Health-On-Callstatic.sharecare.com/promo/askmd/white-paper/Sharecare... · 2018-04-26 ·...

Health-On-Call Using Mobile and Web Technology to

Create More Informed, Better-Prepared Patients and Caregivers

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White Paper

Health-On-Call White Paper

2 Sharecare www.sharecare.com

Patients and Caregivers: Engaged, Online and Social It goes without saying that patients are increasingly engaged in managing their own health care, including using computers, mobile tablets and smart phones to find, download, store and share digital health information. According to 2013 data from Pew Internet, 85% of US adults now use the Internet -- and 72% of Internet users say they’ve looked online for health information within the past year.1,2 For over a quarter of Americans, mobile phones are already an established way to access health tools and information, a number that’s expected to double in the next four years.3,4 The most commonly searched health topics include specific diseases and conditions, treatments, physicians and other health care providers.2

Are Older Patients Online, Too? While people age 50 and over may be less likely to search for online health topics than their younger peers, they still represent a significant online presence: 54% of 50-64 year olds and 30% of people age 65 and over are now logging on to find health information. Among younger people, the rates are 72% for 18-29 year olds, and 67% for 30-49 year olds.4

What About Caregivers?

Underscoring the inherent social nature of health, Pew says over half of online health

research is done on behalf of someone else: 72% of caregivers search online for digital

health information, outpacing non-caregivers on all health topics covered in the survey

-- including specific disease and medical problems, treatments and procedures, drug

options and drug safety.5,6,7

Patients turn to the Internet not to replace providers, but because they’re motivated to become more engaged in their own health care.



2013 Data: Patients and Online Health Information



How Are Patients Using Digital Health Info? Patients turn to the Internet not to replace providers, but because they’re motivated to become more engaged in their own health care. Among the reasons for increasing patient activation and engagement are increased availability, accessibility, awareness, and social exchange of health information. In addition, some evidence suggests patients are motivated to improve their clinical encounter and health care quality using the information they find. A 2012 study published in the Journal of Health Communication found that almost 70% of online health seekers planned to ask their physician questions about the information they found online, and 40% printed online health information to take to their appointment.8

According to Pew Internet, the Internet has changed the way people interact with health information.2,6 While patients still seek face-to-face health care encounters most of the time, access to wireless and mobile devices combined with the prevalence of online resources (such as e-commerce, social media and mobile applications) is making it more possible, more acceptable and more convenient to complete all types of transactions --including health-related ones -- in cyberspace.1,2,6

Ups and Downs of Online and Mobile-Health One of the advantages of increased patient engagement with digital health information is that patients who take an active part in their health care tend to have better outcomes and lower health care costs.9,10 According to a brief published by the Robert Wood Johnson Foundation, engaged patients are more likely to seek and obtain preventive services, adopt positive behaviors, follow treatment and actively ask questions when they see their providers.11

On the downside—for patients, caregivers and the providers who serve them—are problems around quality and credibility of online information, and patient ability to effectively search, sort and comprehend massive amounts of online information.



On the downside -- for patients, caregivers and the providers who serve them -- are problems around quality and credibility of online information, and patient ability to effectively search, sort and comprehend massive amounts of online information. Using Non-Evidence Based Search Engines As the percentage of patients seeking online health information continues to grow, the Internet (along with mobile and wireless technology) is becoming increasingly important as a facilitator of health information flow between patients and providers. Given that, and the fact that 77% of online health seekers are using non-evidence based search engines, such as Google, Bing or Yahoo to find health information, it’s no surprise that the validity of health information obtained by patients is a major concern, not only to patients and caregivers, but also to their providers.6 Patients come to docs with a huge amount of misinformation,” says Michael Roizen, MD, chief wellness officer for Cleveland Clinic, a practicing physician and a member of Sharecare’s editorial advisory board. “They do an Internet search and come up with possibilities that aren’t viable. You can put a symptom in Google and get infinite info --you love empowered patients, but you also want to help them be more selective.”

Navigating Online Information Chaos The Internet provides endless potential and value if used well. However, if not harnessed and combined with quality care from physicians and other trained providers, it also has the potential to increase anxiety and confusion for patients and caregivers -- not to mention, frustration for the medical community. This is especially true if patients are overcome with information overload and cyberchondria (the unfounded escalation of concerns about common symptoms) due to inaccurate, irrelevant or disorganized Internet or symptom checker search results.12, 13



However, to date, the average symptom checker often falls short, providing patients and caregivers with overly-generalized, unreferenced information and health risk assessments—then failing to tie the digital health encounter back to the “real life” patient-provider encounter.

