Technology-enabled health solutions often focus heavily on one of 5 core health motivators. Incorporating elements from each may result in more impactful solutions that map short-term actions to long-term goals.  Let's take a deeper look at one of these health motivation tools--Health Information In Context--all five are listed below (in no particular order).

  1. Health Information in Context
  2. Healthy Competition
  3. Recognition of Achievement
  4. Straight Up Money!
  5. Peer and Clinician Relationships

Historically, patient education has often involved reviewing 'raw' information that is meaningful to clinicians but difficult for patients to interpret.  In addition, caregivers often communicate/educate through care plans created from a clinical perspective using clinical language. 

Technology is enabling much broader patient access to personal medical records which provides an opportunity to rethink how this information is presented/communicated. Considering the context of this important exchange will maximize the impact of these emerging tools.

Context is an interesting concept.  While we often think about context specific to information as in a scale or anchor point for understanding (which is important), an even more important aspect of context for health information might be the details surrounding the transfer of that information. Consider this definition of context from Wikipedia:

Context: "The relevant constraints of the communicative situation that influence language use, language variation, and discourse summary."

There are two fundamental constraints clinicians face when discussing health information with patients; time and knowledge disparity.  

Limitation of time is well documented.  In a volume-based health economic system where time is money, the amount of time clinicians have to interact with patients is extremely limited.  From a patient (consumer) perspective, the sheer volume of information from harried, over-scheduled lives places a premium on time and impacts the ability to engage, digest, and learn.   These constraints of time are exacerbated by a clinical knowledge disparity between clinicians and patients and among patients.

As technology makes information more and more accessible, we are in the midst of a (hopefully) constructive debate regarding who owns clinical data.   In a recent panel at Health 2.0, Lucia Savage, Chief Privacy Officer at the Office of the National Coordinator for HealthIT (ONC), suggested that the more pertinent question might be: "What are people with access to health data doing with it?"  Ms. Savage was speaking about controls and protection but it strikes me that as healthcare providers we should likely be asking ourselves an even more impactful question: 

Are we who have access to 'raw' clinical data working to present that information to patients in meaningful, impactful ways?  

Access to personal health records is one thing, transferring health information meaningfully under the constraints of limited time and disparate knowledge bases is quite another.  In 2010 Wired Magazine ran a fantastic article on this topic: The Blood Test Gets a Makeover.  The article highlights both an improved visual presentation of information and a consistent process of communication that includes anchor points.   In effect, the approach also considers the constraints of the information exchange context in contrast to the standard practice of presenting/reviewing raw numbers and ranges.

Below is a quick (paraphrased) overview of the article's proposed process for communication of lab results:

  1. Simple Summary of the what the test is/is for...
  2. Result with simple interpretation i.e. this result is in the moderate range indicating...
  3. Implications/Risk in real terms i.e. results in this range indicate a percentage risk for a disease/event in the next 10 years...  
  4. Actions: Simple suggestions for how to change this measure with quantified impact on risk i.e. if you lower this measure by this much, your risk for a disease/event will lower that much...

Of course the communication/education challenge reaches well beyond lab results.  There is much work to do but there are also encouraging signs.  Three companies presenting at the recent Health 2.0 conference showed unique approaches to moving beyond health record access toward patient education/communication and impact.  Here they are in their own words:

GLIIMPSE: From Gliimpse To Great

How to use your digital health to care for your analog life.  Our vision is a personalized and shareable health record for all 317,000,000 Americans.

Docola: Simply, Patient Engagement

Docola believes that meaningful conversations between patients and clinicians improve healthcare. We are passionate about engaging conversations which is why we created a solution we know you will fall in love with.

Medtep: Health starts with U

Facilitating lasting behavioral changes by personalizing validated prevention and treatment plans. We take clinical protocols and turn them into care plans that patients can understand.

Effective transfer of health information from clinicians to patients is an important piece of the health motivation puzzle.   In addition to those shown above, there are a multitude of good examples that take advantage of new technology to not only provide broader access to information but also facilitate efficient, improved clinician/patient communication.  

In order to motivate individuals and populations for health and transform health care, we need to be make these best practices standard AND incorporate other motivational tools into complete, impactful, solutions.

Let's get motivating!


As chronic, behavior-driven diseases have replaced acute, infectious diseases as the primary health challenge of our time; we might say the disease prevention focus has shifted from immunization to motivation--immunization controversies notwithstanding. 

Recently, the explosion of mobile technology and social networking has escalated these conversations by providing an overwhelming array of ‘solutions’ for motivating people toward better health. 

Unfortunately, few of these solutions have delivered tangible, sustainable results.  Why?  Motivation, and particularly motivation for health and healthy behavior, is inherently complex and dynamic while solutions have tended to be simpler and more static-- usually focused solely on a single motivator.  

Motivation is a personal thing.   While we may generally have an individual 'motivational profile',  our motivation is also incredibly variable, moving with our unique set of circumstances and sum of experiences at a point in time.  The end result is often that our short-term actions don't map to our articulated long-term goals and we struggle to understand why.  

The vast array of technology-enabled health motivation tools can be roughly categorized by their primary focus on one of 5 core motivators that attempt to address the incongruence of our short-term actions and long term aspirations.

  • Health Information in Context
  • Healthy Competition
  • Recognition of Achievement
  • Straight Up Money!
  • Clinician and Peer Relationships

Over the next few posts, we'll examine each of these 5 core motivators and consider how they might be integrated into more dynamic, impactful, solutions.  

Motivation for health is a massive challenge but with thoughtful dialogue we can make progress toward meaningful tools that address the most fundamental issue we face in health care.  

Let's get motivating!  


