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Author Archives: Susan Promislo

Tackling Great Challenges at TEDMED

Sep 10, 2014, 7:00 AM, Posted by Susan Promislo


TEDMED calls them the “Great Challenges:” Knotty issues that can’t be solved with a simple cure. Reducing childhood obesity. Determining how to engage patients more effectively. Accelerating the pace—and lowering the cost—of medical innovation. Eliminating poverty as a hurdle to good health. Cutting health care costs. Embracing prevention as the most effective medicine of all.

All of these great challenges call for new ways of thinking, new approaches, and a shift in society’s values if we are to conquer them. That’s why the Robert Wood Johnson Foundation is supporting TEDMED, taking place this month in Washington, D.C., and San Francisco—to bring together innovative thinkers, keep the dialogue flowing, and hopefully facilitate some great solutions to these great challenges.

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Trumping ACEs: Building Resilience and Better Health in Kids and Families Experiencing Trauma

Jun 19, 2013, 4:18 PM, Posted by Susan Promislo

ACEs Mobile

Fifteen years ago the Centers for Disease Control and Prevention’s Adverse Childhood Experiences (ACEs) study found that children exposed to traumatic events were more likely to develop mental and behavioral health problems like depression and addiction. They were also more likely to have physical illnesses like heart disease and diabetes.

Today, based on that evidence, we are witnessing a health revolution.

An op-ed published today in The Philadelphia Inquirer highlights a recent summit and ongoing efforts in Philadelphia to raise awareness about the negative impact of ACEs on health, education, and other outcomes. The piece states:

Neuroscientists have found that traumatic childhood events like abuse and neglect can create dangerous levels of stress and derail healthy brain development, putting young brains in permanent "fight or flight" mode. What scientists often refer to as "toxic stress" has damaging long-term effects on learning, behavior, and health. Very young children are especially vulnerable.

The same message was echoed in testimony today at the RWJF Commission to Build a Healthier America convening in Washington, D.C., where panelists like Jack Shonkoff of the Harvard Center for the Developing Child emphasized the need for early childhood interventions that focus on building the capabilities of parents to protect their children from high levels of violence and stress, and model resilience. 

Continuing to develop our understanding of the connection between ACEs and poor health and other social outcomes, and supporting interventions like Child First, Nurse-Family Partnership, and other efforts that work to stabilize fragile families and put children on the path to healthy development  will help shape RWJF’s ongoing efforts to foster a vibrant culture of health in communities nationwide.

Learn more about ACEs

A landmark first for the Archimedes model

Apr 19, 2010, 4:13 AM, Posted by Susan Promislo

At the very end of March, study findings were released in the online edition of The Lancet indicating that it is more effective from a cost and detection standpoint to begin screening for Type 2 diabetes in people between the ages of 30 and 45 — 15 years ahead of what established guidelines had been recommending.  Subsequent screenings should take place every three to five years thereafter.

While this is an important result for the medical community, the most significant piece of this story, in our opinion, was not covered in the news.  What really caught our attention was the fact that this was the first time The Lancet has ever published a peer-reviewed paper for which the research was based entirely on a simulated population and treatment options existing within a mathematical model – in this case, the Archimedes model of human physiology, diseases, interventions and health care systems.

For the study, the researchers simulated a population of 325,000 nondiabetic 30-year-olds.  According to Archimedes President and CEO John Beasley, “This paper presents the results of an international study that would never have been possible using an actual clinical trial. It would have required enrolling and following more than a million people for 45 years; the cost would have been astronomical.  The study examined the criteria for deciding when to screen for diabetes and Archimedes was the only model that could conduct a clinical trial simulation at this advanced level.”