Less Time, More Pressure While patients are sifting through large amounts of online health information and becoming more proactive medical consumers, physicians and other providers are facing information overload on their end as well, due to increasing patient loads, increasing amounts of patient and medical data and the effects of new information and communication technologies.14 In addition to too much information, too little time is also a problem for busy providers. Time with patients and on all job-related responsibilities is short -- and likely to get even shorter given population growth, aging and the 30 million newly-insured patients expected to walk through the door next year under the Affordable Care Act.15,16

Assuming the right content and features, this is good news for developers, sponsors and users of web and mobile health applications and media. However, to date, the average symptom checker often falls short, providing patients and caregivers with overly-generalized, unreferenced information and health risk assessments -- then failing to tie the digital health encounter back to the “real life” patient-provider encounter.

What's more, many patients and caregivers who seek online health information now use search results instead of visiting a qualified physician or provider, while lacking the ability -- often, despite being highly educated -- to discern the validity of the information or its online source. The Power of Online Information Importantly, information obtained from online search and symptom checker results can influence patient decisions about when to engage a physician or provider, as well as behaviors related to diet, exercise and preventive health activities.12



Connecting Patient and Provider Needs Despite the clear challenges, problems with information chaos and too little time have spurred growth in R&D and innovation around patient-provider technology solutions. In 2012, Sharecare, the nation’s fastest growing health and wellness social technology media platform, acquired PKC Corporation, a leading developer of health care decision support software, to create AskMD, an application for mobile devices and the web. AskMD offers a personalized, evidence-based platform that uses pattern recognition software to delve into patient complaints, prompting them with questions about their medical history and symptoms. The result is accurate, relevant, fully-referenced health information delivered to the patient in an organized format, and a thorough history of the patient’s symptoms prepared before the office visit. Patients can print this information or share it electronically with family, friends or their physician. Using GPS technology, the app instantly generates a mapped list of qualified, nearby physicians, so that connecting with health care providers becomes a seamless part of the patient's digital health experience -- not an afterthought.

For patients and providers, this means targeted, productive office visits are more critical than ever. If patients come in misinformed or unprepared, valuable office time that could be spent addressing patient concerns and on personalized patient education may be wasted.17 Says Darria Long Gillespie, MD, MBA, executive vice president of clinical strategy at Sharecare and a practicing emergency room physician, “It can be extremely time consuming to get the core of what’s going on with a patient, and you’re also likely to get different answers if you ask the same question more than once. In the role of patient, most people aren’t great historians and don’t always give doctors the answers or info they need to make the best decisions, especially within the timeframe of a typical office visit.” Add to this the fact that all stakeholders -- providers, patients and payers -- are looking for innovative ways to improve health outcomes, reduce errors and reduce medical costs -- and the need for information technologies that create more informed, prepared patients and facilitate better patient-provider communication is readily apparent.



Combining Patient Data with Medical Knowledge AskMD has its roots in the work of Lawrence Weed, MD, who developed the concept of the Problem Oriented Medical Record (POMR) and the SOAP note in the 1960s. In a seminal article published in the New England Journal of Medicine in 1968, Weed outlined his vision of the POMR as a way to help clinicians deal with and document, in a structured and rigorous manner, the multitude of patient problems they routinely face.18 During the 1970s Dr. Weed led an effort to develop an electronic version of the POMR designed to make patient data more organized and retrievable in clinical practice. In 1991, he founded Problem Knowledge Couplers Corporation (PKC), to continue his work and help solve the dilemma of physicians relying only on their memory and processing capacity to solve complex problems. Optimizing Information for Patients Weed developed his decision-support technology to help overcome the inherent limitations of the human mind when faced with complex health problems. Problem knowledge couplers (known as “consultations” in the context of AskMD) are computerized systems designed to gather relevant patient data and offer clinical guidance on a specific health problem or complaint. After collecting a patient’s data via a detailed questionnaire, the system organizes the data (based on current medical research) to expose meaningful medical patterns and deliver a clinically valid analysis.19 Originally developed to optimize clinical decision-making by anticipating and enhancing a physician’s way of thinking, Weed’s technology is now being leveraged by Sharecare to empower patients and caregivers with physician-quality health information. 20 Years of Research and Development In 1998, PKC began work on a series of contracts with the Department of Defense, totaling over $55 million dollars and contributing to over a decade of expansion and development of PKC’s clinical knowledge platform and medical content repository. Both the platform and content repository were developed with direct input from physicians and used exclusively by physicians prior to Sharecare’s development of AskMD. AskMD is therefore built upon over 20 years of knowledge, expertise, research and development.



