Patti Brennan: Looking Ahead

Sep 16, 2008, 6:03 AM, Posted by Abbey Cofsky

Today, we wrap up our interview with Patti Brennan, Director of Project HealthDesign with a look towards the future. We thank Patti for her thoughtful responses and look forward to seeing the work of the Project HealthDesign grantees during tomorrow's event.

The health care and technology industries will play a significant role in the future of PHRs, who else are you watching as possible pioneers in this field?

I look to John Maeda, who sits on the Project HealthDesign advisory committee (and was inaugurated as the 16th President of the Rhode Island School of Design last week). John is amazing, absolutely amazing.  He is constantly think about how new technology enhances simplicity and enables people to live simply.

I look at industries that have restructured their distribution model. iTunes is a big one for me. I find that fundamentally rethinking something of value and repacking it in a way that enhances its accessibility to people is one of the things we need to look at.

I think about the gaming people, and I think about them not so much because of educational games – that is learning something in games – but rather finding something inherently pleasurable in playing games that leads people to do it more. And basically, we want to find the element in health that would lead people to “do” health more.

But let’s look a little more near-term. There are a couple of folks that I think will play a key role in operationally getting PHRs into people’s hands in a way that improves their health. I focus on the people who are trying to get PHRs into patients’ hands, not PHRs into the hands of providers to improve the clinical workflow. I think Kaiser Permanente has made great strides with KP online. I think it is great that their online system lets patients schedule their own clinic visits or look up their laboratory test results. But these two activities were previously managed by a paid health care staff person and now they’re happening as self-management. I think that’s fine, but I don’t think that’s where the real innovation is. I look at Indivo. Ken Mandl, Isaac Kohane, and their group, because I think they’ve really got an edge on the privacy and patient-controlled access issues and that is really, really important.

I’ve been fortunate to know James Ralston, who’s one of our grantees, for a while, but I’d never gotten to know him as well as I did through this project. And I will tell you that I’ve always watched him with a little bit of edginess, because he’s a physician, and he’s a doctor’s doctor, and he speaks of PHRs as they enhance the physician’s abilities to deliver what physicians believe is good care. I think that’s fine, but, again, not enough. But through this project, I’ve really gotten to understand that his view of physician practice is enormously patient-centered. And so when he talks about getting physicians to have better tools, he talks about it in a very patient-centered way. So I think people who are “bridge” people, like James, bridging the lay view and professional views, are really some of my heroes.

And finally, I look at patients. You know, we spent a long time looking inside people's kitchens and bedrooms to see what they do to manage their health data. They do amazing things. They really do. When they’re trying to remember stuff, when they’re trying to keep track of things, they do very, very clever things, and sometimes under a great deal of adversity. And so I look to the way people have managed their environment to accomplish what they understand their health goals to be. I think if we start with what people already do well and build on it, we’ll have the greatest chance of success.

Project HealthDesign has played a significant role in shaping the advancement of personal health records, how will the nine project teams continue to advance this field?

We were fortunate in that most of our grantees came from active organizations, already pursuing patient-focused tools for health promotion or health care. And so what Project HealthDesign did was let the grantees explore in a more, if you will, fanciful way what the tools of the future might look like. In turn, that’s helped drive some of their local activities, and now we have teams that have already started to seek out additional funding or bring additional information or expertise into their other applications. We also have some grantees who have been partnering with other groups in their regions to take their Project HealthDesign work and build it into new tools.

I think that there’s a good chance that one of the things we’ll come away with is greater awareness on the part of some of the funding bodies about the new investments that are coming. Now, I’m not sure that’s going to, in the short term, enable the grantees to identify new funding sources by the spring. But I hope that it will encourage both the funding agencies and the grantees to continue thinking about how PHRs can enable new kinds of research, both genomic-based research, as well as health care delivery research.

Thanks again to Patti for sharing her thoughts and ideas with us. Check back later this week for highlights from the event and to link to the event webcast.

This commentary originally appeared on the RWJF Pioneering Ideas blog.