We’re excited to see validation of the strength of the Archimedes methodology at this level.  Watch the blog for more updates soon on the status of the ARCHeS project, which will make it possible for public and health policy leaders to access the model to conduct their own virtual clinical trials from their desktops.  The vision is that a wide variety of key decisions will be informed by equally strong results from the model’s predictive analyses, and the sharing of findings powered by Archimedes will become common practice in peer-reviewed journals.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

New Project HealthDesign Grantees Tackle ODL Challenges

Mar 3, 2010, 1:41 AM, Posted by Susan Promislo


Today, Pioneer and Project HealthDesign announced the five new grantee teams 
selected in the program’s second round of funding.  They’ll be breaking new ground in testing ways that patient-generated observations of daily living (ODLs) can be collected, integrated in clinical care processes and, ultimately, organized for action to drive smarter heath decisions by both patients and providers.  Congratulations to the grantees, who rose to the top of an applicant pool numbering nearly 150 with their innovative ideas and robust approaches:

  • Carnegie Mellon University
  • RTI International and Virginia Commonwealth University
  • San Francisco State University
  • University of California, Berkeley, in partnership with Healthy Communities Foundation and University of California, San Francisco
  • University of California, Irvine and Charles Drew University

The teams will be working with patient populations that are managing two or more chronic conditions to collect and store various health observations that arise in the course of their day to day lives.  A later technical challenge will be to figure out best ways to share meaningful signals from these ODLs with providers and integrate that data in to clinical work flows.  National Program Director Patti Brennan writes more about this on the Project HealthDesign blog.

The patient groups are compelling, and you can see how making sense of ODLs and being able to act on them can have a tremendous outcome on their health.  Patients can use technologies like smartphones and biomonitors to harness information that better equips them to manage their conditions and make decisions that hopefully allow them to experience better outcomes, day in and day out.  Providers will get a far fuller picture of the way health plays out for their patients and be able to act on more meaningful information than that typically collected in a periodic office visit conversation. 

For example, parents of low birth weight babies will use a specially designed mobile device, "FitBaby," to record ODLs such as the baby’s temperament, exercise, feeding and sleeping schedules, as well as the caregivers’ stress levels and attitude swings. Providing nearly real-time data to clinicians will help alert them to early signs of health problems, which is crucial in treating low birth weight infants.  Another team will help young adults who suffer from Chron’s disease create visual narratives of their condition and treatment to provide concrete feedback to providers about how they feel from day to day. Patients will track ODLs of physical symptoms like diarrhea, bleeding, and profound weight loss, along with more complex social and emotional observations.

The path is not entirely clear, and lots of questions will be raised along the way.  Which is why the grantees will be sharing their learnings, experiences, road blocks, questions and successes along the way, largely via the Project HealthDesign blog and Web site.  We want their progress to be an open path along which you follow and help to guide.  We’ll be sharing updates and hope you’ll check in often as well.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Join Pioneer at TED 2010 - Health's Future, Powered by You and Your Data

Feb 9, 2010, 11:12 AM, Posted by Susan Promislo


TED2010 – the Technology, Entertainment and Design conference – kicks off today and runs through the 13th in Long Beach, CA, with the Pioneer Portfolio resuming its role as an event sponsor.  There’s an amazing lineup of speakers, and we’re especially excited that two Pioneer grantees will take the main stage.  Nicholas Christakis of Harvard Medical School will be speaking on Thursday about the power of our social networks to influence the spread of health and social phenomena, including obesity, happiness and smoking cessation.  And Phil Howard, chair of Common Good and leading spokesperson for the work we have supported to test administrative health courts to overhaul our broken system of medical justice, will address the TED audience on Saturday.  

They’ll be among impressive company, joining speakers and performers including HIV vaccine researcher Seth Berkley, molecular technologist George Church, Bill Gates, musicians David Byrne and Sheryl Crow, behavioral economics founder Daniel Kahneman, game designer and Pioneer friend Jane McGonigal, chef Jamie Oliver and former CIA operative Valerie Plame Wilson, among many others. 


We’ll be leading two activities at TED – a luncheon on Thursday that will highlight the future of data-driven, patient-centered care.  We’re teeing up the following questions – in a world with abundant, accessible, actionable health data, how will our level of engagement in our health and health care change?  What expectations of doctors, nurses and other providers will we have, and what expectations will they have of us?  If we have and use our data – both those logged in our electronic medical records and those generated in the course of our everyday lives – how might our decisions change?  Behaviors?  Demands? 