Personalized, Valid Health Information for Patients AskMD provides patients and caregivers with an easy-to-use interface that allows them to search for and obtain health information that is real-time, valid, well-organized and personalized to their unique health history. Users can select a “symptoms consultation” to get a list of common causes of a health problem, such as knee pain or shortness of breath. Or they can select a “management consultation” to get information about managing a health condition, such as asthma or high blood pressure. The ability to generate maps of qualified, nearby providers ties the patient’s digital encounter back to the provider’s office -- encouraging “real world” patient-provider encounters when they are needed.

Not Just Another Symptom Checker AskMD’s clinical knowledge platform is extracted from the core literature upon which providers consistently base their practice decisions. The AskMD clinical content development team follows a rigorous policy for methodically reviewing the literature and selecting best-quality information sources appropriate to each specific complaint or health condition. Sources for literature review include:

• Best-of-breed medical textbooks

• Peer-reviewed journals • Evidence-based clinical practice guidelines

• Systematic reviews The AskMD content development team -- including physician reviewers, other medical professionals, librarians and editors -- continually works to update AskMD consultations. Updated text book editions are regularly incorporated and automated, intelligent queries of the scientific journal literature are run on a daily basis. The content team relies on the scientific literature to determine what is included in the platform. Treatments and recommendations are included only when they reach the level of guidelines or endorsement by leading health organizations. They are then analyzed and synthesized using a proprietary system to extract the relevant facts and provide the most important information for patients and caregivers.

Sample Sources Used to Support AskMD Top-Cited Peer-Reviewed Journals • Annals of Internal Medicine • BMJ • Chest • Circulation • Cleveland Clinic Journal of Medicine • JAMA • New England Journal of Medicine • The Lancet • Mayo Clinic Proceedings • Neurology

Gold Standard Clinical Guidelines Asthma Management National Institutes of Health, National Heart, Lung, and Blood Institute. Expert Panel Report 3 (EPR 3): Guidelines for the Diagnosis and Management of Asthma, 2007. Global Initiative for Asthma Executive Committee. Global Initiative For Asthma (GINA) [Internet]. 2012. Global Strategy For Asthma Management and Prevention: 2012 Update. Heart Failure Management Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2005;112(12):e154-235. Jessup M, Abraham WT. 2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults. J Am Coll Cardiol. 2009;53(15):e1-e90. Heart Failure Society of America, Lindenfeld J, Albert NM, et al. HFSA 2010 Comprehensive Heart Failure Practice Guideline. J Card Fail. 2010;16(6):e1-194.



Completing health history questions before office visits may save valuable office time, potentially resulting in more time to discuss concerns and get information directly from the provider. AskMD also benefits patients by allowing them to answer and save history questions while symptoms are happening, before key factors and symptoms are forgotten. Patients can create and save consultations and other medical history -- including medications, preferred physicians and health insurance information -- for themselves and other family members. Their personalized results can be printed and shared electronically with family members, friends or with their provider.

How AskMD Helps Patients

• Provides patients with a real-time source for valid, personalized health information (not generic symptom checker results).

• Allows patients to create and save AskMD consultations and other medical history for themselves and family members.

• Allows patients to create and save lists of medications, medical conditions, insurance information and preferred physicians for themselves and family members.

• Offers opportunities to answer and save health history questions while symptoms are happening, before relevant factors are forgotten.

• Gives patients more time to discuss concerns and education in the office with their provider, with less time spent on history-gathering in the office.

• Offers patients the opportunity to print out and share consultations electronically with family members, friends or their provider.

Conclusion Today’s patients are actively involved in managing their own health care, including searching for health information online and using mobile and wireless devices at growing rates. There is no denying that the Internet and mobile applications will become increasingly important as sources of health information. At the same time, physicians and other health care providers are faced with information overload, increased responsibilities and less time per patient, making productive office visits more critical than ever. Developed and fine-tuned by clinicians over more than 20 years, AskMD is at the forefront of digital patient health management tools. As a mobile and web application that provides evidence-based, peer-reviewed information and personalized results for patients, AskMD uses pattern recognition software to delve into patient complaints, creating an organized, thorough history that can be printed or shared electronically with others, including the patient’s provider.