WHAT IS MY CHART? by Brian Buys

Moving beyond meaningful use to envision meaningful tools

A leading electronic medical records company has a patient portal product called MyChart.  There has been much discussion in health care regarding ownership of medical information and subsequent focus on allowing patients (people) access to their chart/medical record.

It stands to reason that we minimally allow patients (people) access to their personal medical information however there is a more fundamental question we should be asking:

What portions of a patient’s medical record are useful in moving beyond reactive treatment of symptoms toward addressing root causes and optimizing health?

As we begin the long overdue transformation of health care and health economics in the US, we are slowly realizing that while medical chart data is extremely useful during an acute care episode and portions are useful across acute care episodes; it has very little utility in the fundamental pursuit of long-term health and subsequent containment of cost.  Reaching beyond treatment to promote health requires information generated between clinician interactions.

There are a growing number of voices acknowledging this information gap. Recently the American Academy of Nursing released a policy brief: "Putting 'health' in the electronic health record: A call for collective action."  This week, Health Leaders media published an article entitled: "CRM Aims to Finish the Job EHRs Started" highlighting the need for more patient-centric care coordination tools and the Office of the National Coordinator for Health IT released an update to the Federal Health IT Strategic Plan focused on patient engagement and robust population health management. 

There are longer-term trends as well.  While Apple has attracted the most publicity, scores of consumer-focused technology companies have recognized opportunity and focused their attention and considerable resources toward health care.  While these are encouraging signs, a recent report from IMS Health is a reminder there is much more to do: "1 In 10 health apps connects to a device, 1 in 50 connects to healthcare providers."

The bottom line

To address today's health care challenges we must move beyond meaningful use of existing EMR/EHRs toward the development of meaningful tools focused on the underlying opportunities to better promote care coordination, adherence, and health-focused behavior change.  

This is about health.  We're all in it together.  Let's continue to drive the conversation and increase momentum for transformation!



How creatively rethinking the fundamentals of care delivery trumps Big Data and Analytics in the quest for a Health Care Happy Ending.

I recently heard Ed Catmull, co-founder of Pixar, speak at a conference on healthcare analytics.  When I mentioned this to a friend in the animation business, his response was something like ‘that’s really cool but what does Pixar have to do with health care?’ 

The topic was building and sustaining a culture of creativity.  One of Ed’s foundational points was that creativity is in essence problem solving. Another was that technology itself can only advance a cause so far.  The take away for me was that while we have powerful new technologies to apply in the worthy cause of transforming health care; mission success requires continuously and creatively rethinking the fundamentals.

One particular statement from the talk struck me as a fantastic summary of the underlying creative challenge we face in health care:

‘Any right process over time becomes stagnant or corrupt’. 

In its simplest form, the care delivery process in the US (and most developed countries) can be simplified to three phases:

Symptom => Individual Clinician Assessment => Intervention

In this model, individual clinicians perform assessments on many patients and funnel those with similar symptoms toward specific interventions.   

During the period of history in which our greatest health challenges were acute, communicable diseases, this process was appropriate and effective. In contrast, today’s primary health care challenges are complex, chronic, non-communicable diseases with latent and overlapping symptoms. 

The net result of applying this antiquated model to complex chronic disease is a scenario in which patients enter the system in and advanced state of decline and are funneled toward a variety of uncoordinated interventions by a number of individual clinicians.  Unprepared patients are then left to coordinate these often conflicting or overlapping pathways for themselves.  

In short, while our technical ability to assess (diagnose) and treat (intervene) for emerging chronic diseases has increased exponentially over the past several decades, the continued application of this stagnant and oversimplified funneling process has created an underperforming industry rife with conflict and waste.

To be fair, an isolated, linear approach to problem solving is not historically unique to health care. In most other industries however, more agile, iterative, and collaborative processes have already taken hold.  These new processes are supported by a near continuous feed of data.

For many reasons, not the least of which was access to data, health care has been slow to adopt these newer, more dynamic and collaborative models focused on continuous improvement.  

Enter the promising new healthcare era of Big Data, Analytics, and Population Health.  These capabilities represent access to data with the potential to drive tremendous positive change for health care however technical capabilities will take us only so far.  We must creatively rethink the fundamentals of care delivery to unlock this potential.  

Much of the early focus for these technologies and this data has been on identifying patient populations and measuring the impact of various interventions.  While we’ve begun exploring creative approaches in the conceptual form of personalized medicine, our attention is consistently drawn to technical capabilities versus creatively rethinking the fundamental approach to care delivery.

Whether we’re talking about population health or personalized medicine, the key to unlocking the potential of the technology and data is creative problem solving at the fundamental process level.  We must rethink the current care delivery model in which individual providers funnel populations of patients with similar symptoms toward common interventions.

Whatever it’s final form; a new delivery model must be dynamic and collaborative.   Rather than focusing on patient populations, it should involve caregiver communities following individual risk-stratified patients and coordinating strategy toward behavior change

The transformation looks something like this:


Symptom => Individual Clinician Assessment => Intervention


Risk Assessment => Care Team Coordination => Behavior Change

In this new model focused on today’s chronic disease challenges, analytics-driven risk assessments replace symptoms, care team coordination replaces individual assessment, and behavior change replaces intervention as the primary goal.

We’ve begun to travel down this path by focusing much of the current health technology discussion on interoperability.  As one of my tech friends likes to say however, ‘getting the computers to talk to each other is easy—getting the people to talk to each other is another story.’  Perhaps we can take a lesson from Pixar and Ed Catmull.  Pixar began as a technology company.  In the end Ed’s passion became developing and sustaining a culture that aggressively fosters and defends creativity.  In turn, that creative culture is constantly vigilant for processes that have become stagnant or corrupt. 

Perhaps following Pixar’s lead can help write a happy ending for Health Care.