It’s a fascinating conversation, and one that will feature Pioneer team director Paul Tarini as moderator WIRED executive editor Thomas Goetz and Beth Israel Deaconess primary care visionary and Open Notes grantee Tom Delbanco.  Thomas is releasing a book called The Decision Tree later this month that explores this new approach to health in which patients harness their data and use decision trees – essentially health-oriented flow charts – to engage more meaningfully in health decisions and manage their care more intentionally, leading ideally to better outcomes.  Tom will spotlight the role for providers to innovate in this space.  He’s leading the way in making health data for the patient – not just about the patient – by placing the information doctors enter in our medical records and clinical encounter notes,directly in our hands and revolutionizing our role in our health care.  We'll record the event and post it as a Podcast later in the week.   We’ll also be running an exhibit space all week, the centerpiece of which is a video drawn from interviews with a range of Pioneer staff, grantees and other experts on the leading edge of this data-driven, patient-centered vision.  A big shout out to our partners at DDB Issues and Advocacy, who turned hours of telephone interview transcipts in to a beautiful, dynamic and thought-provoking brief video that makes text – and these ideas – jump off the screen and challenge you.  I love this video and urge you to check it out and add your ideas and reactions on our YouTube page.

Pioneer will be live-tweeting from TED and we invite you to join us in the conversation on Twitter, where you can provide your answer to this: In a world rich with actionable health data, how will our relationship with doctors change?  Use the #pioneerdata hashtag and spread the conversation online.

Finally, we’ll be blogging the sights, sounds and stories of TED this week, so check back frequently.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

CBS Sunday Morning to Feature Common Good, Health Courts

Oct 16, 2009, 4:44 AM, Posted by Susan Promislo

This weekend, tune in to CBS Sunday Morning for its lead story on Common Good, which, together with researchers at the Harvard School of Public Health, has been analyzing and testing the viability of a system of administrative health courts to more rationally handle medical injury claims.  The CBS piece will look broadly at legal fear in America, a key thread in Common Good Chair and Founder Philip Howard's new book, Life Without Lawyers.  Interviews touched on health courts and their potential to reduce errors, boost patient safety and improve the overall quality of care, in addition to producing a more functional and effective process for resolving medical liability disputes.  Click here to find out where and when to watch in your area.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Are questionable dosing practices fueling antibiotic resistance?

Oct 11, 2009, 11:34 AM, Posted by Susan Promislo

This post comes to us from Patricia Geli Rolfhamre over at Extending the Cure.  More in-depth conversation about antibiotic resistance and the future of our nation's supply of antibiotics is happening on the ETC blog.


Are there ways in which we can reduce the spread of antibiotic resistance by treating patients more strategically? The dosing and duration of antibiotic treatment have been shown to be critical determinants of the likelihood of curing an infection and of the emergence of resistance.   Adjusting these factors to a patient’s individual condition instead of treating every patient with the same antibiotic regimen may be an easy step toward fighting resistance.

Research reports from the American College of Emergency Physicians annual meeting in Boston earlier this week revealed that doctors who work in hospital emergency rooms rarely adjust antibiotic doses for obese patients. The consequences are an increased risk of treatment failure and resistance development. Yet it is unclear how much this will spur the growing resistance epidemic. Given the fact that more than a third of the US population is obese - this trend is worrying. But solving the obesity problem or adjusting the doses for obese patients is only a part of the answer. The other important parameter for successful treatment and for which a one-size-fits-all approach has generally been applied is the duration of treatment.

Antibiotic guidelines have historically been developed to maximize treatment efficacy and minimize toxicity – without the consideration of resistance development. This has led to the creation of duration guidelines that are unnecessarily long. One example is the treatment of otitis media, which results from a middle ear infection caused by Streptococcus pneumoniae (by volume, the leading cause of antibiotic resistance). For this specific case, three days with antibiotic treatment has been shown to be no less effective than ten days. Despite this fact, we continue to recommend that patients complete the full ten day course of antibiotic treatment, thereby accelerating the rate with which resistance evolves and spreads.

