I never got to show these slides, but I blogged their existence and told people to go look. With over 2000 views in the first week, I guess people did. Ya can't keep people off social media! :-)

1. Information at the
point where it’s needed
makes all the difference.
“e-Patient Dave” deBronkart
Twitter: @ePatientDave
facebook.com/ePatientDave
LinkedIn.com/in/ePatientDave
dave@epatientdave.com

2. Social media
is like capillaries,
moving information
like a nutrient.

3. Social media is like capillaries,
moving information like a nutrient.

4. If you’re looking for
information in a “1.0” way
and it’s moving in 2.0 ways,
you won’t know what’s
happening.

5. Web 2.0: “When the web began to
harness the intelligence of its users.” –
Tim O’Reilly

6. Liquidity
transforms
what’s possible
because it
alters the availability
of a vital resource.

7. Not Liquid
• Moving it takes effort
• Slow and predictable
• Unexplained arrivals
are suspicious
Liquid
• Frictionless – controlling
the flow takes effort
• Fast and unpredictable
• “Tracks” everywhere, free

9. “Shift Index”
“We are shifting from a
world where the key
source of strategic
advantage was in
protecting and
extracting value
from a given set of
knowledge stocks ...

10. “Shift Index”
“...into a world in which the
focus of value creation
is effective participation
in knowledge flows.”
–Thomas Friedman
Pulitzer prize winner (3x)
New York Times
January 19, 2010

11. What could be
more patient-centered
than your child’s doctor
not being ten years
out of date?

12. Physician adoption of new
practices years after discovery
The “17 years” thing
From A. Balas, Institute of Medicine, in Yearbook of Medical Informatics 2000
Flu vaccine, year 32:
55% doing it,
45% still not
Beta blockers, year 18:
62% doing it,
38% still not
Cholesterol, year 16:
65% doing it,
35% still not
Diabetic foot care, year 7:
20% doing it,
80% still not
Creative Commons Attribution / Share-Alike
May be distributed with this license included

13. The Fourth Paradigm on years to
disseminate new medical knowledge
Scurvy!
264!
years!!

14. h
Scurvy!
oft
264!
years!!

15. Dr. Lindberg:
400 years
If I read two journal articles every night,
at the end of a year I’d be 400 years behind.
It’s not humanly possible to keep up.

16. The lethal lag time:
2-5 years
The time it takes after successful research is completed
before publication is completed and the article’s been read.
During this time,
people who might have benefitted can die.
Patients have all the time in the world
to look for such things.

17. Death by Googling:
Not.
(Dr. Gunther Eysenbach, Europe: 0 deaths found in a three year search)
Compare with
To Err is Human
(98,000 deaths/yr
Nov 1999)

18. Physician as trusted authority
“The oft-expressed
fear that patients are
using the internet to
self-diagnose and selfmedicate without
reference to medical
professionals does not
emerge in national
phone surveys or in
this special raredisease community
survey.”

19. “There’s crap on the internet.
We need to get out there and
balance it”
Wendy Sue Swanson, MD
Mother & pediatrician
@SeattleMamaDoc
Facebook too

20. An OB/Gyn on social media??
@MacObGyn
• “The more info we push out, the better decisions they make”
• “We’ve taken a demographic group and through connected
technology they’re engaged in their health”
• “Our patients tell their friends – ‘and he’s on Facebook’”

21. Patients know
what patients want
to know.

22. Sugata Mitra (TED Prize):
Self-organized
learning environments

23. Will we ever see

24. Self-organized
patient environments?

26. Not Liquid
• Moving it takes effort
• Slow and predictable
• Unexplained arrivals
are suspicious
Liquid
• Frictionless – controlling
the flow takes effort
• Fast and unpredictable
• “Tracks” everywhere, free

27. Physician is still the trusted
authority (Susannah Fox, Pew Research)
“The oft-expressed
fear that patients are
using the internet to
self-diagnose and selfmedicate without
reference to medical
professionals does not
emerge in national
phone surveys or in
this special raredisease community
survey.”

28. My favorite
complaint about
patient engagement:

29. “Patients are the only
ones who don’t have
any skin in the game”
– Practice manager, quoted in
Health Leaders, Fall 2011

30. What happens
when a consumer
tries to be responsible
about costs?

31. The choices they offered
Premium'
'
Deduc+ble'
'
Co0pay'
a4er''
deduc+ble'
Max'OOP'' Stop0loss'max'
(deduc+ble'' (in0network'+'
+'co0pay)'
out)'
Op#on&A&
$894&&
$1,000&&
20%&
$3,500&&
$12,500&&
Op#on&B&
$705&&
$2,500&&
20%&
$5,000&&
$12,500&&
Op#on&C&
$581&&
$5,000&&
20%&
$7,500&&
$12,500&&
Op#on&D&
$495&&
$10,000&&
0%&
$10,000&&
n/a&
Op#on&H&
$624&&
$5,950&&
0%&
$5,950&&
$12,500&&

32. I know – run some scenarios!

33. =IF(maxoop<J17+J18,maxoop,J17+J18)

34. I know – graph it!

35. Insurer actuaries
have this picture.
Patients don’t.
That’s called
information asymmetry
(an advantage in war)

36. People perform better
when they’re
informed better.

37. It’s perverse
to keep people
in the dark
and call them ignorant

38. Speaking of
skin in the game…

40. “How much will this cost me?”
Hospital: “We don’t know – ask
your insurance.”
Insurance: “We don’t know –
ask your hospital.”

41. So I did what empowered
buyers do dave.pt/skincancerRFP

42. Of course,
I got no responses
to my RFP.
So I spent months calling
around and asking “What will
show up on the bill?”

44. So at TEDMED, this guy irked
the crap out of me:

45. Him:
“Patients spend 10x more time
choosing a TV
than choosing healthcare”
[Me:
Dude! There’s no info
for patients to research!]

46. Punch line:
When I was shopping,
his lab was one of the ones
who said
“We don’t know”!
Fix that,THEN we’ll see
what patients do.

47. Information at the
point where it’s needed
makes all the difference.
“e-Patient Dave” deBronkart
Twitter: @ePatientDave
facebook.com/ePatientDave
LinkedIn.com/in/ePatientDave
dave@epatientdave.com