr. Bazil about the cognitive processing that goes on while we’re dreaming, it’s possible that this increased mental bandwidth could help us solidify more memories each night.)

These are just a few methods researchers are finding effective in influencing people’s behavior when it comes to health. There are certainly others, such as social scientist BJ Fogg’s idea about creating tiny habits (hear an interview with BJ in the last episode of our Pioneering Ideas Podcast–incidentally, Sheena and Barry will be featured in the next episode, coming soon). I also wrote recently about the idea of applying the idea of microtargeting to health and health care.

What other ideas do you have, or have you read about, for influencing people’s health behavior? How can we apply these ideas to helping Americans catch some zzz’s?

Think about it tonight while you’re dreaming!

Wed, 12 Feb 2014 08:00:00 -0500 Lori Melichar Behavior change Health promotion and disease prevention Pioneer Blog - Pioneering Ideas <![CDATA[With Project ECHO, the U.S. Army Takes a Team Approach to Combating Pain]]>

RWJF grantee Project ECHO is helping the U.S. Army treat service members all over the world who are suffering from chronic pain–a huge, complex, and growing problem for the military. Project ECHO is a collaborative model of medical education and care management that dramatically expands the capacity of primary care clinicians.

The lack of pain specialists in remote areas has been part of the challenge.  Now, primary care providers, such as family doctors and nurse practitioners, are learning to fill this void through Project ECHO, bringing an integrated, holistic approach to pain management that includes massage, acupuncture, biofeedback, and yoga.  At ECHO “boot camps,” specialists and primary care providers learn how to work together as a team.

“It is the ‘teach a man to fish rather than hand him a fish’ mentality that allows us to build champions and build capacity in remote areas,” Col. Kevin Galloway, chief of staff for the U.S. Army Pain Management Task Force, explains in a new video produced by the Army and the University of New Mexico Health Sciences Center, where the ECHO Institute is based.

Dr. Sanjeev Arora, the social innovator and creator of Project ECHO, notes that the partnership with the Army demonstrates how the ECHO model can be applied in large health systems to bring needed care to more patients with complex, chronic conditions.  Watch the video below to see how Project ECHO is helping to make a difference for America’s wounded warriors.

U.S. Army adapts HSC's ECHO model
Tue, 11 Feb 2014 11:30:00 -0500 Pioneer Blog Team Access and barriers to care Quality of care Medically underserved areas Pioneer Blog - Pioneering Ideas <![CDATA[Utility Data May Create Innovative Safety Net for Seniors]]>

In the wake of Google’s acquisition of Nest, the much buzzed about maker of sensor driven thermostats, we’ve made our own investment in a Silicon Valley organization that seeks to make smart use of household utility data. The Palo Alto Medical Foundation Innovation Center is developing a home-based solution for proactively detecting changes in a senior’s social and physical health status. LinkAges Connect will use in-home data signals, such as utility use patterns, to monitor older adults’ health and support independent living at home.  Significant changes in use patterns will automatically trigger an alert to caregivers, thus providing a community safety net for seniors and peace of mind for their loved ones. As we look for sustainable solutions in elderly care, this nonintrusive home-based system could improve health outcomes for seniors by reducing accidents and hospitalizations.

RWJF has provided the Innovation Center with a three-year grant to develop and evaluate linkAges Connect, with the goal of learning more about how real time/real world data can help seniors age independently and potentially help other populations maintain independence and improve their health. This grant is part of RWJF’s broader effort to explore the power and value of data generated in real world and in real time to improve health. Could patterns in our utility usage provide a key to help reduce hospitalizations and keep us healthy? See what else we can learn from our thermostats by following the project at @pamfinnovation.

Thu, 30 Jan 2014 16:30:00 -0500 Pioneer Blog Team Data Aging Networks Pioneer Blog - Pioneering Ideas <![CDATA[Faces of Public Health: Daniel Zoughbie]]>

We have evidence from the work of Nicholas Christakis and others that our health is influenced by our social network—our friends, family, co-workers and neighbors. With Microclinic International, we’re learning how and why health behaviors are spread socially and how to best harness social networks to manage chronic disease and improve health. Learn more in this NewPublicHealth interview with Daniel Zoughbie, PhD, MSc, of Microclinic International.

Mon, 27 Jan 2014 12:00:00 -0500 Deborah Bae Networks Health promotion and disease prevention Public health Pioneer Blog - Pioneering Ideas