Mary Meeker from KPCB recently delivered her gallery of “2013 Internet Trends” at the All Things D conference (#D11). I was originally directed to this data marathon from the mobile perspective via Brian Dolan (@mobilehealth). However, Meeker’s presentation is much more than that. It is a sprawling look at the Internet of Things, Traditional Industries Being Re-Imagined, and Sharing Everything. Fortunately, her mammoth 117-slide deck (that was delivered quickly in just 20 minutes; video here) has been placed on @Slideshare.
It is a lot to process, but here are just a few points that jumped out at me from Meeker’s presentation:
- The average smartphone user reaches for his/her device 150 times a day (what does this hint at for wearables?)
- Percentage of residents who ‘share everything’ or ‘most everything’ online: USA (15%) compared to Saudi Arabia (60%)
- JD.com offers same day package delivery with real-time map tracking…often by bike…in China
- Amazon was the third largest provider of tablets in 2012 (behind Apple & Samsung); overall tablet growth has outpaced smartphone growth
- 77% of academic leaders at 2,800 colleges perceive online education as the same or superior versus face-to-face education
- Top “Learning Tools” from “learning professionals” worldwide included: 1. Twitter 2. YouTube 3. Google Docs…7. Skype 8. PowerPoint…12. Evernote 13. Slideshare 14. Prezi
- Mary Meeker is funny, who knew?
Again, there is a lot of information here and some require a deeper dive, but this is a great resource to answer some questions and stimulate more.
Since the demand for pharmacy residency spots far outstrips the supply – only about 60% of students match nationally – my colleagues Josh Caballero, PharmD, BCPP and Sandra Benavides, PharmD created a course to better prepare students at our College of Pharmacy to pursue a residency. Over the next couple of years, students completing that course went on to match 80% of the time. That success eventually turned into the recently published book, Get The Residency: ASHP’s Guide to Residency Interviews and Preparation edited by Drs. Caballero, Benavides, and I. The book was written in collaboration with faculty, clinicians, and residency program directors from across the country. I am pleased that it has been well received by students and reviewers alike and has entered its second printing. Currently, Dr. Caballero directs a neurocognitive fellowship and I serve as a director of a fellowship in consumer health informatics.
Skinny jeans are a surrogate marker, Nick Gross was not who I expected, and the e-patients are even braver than I thought. Listening to the Club Med X play list (selections at bottom), I found myself reflecting on the things I learned, who I spoke with, and what inspired me at Stanford Medicine X.
The Things I Learned
Bringing the science/citizen science
Scientist and wine aficionado Ian Eslick (@ieslick) was the first winner of my daily ‘Bringing the Science’ (BtS) award at Med X. He explained how his own condition of psoriasis informed and affected his approach in creating the first MIT-run authoring experiment. The purpose of the experiment is to study “how patients think about self-experimentation and figuring out how making changes impacts them” at PersonalExperiments.org. He also opened the door to the n-of-1 vs epi debate and the idea of future sampling.
The next day CEO of Asthmapolis David Van Sickle (@dvansickle) claimed the coveted (albeit fictitious) BtS award with his fantastic marriage of humanizing the process of research with almost zealous inquisitiveness. He shared the origin of his obsession of “stalking asthma” from Navajo villages to Alaska and then to the CDC where the limitations of public health data and the role of technology were crystallized for him. Van Sickle went on to describe his excitement about the role of mHealth in preventing diseases in populations. Acknowledging that I may have sipped the Kool-Aid when it moved into mHealth for prevention, you must watch his 15 minute talk. “The hardest cause to identify is the one that is universally distributed.” Indeed.
Rhiju Das was the very next speaker discussing EteRNA, which necessitated creation of the ‘Bringing the Citizen Science’ faux-ward. His Das Group at Stanford in conjunction with Carnegie Mellon challenges citizen scientists and gamers to create RNA sequences that fold into target shapes via the interface they’ve developed. Interestingly, in part due to Das’ involvement as part of the team that created Foldit, EteRNA is seen as its successor by some.
Role of design and UX
So, it turns out design isn’t just for architects and frogs anymore. I had some feel for the roles of human-computer interaction and behavioral health design from working with researchers and others like Tonic. However, I was blown away by the roles of design and UX ranging from the seemingly mundane (e.g., hospital equipment) to the ambitiousness of the IDEO Design Challenge Workshop to its potential in transforming children’s fears about nebulizer treatments into nurturing moments.
