Launching a Center for Consumer Health Informatics Research

We are very excited that the Nova Southeastern University College of Pharmacy has officially launched our Center for Consumer Health Informatics Research (CCHIR)! Like all undertakings of this magnitude, it has been in the works for some time and has benefited from tremendous support from many corners – in particular the Chair of the Department of Pharmacy Practice and the Dean of the College of Pharmacy. Below is a presentation outlining some basics about the Center. I look forward to working with its faculty and collaborators and steering the CCHIR toward many great developments in the future.

@kevinclauson

 

UPDATE: The dedicated site is up at www.CCHIR.com

Texting for Diabetes @ Medicine 2.0’11 Stanford

For Medicine 2.0 (#med2) at Stanford this month, I am excited to be delivering a Research in Progress presentation of our study,  “Impact of Texting and Predictive Potential of Health Literacy on Medication Adherence in Type 2 Diabetes Mellitus”. The study, supported by the McKesson Foundation Mobilizing for Health grant program, aims to help a diverse and largely uninsured and underinsured population in South Florida improve adherence to the medications they take for type 2 diabetes mellitus. Our study intervention is designed as a simple series of text messages through treatment targeting one of the primary hurdles to optimal medication adherence – reminders. I will also be sharing our plan for integrating health literacy assessments and disease state knowledge into the clinic EHR as a means to provide more patient-centric counseling and support. Our hope is that we produce an effective intervention to improve health which is also low-cost and thus ultimately scalable. There are a lot of scary numbers being bandied about for diabetes such as its $174 billion annual cost and forecasts that as many as 1 in 3 Americans could develop diabetes by 2050; it would be massive if this contribution could assist in stemming the tide.

Beyond being surrounded by a great study team, I have also been fortunate that providers at our primary care clinic partners have become very enthused about the study. We actually amended our original protocol to account for the fact that physicians at other clinics within the Memorial Healthcare System approached us and volunteered to help recruit participants.

Over the years, Mednet and its offspring, the Medicine 2.0 Congress have been among the most ambitious, surprising, and practically beneficial conferences I’ve attended.  Every year I see new attendees from seemingly disparate areas and sectors that come and then find commonalities that produce stimulating discussions, research collaborations, business ventures, and even friendships. This year will continue that tradition with the pre-conference lineup at the Stanford Summit on September 16, 2011 and the two-day Medicine 2.0 conference proper that follows on September 17th and 18th.  I will be there to share our research to date and eager to participate in the other sessions. I hope to see you there too!

@kevinclauson

Community pharmacists’ use of language access services

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.

@kevinclauson

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.

Mobile Health 2011: A Look Back at What Really Worked

Stanford Guest House

Mobile Health 2011: What Really Works at Stanford University (#mh11) is over, so it’s time for a quick look back at the conference.  To borrow (steal?) from conference organizer, Stanford Persuasion Technology Lab director, and quick-change artist @BJFogg – I am going to take a retrospective look at my experiences there through the device of ‘home runs’.  For full speaker slide decks, you can click here.

Conference Atmosphere Home Run
I have been to a lot of conferences…pharmacy conferences, medical conferences, informatics conferences, and social media conferences.  However, I have never been to a conference that seemed more along the lines of an ‘event that happens to be interspersed with speakers’.  This is not an indictment of the quantity or quality of the speakers; somehow there were >50 of them smoothly shoehorned into two days.  The comment is more about the carnival-like atmosphere surrounding the conference that made it fun and exciting, and contributed to a very collegial vibe.  One of the best aspects of Mobile Health was the extended breaks.  They were just plentiful enough and twice as long as an average conference.  If you think about the old chestnut ‘the best value at a conference is the hallway conversations’…voila! Those breaks doubled the value of the conference.  Also helpful was Fogg’s “giving permission” to all attendees to go up to anyone there and say hello, reinforced by the speakers largely making themselves available after panels concluded.  I’m still undecided about a few things (e.g., the birds and the bees); however, balancing all the West Coast wackiness was the fact that the conference was timed and chimed down to the minute.  Seriously.