References 1 Pew Research Center. Who's online trend data (adults), 2013. Pew Internet & American Life

Project.http://pewinternet.org/Trend-Data-(Adults)/Whos-Online.aspx. Accessed July 10, 2013. 2 Fox S., Duggan M. Health online 2013. Pew Research Center's Internet & American Life

Project. January 15, 2013. 3 Manhattan Research. Mobile health trends for 2012. http://manhattanresearch.com/Images---

Files/Data-Snapshots/Mobile-Health-Trends-for-2012. Accessed July 3, 2013.

4 Fox S., Duggan M. Mobile health 2012. Pew Research Center's Internet & American Life Project. November 8, 2012. http://www.pewinternet.org/Reports/2012/Mobile-Health.aspx. Accessed July 10, 2013.

5 Fox S., Duggan M., Purcell, K. Family caregivers are wired for health. Pew Research Center's Internet & American Life Project. June 20, 2013. http://www.pewinternet.org/~/media//Files/ Reports/2013/PewResearch_FamilyCaregivers.pdf. Accessed July 10, 2013.

While traditional symptom checkers deliver generic, unreferenced information based on a few standard questions, AskMD goes deeper, empowering patients to actively engage in their own health care and become more informed, better-prepared patients, potentially improving communication with their provider and enhancing their own patient experience.

About Sharecare Sharecare is a health and wellness social media platform that connects people with top-ranking experts ranging from doctors and specialists to hospitals, health care companies and health conscious consumers. The power behind the site’s unique Q&A format is its collective wisdom, providing health-seeking consumers with answers reflecting multiple expert perspectives -- greatly simplifying the search for quality information. Created by Jeff Arnold and Dr. Mehmet Oz in partnership with Harpo Studios, Sony Pictures Television, and Discovery Communications, Sharecare allows people to ask, learn, and act upon questions of health and wellness, creating an active community where knowledge is shared and put into practice -- simply said, sharing care. Launched in 2010, Sharecare is based in Atlanta, Georgia. AskMD is an information tool that allows users to be better informed. The application is not intended to collect or provide information in connection with services provided by a health care provider to patients. Health care providers must continue to comply with their obligations of patient confidentiality, including without limitation, their obligations under the Health Insurance Portability and Accountability Act ("HIPAA"). Sharecare's services to users are governed by the Sharecare Terms and Sharecare Privacy Policy at Sharecare.com. Additional terms and conditions may apply.



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7 Cohen RA, Adams, PF. Use of the internet for health information: United States, 2009. Centers for

Disease Control and Prevention. Number 66, July 2011. www.cdc.gov/nchs/data/databriefs/db66.htm. Accessed June 9, 2013.

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and care experiences; fewer data on costs. Health Affairs. February, 2013; 32(2):207-214. 10 Hibbard J, Greene J, Overton V. Patients with lower activation associated with higher costs;

delivery systems should know their patients’ scores. Health Affairs. February, 2013; 32(2):216-222 11 Which approaches encourage patients to become more engaged in their own health care?

Robert Wood Johnson Issue Brief, January 2012. http://www.rwjf.org/content/dam/ farm/reports/issue_briefs/2012/rwjf72086. Accessed July 3, 2013.

12 White RW, Horvitz, E. Cyberchondria: Studies of the escalation of medical concerns in web search. ACM Transactions on Information Systems, November 2008; 27:4(23). http://research. microsoft.com/apps/pubs/default.aspx?id=76529. Accessed June 11. 2013.

13 Greenberg, R. Health care advice: The problem of health information overload. Huff Post Healthy Living: The Blog. June 10, 2010. http://www.huffingtonpost.com/riva-

greenberg/health-care-advice-the-pr_b_605606.html. Accessed December 8, 2013. 14 Hall A, Walton G. Information overload within the health care system: a literature review. Health

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and aging population? Health Aff. 2008; 27:w232-41. http://content.healthaffairs. org/content/27/3/w232.abstract. Accessed July 9, 2013.

16 PricewaterhouseCoopers. 30 million newly-insured under the American Affordable Care Act: who

are they? http://www.pwc.com/us/en/health-industries/publications/health-insurance-exchanges-and-medicaid-expansion.jhtml. Accessed July 25, 2013.

17 Haupt, A. How to maximize a doctor visit. U.S. World & News Report. July 26, 2011.

http://health.usnews.com/top-doctors/articles/2011/07/26/how-to-maximize-a-doctor-visit. Accessed December 8, 2013.

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