Self-trackers and Quantified Self
Before the Med X Self-Tracking Day, I was peripherally aware that people like @FredTrotter were hacking away at things and tweeting their weight and that Ernesto Ramirez (@e_ramirez) was causing waves in something called Quantified Self. But I definitely did not realize how widespread self-tracking is until @SusannahFox debuted her new Pew data (re-defining it for much of the crowd), nor did I appreciate how creative (@nancyhd; Winner: Best smile-powered LED headdress) or dedicated (@bettslacroix) some of those involved are. This is an area worth exploring for future research and I’ll be curious to see what comes of some of the specific efforts such as MyMee.
Who I Spoke With
Surprises and plans
Just because it seems cliché to say that the best part about conferences are often the hallway conversations doesn’t make it any less true. In this case, the Medicine X First Look video archive of the entire conference goes a long way for those who couldn’t make it…but being surrounded by the attendees of this conference conferred an entirely separate set of benefits and opportunities. I had a series of eye-opening impromptu meetings and promising conversations. One was with Nate Gross (he of the minimalist Twitter handle @NG; co-founder of Rock Health and Doximity) at a group dinner. As I have zero feet in the business world and most of my business savvy comes from having watched the movie Wall Street in 1987, I was sort of resigned to sitting next to a brusque, bottom-line type. Instead, I found him to outwardly be a more contemplative sort who spent more time observing than speaking…or maybe he was just happy to be seated next to someone who didn’t have something to pitch.
Most of my other notable conversations portended more specific possibilities. I found myself in one sitdown listening to opportunities described on the fly between AMIA Fellow and researcher Qing Zeng-Treitler, Medify’s Derek Streat, and Alliance Health’s David Goldsmith (@dsgold). Later I enjoyed an intial exploration with Sarah Kucharski (@AfternoonNapper) about extending the role of the patient in research design. That was a conversation I suspect will continue.
What Inspired Me
Two people and an object
Unsurprisingly, it was the people and their stories at Medicine X that I found most inspiring. Many of the Ignite talks by the e-patient scholars were personal and touching, but I found two people particularly so. Sean Ahrens has taken his own story about Crohn’s and literally built a community for others suffering with the same struggles in Crohnology. It’s amazing to me that someone with a potentially debilitating condition refuses to cave to its daily demands and instead sources it to create a virtual bridge to connect and benefit others.
The other person is @DanaMLewis. Personal bias aside (see panel slide deck), to have a person at her age & stage create another type of virtual community in #hcsm that has such far reaching effects that it even inspires Alicia (@stales) Staley (herself quite the wow-inducer) to create #bcsm is immensely encouraging to me.
Youth. Creation. Connection. Wow.
A different kind of enchanted object
Watching David Rose of Vitality present at the mHealth Summit introduced me to the concept of the ‘enchanted object’. At Med X, I saw a more literal version of this implemented in the form of the Magic Mask. The Magic Mask used augmented reality tech and lessons from IDEO to transform what can be a frightening experience of nebulizer treatments to a parent-involved storybook time for these children with asthma. Trust me, you’ll want to read the full description of this work by @RoujaPakiman and @LucieRichter here.
Our Panel and Fin
An e-patient, an entrepreneur, and an academician collaborate to conduct research. In our panel, @DanaMLewis, @BorisGlants, and I tried to share our lessons in adopting the participatory design model for research. Hopefully we were able to inform a bit about misteps and successes and provide a dash of inspiration so that more patients and researchers will partner to capitalize on the strengths of each other.
I have been to a lot of conferences, and no one puts the level of thought and care into each detail of a conference like @LarryChu. This was a stellar experience that I look forward to next year!
Club MedX Playlist (selected songs)
Harvest Moon – Poolside
Night Falls – Booka Shade
Pharaohs – SBTRKT
4 years – Kid Savant
Rocket No. 3 – A Rocket in Dub
Skylight – Gramatik
Save the World – Swedish House Mafia
Shuffle a Dream – Little Dragon
Somebody That I Used to Know (feat. Kimbra) – Gotye [h/t @iam_spartacus who told me who the artist was, as I am old and thought the chorus was Sting]
TC (Theft Citation i.e., where I stole this post title from): I read @SusannahFox’s post on Stanford Medicine X. As with many of her posts (and I think she would agree), some of the best value is in the comments. In this case, it was the contribution by David Goldsmith who pointed out that Med X is the rarest of birds in that it managed to both inform AND inspire.