Lodging Home Run
It’s almost like this place is a secret or something.  I stayed at the Stanford Guest House for their conference rate of $109.  You can barely stay at a Roof Rouge near a major city for that.  The rooms and hotel were basic and a little Spartan, but the beds were comfortable, the place was immaculately maintained, and the staff was gracious and knowledgeable.  The deal-maker was that the Stanford Shuttle (Marguerite) had pick-ups ~ every 20 minutes to take you all over the campus.  There was also a Guest House shuttle that could be reserved (e.g., to take you to the Alumni Center‘s conference venue).  The only drawback was that there were no dining options in-house or within easy walking distance.  Definitely will stay here again next time I’m at Stanford.

Almost Made Me Apply for a Job in Public Health Home Run
Sharon Bogan.  You just have to love somebody with that kind of spirit, fighting the good fight, excerpting Monsters, Inc., innovating in resource-limited settings, and inviting litigation (for others).  Everyone I’ve met from King County Public Health going back to the mhealth Summit has been a gem.

Goosebump Home Run [tie]
Green Goose and Proteus ingestible event markers.  Check them out.  Seriously.  They *literally* gave me goose bumps in thinking of potential applications of their technologies during their presentations.
Honorable mention: Google Cow presented by Google’s Chief Health Strategist (@rzeiger).  Technically he was focusing on Google Body, but since I had already seen Body I was pretty happy to see the bovine version.

Reunion Home Run
It was great to see @chiah @EndoGoddess @JenSMcCabe  KarenCoppock  @LarryChu  @SFCarrie  @SusannahFox and loads of others again!

New Peeps Home Run [misc]
If you are worried about our future, know that we are in good hands with people like @hcolelewis coming on the scene
Most likely to isosceles with regarding mHealth, PAHO, & Uruguay @JuanMZorrilla
Most likely to invite for Skype in guest lecture in my Consumer Health Informatics course @QpidMe
Most likely to explore the mHealth studies based out of our campus in Puerto Rico with @MarcosPolanco
Most surprised to find in my back yard Vic Shroff
Note: any conversations that included words like NDA, lawyer, or launch are not listed here for obvious reasons.

Failed to Connect at All Strikeout
I would have liked to have spoken with @enochchoi

Conversationus Interruptus Strikeout
The Keck and and PHI guys

Best Laid Plans Strikeout
Climate control and the janky A/C resulted in groups of attendees going to the outer hall and watching panels on a screen and/or going outside to cool off.
(Dis)honorable mention: minimal power outlets/juice available was surprising.  This problem was offset somewhat by the length of the breaks which allowed for both networking and recharging.

Least Favorite Panel
The Partnerships panel was my least favorite.  It definitely had eye-opening moments for some attendees and there were interesting discussions and placements (e.g., possibly the least and most idealistic two people at the entire conference were seated next to each other).  However, most of the discussions were pretty familiar to me from having gone through many of the processes described.  So my bias/preference would have been to have instead heard more specifics about MedPedia from James, Medic Mobile or Social from Josh, etc.

Overall Favorite Panel
Very tough decision as there were several really outstanding ones.  I considered a tie here but was able to pull the trigger and name “Methods and Measures for Research and Evaluation” as my favorite overall panel.  The moderator and panelists all had great content to share and illuminated a lot of the challenges in conducting research in this space.  Plus the Open mHealth initiative is so encouraging!  I think this panel is a ‘must view’ for everyone as it can help in introducing a common language that could lead to better coordination and scaling of efforts as well as providing guidance for individuals.  Overall, the quality and detail of this panel was exemplary.  I ended up choosing it in part based on the criteria of ‘if I could only have the full video of one panel’ because of its high utility for me and in sharing with multiple audiences.  Many of the slide decks from this panel are here.

Final Verdict
I am definitely happy I attended both the pre-conference workshop by @BjFogg (although it mostly served to whet my appetite for the full Boot Camp) as well as the conference proper.  I have been to some good conferences that were one-offs, but will absolutely figure out a way to make it back to Mobile Health next year.  My two most substantial takeaways were that the construct of this conference was singular in nature and that it was probably easier to connect with potential collaborators here than at any other conference I’ve attended.