Regardless of the fact that antibiotic drugs have been used for some 70 years to cure bacterial infections, knowledge on how to use these drugs is still incomplete. And with lack of knowledge, we tend to fit the same approach for treating all infections among all patients. With resistance growing, it is time to ask ourselves: how long can we wait before we change the way we use antibiotic drugs, and are we willing to risk the consequences?

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Mix of things to check out

Jun 11, 2009, 10:00 AM, Posted by Susan Promislo

A bunch of things caught my eye today that may be of interest.  First, given that the Games for Health conference kicks off today and I have to sit it out this year, I was especially glad to see this article in the Syracuse Post-Standard.  It profiles one of our Health Games Research grantees, Cornell University, which has given middle-schoolers iPhones loaded with a game designed to encourage healthier eating choices.  The way they do it is pretty clever, though...the kids take care of their own virtual pet and snap photos of their food selections, which are sent to the Cornell research team.  When indicated, the virtual pet will prompt the kids to consider, say, trading in their chips for a yogurt next time.  It's more of a fun interaction than preaching, as the article points out, and it goes wherever the kids go.  I like that it shows how health is playing out apart from health care settings and encounters, and how games and game technologies may provide ways to deliver health messages to kids in ways that are so much more up their alley, and potentially so much more effective.

Second, Steve Downs and John Lumpkin blogged on June 1 on "Catalyzing an App Store for EHRs," which our friends at the Health Care Blog were kind enough to re-post.  A great conversation has kicked up around this - read the comments and add your own thoughts.

Finally, Project HealthDesign received 145 new proposals last week in response to its Round 2 CFP. National Program Director Patti Brennan talks about the breadth of ideas and wide range of observations of daily living that teams proposed - they'll be working together with patients managing multiple chronic diseases to capture and analyze health data generated in the course of daily life and test how it can be integrated in to clinical care workflows.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

The Need to Disrupt the Patient Gown: New Research, New Thinking

May 11, 2009, 5:47 AM, Posted by Susan Promislo

The efforts of Pioneer grantee North Carolina State University to redesign the current hospital gown are featured on the front page of today’s Wall Street Journal.  Congratulations to Blan Godfrey, Traci May Lamar and the NCSU team – it’s great to see prototype designs emerging from their comprehensive research to determine the needs, constraints and priorities of players up and down the hospital gown supply and demand chains.

The article takes a light touch with the subject matter.  True, most everyone hates the gown because it’s an unmitigated fashion disaster…ugly, flimsy, see-through, ill-fitting, inconvenient, hard to tie or fasten, and often thoroughly humiliating in its, er, exposure.  I’ve searched for who is buzzing about this story so far, and it’s been highlighted on the (presumably official, but who knows) Twitter stream of French fashion house Givenchy – I’m thinking this is an RWJF first.

But this project was always designed to go deeper, and there’s a real vision and potential for change in health and health care that motivated Pioneer’s decision to support this work.  Indeed, it’s interesting to think about it in the wake of Clay Christensen’s visit last weekThe current patient garment is a classic, ubiquitous example of a job that is not getting done for patients or, as the NCSU research shows, care providers either.

Between the survey research and focus group findings at the heart of this project, we’ve learned some interesting things about the gown, how people feel about it, and its impact on care.  The upshot is that it’s never been about just looks: 

  • 87% of caregivers felt the current gown sometimes interferes w/ administering IVs, catheters, feeding tubes or other devices. 

  • 88% responded that the gown sometimes or always affects the emotional wellbeing of patients.  66% thought it sometimes or always affected patients’ physical well-being.

  • 74% of nurses are involved in the gowning process; patients are not comfortable with how to put the gown on when confronted with it, so that even if they’re not seriously ill or impaired, they typically ask nurses for help.

  • Some patients confessed that they may limit their mobility becaused they are concerned about being overly exposed in areas outside of their hospital rooms – people don’t just lie in bed anymore to get well. 

  • Patients tend to use a second gown as a robe to cover them from the back, which effectively doubles the cost and time of collecting, laundering and stocking gowns.