As the profession of pharmacy continues to evolve in response to society’s health-related needs, one of the most pressing developments is the demand for more residency training opportunities. The demand currently far outstrips the supply of residency positions, and 2010 saw nearly 1 in 3 applicants fail to secure one through the Match. The onus on us as pharmacy educators is two-fold. Nationally, we need to scale up existing slots and help create new programs. Locally, we need to prepare our students as intensively as possible to help them compete for residencies that will help transform them into agents of change for the profession.
To that end, a couple of my colleagues developed an elective, Residency Interviewing Preparatory Seminar (RIPS), the details of which were recently published in the American Journal of Health-System Pharmacy. I was fortunate to be involved in this course aimed at developing our students’ core skills in the process including: improving their interviewing and presentation skills, professionalism, and developing their curriculum vitae (CV) and personal statement. As the course was targeted to P4s (i.e., completing the final, clinical phase of their education) who were at their rotation site all day, the class was held weekly for two hours in the evening and timed to be completed directly before the Midyear Clinical Meeting.
Completion of the RIPS course demonstrably improved the confidence of the enrolled students and 78% of RIPS students that cycle secured a residency. Nationally, the success rate is only around 62%, although these numbers cannot be directly compared. We have continued the course since publication and the most recent iteration saw a further increase in the percentage of RIPS students able to secure a residency position. Plans are to continue an iterative approach to course development.
When you teach at a University with multiple campuses (in our case, Fort Lauderdale and Palm Beach in Florida and Ponce in Puerto Rico) even with live, interactive videoconferencing – you have to try and figure out ways to connect with your students at different sites. We’ve tried different methods over the years with varying success, but one that worked well early on was the use of an audience response system (aka clickers). This is something I talked about previously in the presentation, “The Science Behind Engaging Students in Class“.
Our recent article in the American Journal of Pharmaceutical Education basically describes our multi-campus implementation and measurement of its impact on student engagement, satisfaction, and opinions about projected use of clickers in other courses. We also touched on related issues, such as clickers’ possible role in helping desensitize communication apprehension in students.
Clauson KA, Alkhateeb FM, Singh-Franco D. Concurrent use of an audience response system at a multi-campus college of pharmacy. American Journal of Pharmaceutical Education. 76(1):6.
The Consumer Health Informatics & Web 2.0 in Healthcare elective I coordinate for the college of pharmacy wrapped up in December and the ‘votes’ are in about the course. I felt the course went more smoothly this semester and was thrilled to again be able to expertsource several topics by benefiting from guest lecturers. However, the final decision (as always) rests with the students, whose opinions were solicited in the quest to improve the course.
The final exam is an all essay affair (which is not exactly universally popular) and at the end prompted the students to share their opinions on the most and least useful/interesting lectures of the semester along with other feedback.
Based on the comments they wrote, the topics that generated the most traction among students were mHealth and eProfessionalism. Students conveyed they were most intrigued about the potential of mHealth and felt like the issues within eProfessionalism were most personally relevant in their lives. Contributing guest lectures on these topics were leading social media & pharmacy thinker and University of Kentucky professor Jeff Cain (@DrJeffCain) and pediatric endocrinologist-turned-entrepreneur Jen Dyer (@EndoGoddess), who has created an eponymous app. Dr. Cain’s contribution, in particular, may end up having the most longevity of all topics within the course.
However, the most polarizing topic (and lively discussion) was spurred by the guest lecture “Spread the Love, Nothing Else” by Ramin Bastani (@RaminB) of Qpid.me. I first met Ramin at @BJFogg’s excellent Mobile Health @ Stanford. While I wasn’t entirely sure what I thought of the STD-notification idea initially, I certainly believed it would be a great tool to engage students about issues surrounding mHealth, the changing nature of communication via social media, and public health. It was. They were.
A sneak peek of data and a physician perspective on use of social media caught the attention of a group of our students as well. Stanford Medicine X creator and AIM Lab Director Larry Chu (@LarryChu) provided an interesting look via his analysis of 4999 online physician ratings.
The most pharmacy informatics-centric and global perspectives that resonated with students were provided by Jerry Fahrni (@JFahrni) of Talyst and Brent Fox (@Brent_Fox) of Auburn University, respectively. The course (unsurprisingly) is focused on the consumer health subspecialty of informatics, but those students who already are planning a path in pharmacy informatics clearly took to Dr. Fahrni’s lecture.
One of the new topics this semester was #SocialGood where we talked a bit about efforts like Free Rice and Kiva. It was really inspired by The Dragonfly Effect lecture from the 2011 Medicine 2.0 Congress. It was pretty primer-y and could likely benefit from a guest lecturer (suggestions?).