@kevinclauson

Update: other perspectives on the conference have previously been posted here by @thulcandrian of AIDS.gov and a take on mHealth by @geoffclapp here.

Update 2. Here is a new conference highlights post by Craig Lefebvre (who I wish I had realized was @chiefmaven when I met him there)

Update 3: ‘Text in the City’ founder Katie Malbon has written the most ambitious mh#11 wrap-up to date

Update 4: If @TextInTheCityNY had the most ambitious/complete post, @geoffclapp has added the most thoughtful and thought-provoking review to date

Update 5: From the ‘people I wish I had a chat with’ file at #mh11, @AndrewPWilson has now provided his main takeaways from Stanford

Update 6: Patient-centric thought bubbles and more from e-Patients.net rep @msaxolotl at #mh11

Update 7: Jeff Kellem (@slantedhall) provided a tech-focused list of quick hits from the conference

Update 8: David Doherty (@3GDoctor) has added the most contrarian view of the conference to the conversation here

Pharmacist use of social media

The most recent hat tip for alerting me that one of my articles was published goes to @redheadedpharm, who also has one of the most thoughtful pharmacist authored blogs out there IMHO.  I should note that by drawing my attention to the article, TRP does not endorse the contents nor see eye-to-eye with me regarding pharmacists, pharmacy, or social media.  And that’s ok. I have to think no rational person just wants an echo chamber.  In fact, I may revisit the whole ‘landscape of pharmacist blogs’ in a future post if I can figure out a way to do so that doesn’t involve generating the hate e-mail and widespread snark that the AJHP article did.* 

In any event, I did want to share that the article I assisted Drs. Alkhateeb and Latif with is titled Pharmacist use of social media and was published in the International Journal of Pharmacy Practice.  As you can see to the left, this is a Short Communication and essentially provides a snapshot of social media use by pharmacists in West Virginia.  The most frequently used applications in this group of surveyed pharmacists included: YouTube (74%), Wikipedia (72%), Facebook (50%), and blogs (26%). Twitter (12%) and LinkedIn (12%) were also used by the respondents.  In a sense, it was a confirmatory study in that it verified some things we thought we knew about pharmacists and social media.  Some of the findings (e.g., 50% use of Facebook) were a little surprising.  Use of Facebook, in particular was examined a little more in-depth; only 15.8% indicated they used it for any professional purpose.  Usage patterns largely reflected those of non-healthcare professionals…these pharmacists used Facebook to keep in touch with colleagues, chat, upload pictures, etc. 

@kevinclauson

*It’s interesting how ‘hate e-mail’ can be a touchstone for publication topics.  The pharmacists blog study generated a dubious top 5 level volume of hate e-mail.  It was among the best written hate e-mail (which was oddly encouraging), but didn’t come close to the level produced after our Wikipedia paper came out.  To be fair, the sheer number of Wikipedia users and the widespread coverage** it received probably contributed to its you-are-as-bad-as-the-scientists-doing-research-on-puppies outrage. 

**Curious fact, of all the interviews I’ve done about our research over the years (e.g., New York Times, Wall Street Journal, CNN, BBC, NPR, New Scientist, etc.) the most hardcore fact-checkers were from Good Housekeeping and Fitness Magazine. Seriously.

Intersection of social media and research

There are a number of initiatives, sites, and platforms trying to capitalize on the power of social media and social networking to enhance research efforts. A few of them are ResearchGate, Health InnoVation Exchange (HIVE), and VIVO.  Each offers something a bit different; for a full list of ‘biomedical communities’ check out this excellent resource by @Berci Mesko.

Aside from those ‘communities’, can social media enhance research?  For me, the answer is a resounding yes.  I have both observed and directly benefitted via plenty of resources.  Here is a random sample: a source of support for grad students that hosts data sets, actual datasets made freely available for conducting research, a how-to for using Facebook to recruit survey participants,  and a prelim study on use of Facebook for health education.

However, for me, the clearest benefit has been from social networking tools; chief among those is Twitter.  It has helped my research by: 1) connecting me to people with complementary expertise for collaborating on research projects, 2) exposing me to different types of expertise and ways to approach problem solving for research, and 3) creating a filtered source of relevant information about research.

