The Culture of Disparities

Improving Minority Health

Report urges use of HIT to improve minority health. http://ow.ly/hY4mf

Health and eWorms

Locked in but not locked out.

Health Apps Rising

Today, Tuesday, July 17, 2012 iHealthBeat is reporting that although the number of mobile health applications has grown dramatically over the past few years, there has not been a corresponding rise in the number of people downloading health apps. Brian Dolan, editor and co-founder of MobiHealthNews, said data show the number of consumer health apps in the Apple Store has increased from 2,993 in February 2010 to 13,619 in April 2012. He noted, "But a persistent trend is that the majority of these apps are focused on tracking fitness or diet ... and far fewer are focused on what most people would consider true health problems, like chronic conditions or chronic condition management." Recent data from the Pew Internet and American Life Project indicate that about 88% of U.S. residents have a mobile phone and about 50% of those are smartphones. However, only about 10% of smartphone users have downloaded health-related apps, a figure that has remained steady since 2010. Susannah Fox, lead health researcher for the project, said, "We are in a situation where we have the technology and we certainly have the need -- just look at all of the statistics on the rise of obesity and other unhealthy trends." She added, "But what we have not yet seen is an uptick in the percentage of people who are adopting and using these health apps." Lee Ritterband -- director of the behavioral health and technology program at the University of Virginia -- noted that "We know very clearly that one size doesn’t fit all when it comes to the range of health issues: People need different things and need to be helped along and prompted given their particular needs" (Butler, Washington Post, 7/16). Current national demographic trends highlight the problems of a one-size-fits-all approach to health and healthcare. First, the aging of the US population is one of the most important demographic trends that will affect the future healthcare system. The currently aging health workforce also raises concerns that many health professionals will retire about the same time that demand for their services is increasing and when the healthcare system has little ability to respond quickly through traditional provider training programs Secondly, the changing racial and ethnic distribution of the population also has substantial implications for the future healthcare system. Disparities in access to care account for part of this difference, in addition to other language, cultural and socio-environmental factors. This has significant implication for providers. Between 2000 and 2020, the percentage of total patient care hours physicians spend with minority patients is projected to rise from approximately 31 percent to 40 percent. So what’s the solution? Given consumer health IT’s increasing role in clinical care and patients’ self-care and self-management, one potential solution lies in designing health IT that is socioculturally-informed. To Health IT designers though, creating culturally informed consumer health IT can seem daunting. Recently a Culturally-Informed Design Framework has been proposed as a guide to socioculturally conceptualize and personalize four key dimensions of health IT including 1) the technology device/platform, 2) application functionality, 3) technology content/messaging, 4) the user interface. Informing design choices by a deep understanding of the user’s clinical needs and sociocultural factors may be the only way for emerging health IT tools to help the US healthcare system overcome the health challenges that lay before us. Read more: http://www.springerlink.com/content/2190-7188 Read more:http://www.ihealthbeat.org/articles/2012/7/17/number-of-health-apps-rising-but-download-rates-remain-low.aspx#ixzz20vPaCz9D