All-in-all, the course had some great moments, I think the students took away some useful tools and ideas, and I definitely learned an enormous amount from them and the guest lecturers!
The most recent issue of the American Journal of Pharmaceutical Education featured a Technology in Pharmacy Education section. There is some really interesting reading in this section including, “Use of Twitter to Encourage Interaction in a Multi-campus Pharmacy Management Course” by @Brent_Fox. Brent actually authored several articles including, “Knowledge, Skills, and Resources for Pharmacy Informatics Education“, which he wrote along with the newly installed Chair of the ASHP Informatics Section Allen Flynn, informatics luminary and frontliner Chris Fortier (@FortiPharm), and I. With this article, we tried to summarize the baseline informatics knowledge that pharmacy students should possess upon graduation, framed within med use processes. My hope is that it will be of real practical use to educators and others as specific recommendations are provided regarding activities and resources for class and curricular integration, rather than just observations made from 30,000 feet. Also, as with all articles in AJPE, this one is open access (OA) in that it can be accessed free, full-text by anyone.
Source: Fox BI, Flynn AJ, Fortier CR, Clauson KA. Knowledge, skills, and resources for pharmacy informatics education. Am J Pharm Educ. 2011;75(5):Article 93.
One of my pet interests is health literacy and its far-reaching impact on quality and access to healthcare. The issues surrounding it can almost be insidious in nature. Despite this, health literacy is typically only given superficial coverage in traditional training programs.
Here in South Florida we have an especially diverse patient population with a higher than average percentage of those with limited English proficiency (LEP). It’s pretty intuitive, but LEP patients are (unfortunately) more likely to encounter barriers to health care and are associated with poorer outcomes than non-LEP patients.
In part to address this, there was actually an Executive Order mandating ”meaningful access” be given to LEP persons for Federally-funded activities (what, you didn’t think ‘meaningful use/access’ was limited to EHRs and the like?). Consequently, hospitals, clinics, etc. began incorporating translators and other language access services (LAS) as SOP (at least on paper) due to their receipt of Federal funding/payments. However, a funny thing happened on the way to implementation in community pharmacies – much as those pharmacies and the healthcare professionals that staff them are treated differently than similar entities/professionals in our system of health care…this mandate has been treated more as a voluntary compliance issue. What, if any, impact has this had on reimbursement or outcomes? The jury is still out. However, as a first step to methodically examine this issue, we conducted a national survey of availability and use of LAS in community pharmacies; the initial results of which have recently been published in the Journal of the American Pharmacists Association (JAPhA).
Pharmacist responses to the survey ranged from descriptions of widely advertised and seamlessly integrated interpretation (verbal) and translation (written) LAS services to the (rarely observed) attitude of ‘if they’re in our country they should speak English’. Overall, we identified issues regarding awareness (e.g., about half of pharmacies with LAS capacities did not report making them known to patients), use of LAS (e.g., about 40% said they ”never” used interpretation/translation tools), and workflow/time (e.g., a quarter of respondents said they simply lacked time to use LAS). Alternately, there were encouraging signs as pharmacies that did apprise patients of LAS availability used a variety of methods including in-store direct notification, signage, flyers, and targeted mailings. Additionally, more LAS products are becoming available such as Elsevier’s MEDcounselor Languages module, which advertises SIG translation and patient education materials in 14 languages. Another gem that area pharmacists have started using (albeit moreso in AmCare clinic settings) is the free MediBabble iPhone app. My understanding is that a future update will (ahem) include pharmacists in the introductions section.
Unfortunately, our article “Community pharmacists’ use of language-access services in the United States” is behind a subscription wall, but I would be happy to answer any questions that I can.
Disclosure: A couple years ago we received a grant from one of the quadrillion companies Elsevier operates for an unrelated research study. Inclusion of their product in this post is mostly due to timing (I just received an email about it), and should probably not be construed as a conflict of interest except for the most Mel Gibsonian of conspiracy theorists. Separately, this JAPhA LAS study was funded by a NSU President’s Grant. Going forward we are planning to study the LAS disconnect further, as well as possible solutions that may include tools such as automated LAS kiosks in pharmacies and online functionality as well as LAS availability notification via social media; funding source(s) TBD.
Source: Feichtl MM, Clauson KA, Alkhateeb FM, Jamass DS, Polen HH. Community pharmacists’ use of language-access services in the United States. J Am Pharm Assoc. 2011;51(3):368-72.