It’s that last item that I want to focus on.  A little over six months ago, I saw a tweet from @mindofandre (who has the excellent Pulse+Signal) announcing a RFP for the Mobilizing for Health grant by the McKesson Foundation.  For some reason, I did not see that RFP on my Community of Science alerts, or any of the other resources I use to stay informed on grant opportunities.  Thankfully, I did see it on Twitter.  It looked like a great match for a study our mHealth group wanted to conduct. Fast-forward 6 months and past lots of heavy lifting by my colleagues, and we are very happy we’ll be able to conduct that study as ours was one of the proposals funded!  Now that I think of it, Andre was the person who put us into touch with several other mHealth researchers about 10 months prior to that as well – quite the Gladwellian Connector, that one.  In any event, this is just one example of the intersection of social media and research.  The tools are there, you just have to use them.

Oh, and in the best pay-it-forward tradition, here are two outstanding mHealth research-related opportunities:

  1. NIH/OBSSR mHealth Summer Institute where early career investigators will get an intensive weeklong experience to learn about mHealth research. (Deadline extended until March 10)
  2. The new cycle for the McKesson Foundation Mobilizing for Health grant has begun and Letters of Intent are due on April 1, 2011.

I’d love to hear any examples of how social media has impacted your research – by creating opportunities, informing you, using it as a tool to collect data, connecting you with potential collaborators, etc.

@kevinclauson

Pimp My Poster

Like many colleges of pharmacy, ours added a seminar component years ago. The seminar has since been expanded to include a paper, a poster, and a podium presentation.  The topics range from literature-driven examinations of therapeutic controversies to original research tied to the faculty mentor’s specialty.  This year I was responsible for the recitation on the poster component.  This slide deck is what I used for that lecture.  Two particularly notable resources for me in assembling this lecture included the piece in The Scientist that inspired the name [1] and the site maintained by the Godfather of Scientific Posters: Dr. Colin Purrington [2].  If you want to dig a little deeper, here are my current favorite articles on the topic as well [3-5].  The full-text of all of these journal articles is currently available online for free.

I’ve benefitted from attending a lot of conferences over time and have seen (and continue to see) posters that are masterful creations, along with others that are absolute rubbish.  I posted the ‘Pimp My Poster’ slide deck here in hopes that it may be a resource to others, but am also keen for feedback to improve it for future iterations. 

@kevinclauson

[1]  Westly E. Pimp my poster. The Scientist 2008;22(10):22.
[2]  Purrington CB. Advice on designing scientific posters. 2009. http://www.swarthmore.edu/NatSci/cpurrin1/posteradvice.htm Accessed February 2, 2011.
[3]  Erren TC, Bourne PE. Ten simple rules for a good poster presentation. PLoS Comput Biol 2007;3(5):e102.
[4]  Hamilton CW. At a glance: a stepwise approach to successful poster presentations. Chest 2008;134(2):457-9.
[5]  Wood GJ, Morrison RS. Writing abstracts and developing posters for national meetings. J Palliat Med 2011 Jan 17 [Epub ahead of print].

Medicine 2.0’11 at Stanford – Call for Abstracts

The Medicine 2.0 World Congress on Social Media and Web 2.0 in Health, Medicine, and Biomedical Sciences is one of the most valuable conferences I have ever attended.  It has been the meeting in this arena with the clearest focus on actual research and evidence for Medicine 2.0 issues and also offers the best opportunity to connect with other researchers, clinicians, e-patients, business and policy people.  In fact, the very first Medicine 2.0 Congress was where I was introduced to (and/or first met IRL) so many people who went on to become research collaborators, colleagues, and friends. 

In the spirit of that original meeting, I am excited for this year’s Medicine 2.0 at Stanford (September 16-18, 2011).  I have always appreciated the fact that Medicine 2.0 has truly been an international gathering, but am happy to see that it is coming to the United States for the first time.  I am also eager to see another first,  the one-day Stanford Summit at Medicine 2.0, which will directly precede the Medicine 2.0 Congress.  The Summit is lining up to have an incredible array of moderators and panelists.