Uncomfortable with being Comfortable

Fitness maven Jeanette Jenkins recently tweeted that “to see big results you have to get comfortable with being uncomfortable.” In other words, making change happen, inevitably leads to emotional or physical discomfort. If you are serious about change you must be willing to endure a lot of discomfort. While this is no doubt true, I would take things one or maybe two steps further and say “Disruptive change will only happen when you become uncomfortable with being comfortable”! Yes, change is almost always hard. But not all change is sufficient, significant nor even good! There is probably no better example of this than in healthcare. Over the past decade there has been a significant amount of work done to understand healthcare disparities. This work has led to a lot of change (practice, interventions, policy, pharmacology) in many areas (Social Determinants of Health, Cultural Competency, Community Partnerships, Community Based Participatory Research, Environmental Health, Populomics, Big Data Science etc…) that took a lot of effort, on the part of many people to achieve, and the progress continues. Yet, as we look across our nation, as the latest volume of the National Health Care Disparities Report indicates, there has been no significant, sustained improvement in any disparity in almost a decade! Similarly, a huge amount of effort at many levels is occurring around the notion of bringing our healthcare system into the digital age through notions of Personalized Medicine, Genomics and more recently Health Information technology (clinical decision support tools, Consumer Health Informatics tools, Health Information Exchange). As with the previous example, much effort along these lines, has resulted in much change in many areas, however the hypothesized and potential impact of drastically improved healthcare processes and outcomes, particularly at the population level, have not been realized. While it can be credibly argued that we are just at the beginning of innovation curve in both these areas (as such it would be impossible to see significant change yet), I believe this is not the primary reason keeping disruptive improvements from happening. I believe this because when you study change, the type of large, life altering change that is so significant, the results could not have been predicted at the outset – so called disruptive change (iPhone, PC, Internet) – it rarely occurs as the end product of incremental improvements over time. Rather, the innovators, inventors, physicians, entrepreneurs or visionaries simply refused to be satisfied with the then current norms or absolutely relentlessly sought solutions to challenges that most others considered impossible. In other words they became uncomfortable with accepting the status quo or reaping the comforts that the status quo afforded, even though others may not be able to receive the same benefits. They became driven by the pursuit of one thing, not just change, not only improvements, not financial gain, but rather large scale solutions and wide spread problem elimination! They pursued these goals often in the face of constant criticism, in spite of the “conventional wisdom” and even against the realities of their own past experience! They remained focused on the notion that societal solutions or personal triumph over failure was achievable…period! Whether the goal is personal weight loss, professional achievement, disparities elimination, patient access to personal health data, societal health improvement, or global peace, resist the logical, evidence based tendency to be satisfied with “change”, and release yourself to achieve what others think impossible by first becoming uncomfortable with being comfortable!

Health by Southwest?

Although most health and HIT technophiles probably have never heard of it, The Austin Interactive Technology festival, (or South by Southwest [SXSW] as it is otherwise affectionately known) may soon become a “must attend” event for those serious about staying ahead of the health technology innovation curve. Last year almost 20,000 people attended. This year before it is all done there'll be more than 1,000 panels and presentations spread across 15 Austin Texas campuses.

Recently at SXSW, Ray Kurzweil made a presentation about his vision of a technology enhanced future. Kurzweil has been called a “genius" by the Wall Street Journal, and "the ultimate thinking machine" by Forbes. He was the principal developer of the first CCD flat-bed scanner, the first omni-font optical character recognition, the first print-to-speech reading machine for the blind, the first text-to-speech synthesizer, the first music synthesizer capable of recreating the grand piano and other orchestral instruments, and the first commercially marketed large-vocabulary speech recognition.

Mr Kurzweil believes that humans and technology are blurring and will eventually merge. (most of us have already grown smart phones and other digital devices at the ends of our fingers.) "We live in a human-machine civilization where everybody has been enhanced with computer technology," he told a capacity crowd of more than 3,000. "They're really part of who we are.” Kurzweil believes technology is advancing so fast that previously unimaginable inventions will be a reality within decades. He cited nanotechnology -- microscopic computers -- that will be 1,000 times more powerful than human blood cells and injected in people's bloodstreams to give them superhuman endurance. He also believes computer technology is democratizing society by empowering people."You can start world-changing revolution with the power of your ideas and the tools that everyone has," he said. "A kid in Africa has access to more information than the president of the United States did 15 years ago." He also predicted that "Siri will get better.", Moore's Law, will become outdated and useless in the next 8 years and in the future search engines aren't going to wait to be asked. They'll be listening [to humans] in the background. And [the search results] will just pop up."

Speculation, fantasy you say? Perhaps. What’s clear is that while everything has not come to pass, in 1960, the things we thought we would have and do in the year 2012 are in many cases, well beyond our 1960’s imaginations! So if things continue as they have, Healthcare in 2052 will likely look very different than what it looks like today, and technology will have a large role to play in what it does looks like. Healthcare leaders should embrace and help lead this inevitable change or else they will be forced to get out of the way and simply follow the innovation of others.

FMI - http://www.cnn.com/2012/03/12/tech/innovation/ray-kurzweil-sxsw/index.html