  • There is the perception that nicer, more dignified gowns may help patients feel better emotionally and be more active, boosting their prospects for and pace of physical healing and recovery.  Patients are struck by their loss of dignity and control in the hospital experience..."If I have this gown, I’m really sick.”

It seems that there are certain things in medicine that we do because they’ve always been done that way; such is the case with the patient gown.  It’s become institutionalized as part of the status quo and has gone unchallenged for decades.  It seems so simple and obvious to change the gown and bring it in line with 21st-century care requirements and patient needs and preferences – however, if it were that simple, it would have happened.  As NCSU’s Traci May Lamar states in the article, "We thought that it would be a much easier problem to tackle."

A redesigned garment that is more dignified and respectful – while still meeting the needs of care providers, suppliers, laundry services and others in the health care supply chain – may have a transformative impact on patients’ care and their experiences in the hospital.  If  we can pull it off, an innovative redesign effort that better meets patients’ and providers’ needs may have day-in, day-out implications for improving efficiency, reducing waste and cost, enhancing patient engagement in their healing, and ultimately, boosting their satisfaction in health care environments.

More importantly, though, we think that possibilities to redesign the patient gown are a springboard to opportunities to design innovations throughout health care that make a big difference in the lives of patients.  We see the disconnects between the garments patients want and the one they currently get as emblematic of the larger opportunity before us to provide care that is truly patient-centered, more consistently, and more comprehensively.  And to engage market actors in the search for disruptive innovations that make patients feel like the system is working for them.

Ultimately, though, the patient gown may be the tip of the iceberg…we all know it’s not just the gown that needs to be more respectful of and responsive to patients’ preferences, needs and values.  However, it represents a critical step toward improving the quality of health care for all patients and ensuring that every American receives the care and respect that they need and deserve.

There are some very real health care realities interwoven in to the dreaded patient gown, and these are points that we wish the Wall Street Journal article had touched on a bit more.  What opportunities do you see for market players to disrupt the status quo and push change forward?  If it’s truly time to be “Down with the Gown,” what should emerge in its place?

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Join Us for Games for Health 2009--Boston, June 11-12

May 4, 2009, 12:48 PM, Posted by Susan Promislo


The 5th Annual Games for Health Conference is coming to Boston on June 11-12 with a packed lineup of speakers from game development firms, health and medical institutions, academic and research institutions and elsewhere.  The conference has grown in to the premiere event for networking, identifying new opportunities and sharing learning in this dynamic space.  This year features three game expo spaces, special tracks on both exergaming and cognitive health, and 55 sessions covering the latest in:

  • exergaming
  • disease and health management
  • skills and workforce training
  • rehabitainment
  • epidemiology
  • virtual worlds and health

Here's a sampling of some of the sessions and speakers - click here for a full program schedule to date and to watch a video on upcoming event highlights:

  • Jacob Vogelstein, Johns Hopkins Applied Physics Lab - Using Guitar Hero III to create a novel training and evaluation device for upper-extremity amputees
  • Debra Lieberman, Univ. of California, Santa Barbara and Health Games Research national program - The Coming Age of Sensor-Based Health Games
  • Paul Blair -- Capturing Wiimote & Accelerometer Data for Active Gaming Evaluation
  • Ben Heckendorn, benheck.com - Modding and Hacking Game Hardware for Health: Ask and you might receive...
  • Doris Rusch, MIT/Gambit - "Akrasia": Metaphorical Depiction of Addiction

Pre-conference workshops will also take place on June 10:  Games Accessibility Day features talks, networking and demos dedicated to making all games more accessible, and helping people with disabilities play their way to better health and wellness.  Virtual Worlds and Health Day looks more in depth at the potential of virtual worlds, which combine social systems with game-based interfaces and graphics to create entirely new spaces to train, practice and visualize. Such systems hold great promise for advancing health and health care through layering on of game play or enabling pure simulation or new forms of social interaction.

Click here to register -- a 15% registration discount is available by plugging in dmgfh09 to the registration code box.  Lodging and conference events are at Boston's Hyatt Harborside Hotel.  Please spread the word and hope to see you there!

This commentary originally appeared on the RWJF Pioneering Ideas blog.