Given the quality of the attendees and the opportunities for discussion/dissemination of your research (and networking), if you are working in this field I would strongly urge you to respond to the Call for Abstracts, Presentations, Interactive Demos, Startup Pitches and Panel Proposals for Medicine 2.0 at Stanford.  The deadline for submission is a (rapidly approaching) March 1st, 2011.  You can click on the link for the Call or start the process by watching the overview below by this year’s Conference organizer, Dr. Larry Chu.  Also, feel free to contact me with any questions and I look forward to seeing you there!

@kevinclauson

Medicine 2.0 Call for Abstracts from Larry Chu on Vimeo.

Soapbox 2.0: Use of blogs by pharmacists

I saw a tweet by John @Poikonen that alerted me to the fact that a second article in as many weeks has been published on pharmacy and blogs.  Two pharmacy students (Justin Elkins and Chilla Goncz) and I authored “Use of blogs by pharmacists“, which appears in the new issue of the American Journal of Health System Pharmacy.  We identified all blogs that were pharmacist-authored, active (i.e. posts in the last 3 months), and written in English.  Blogs focused on pharmacy, but not written by a pharmacist were excluded.  Forty-four blogs were identified that fit those criteria.  We used the most recent 5 posts to assess the blogs based on six categories (e.g. practice based topics, identifying information, positive language, critical language, professionalism and miscellaneous). 

Most pharmacist blogs (68%) were written anonymously (versus 43% in Lagu’s study of physician and nurse blogs).  Pharmacist bloggers were equally represented by community (43%) and non-community settings (43%); the practice settings of the remainder were indeterminable.  These blogs most commonly used positive language to describe the profession (32%), other health care professionals (25%), and patients (25%).  Critical language was more commonly observed in descriptions of patients (57%); almost half of all posts contained profane or explicit language (48%). 

Most of the blogs (71%) contained mentions of pharmacologic therapies and current healthcare events (66%).  We also noted that 25% of these bloggers had a Twitter account (relative to 11% of the general population in the same timeframe per Pew).  Out of the 11 pharmacist blogs that were ranked by Technorati, all but two were primarily of a ‘ranting’ nature (e.g. Angry Pharmacist, Angriest Pharmacist, Your Pharmacist May Hate You).  Interestingly, the only two ranked, but non-ranting blogs were written by non-US pharmacists. 

Our full AJHP article lists all of the 44 blogs and while it is not open access, my hope is that via ASHP Connect and rapid response that this list of pharmacist blogs can be updated and curated using our article as a starting point.   

@kevinclauson

Analysis of pharmacy-centric blogs

We’ve seen analyses of blogs by physicians & nurses [1], medical bloggers [2], etc.  However, the excellent article “Analysis of pharmacy-centric blogs: Types, discourse themes, and issues” by Jeff Cain (@jjcain00) is the first analysis of pharmacy-centric blogs.  It appears in the the new issue of the Journal of the American Pharmacists Association and presents a balanced view of the pharmacy blogosphere.  It found that social media promotes transparency (except for authorship).  It also recognized that the degree of disinhibiton in the Web 2.0 world may have contributed to a substantial number of these blogs containing negative content about patients, pharmacy, and other healthcare professionals.  Cain and Dillon categorized 136 pharmacy-related blogs into: news, personal views, student oriented, career focused, etc.  Blog posts were also scored as positive (e.g. demonstrating empathy, supplying helpful drug information), negative (e.g. complaints, foul language), or neutral.  Cain and Dillon asserted that despite three of the top four blog themes being negative, these blogs likely had no real impact on the public perception of pharmacy as their readership “likely does not extend beyond the personal acquaintances of the bloggers and others in the profession”.  Overall, they found a variety of blog types with a preponderance of negative and derogatory posts.  Some primarily positive ones were identified as well.  The authors suggested the personal view blogs may be best used to educate student pharmacists and the profession about issues they will face.

@kevinclauson

[1] Lagu T, Kaufman EJ, Asch DA, Armstrong K. Content of weblogs written by health professionals. J Gen Intern Med 2008;23(10):1642-6.
[2] Kovic I, Lulic I, Brumini G. Examining the medical blogosphere: an online survey of medical bloggers. J Med Internet Res 2008;10(3):e28.