Slides from the workshop at the annual Planetree conference in Montreal 7 octobre 2013

1. Inforium®
opens the internet for
shared decision making
2013 Planetree Annual Congress,
Montreal Octobre 7
Dr. M.L.Y.M. Oei, Dr. M. Vleming
MD, PhD, ENT-surgeons
Flevoziekenhuis, Almere, The Netherlands

2. Introduction

3. Contents
• Introduction
• Shared decision making: How can we help to choose?
• Reliable medical information: BetrouwbareBron.nl
(Reliabesource.nl)
• How do we beat Dr. Google?
• How we do it in the Flevo Hospital
• Conclusions and future developments

4. Shared decision making
• An approach where clinicians and patients share the best available
evidence when faced with the task of making decisions,
• and where patients are supported to consider options, to achieve
informed preferences
• Elwyn et al. 2012

5. How do we make choices?
• Determine your goal.
• Determine its value.
• Arrange and examine the options available to reach it.
• Determine the likelihood of each option meeting your goal.
• Choose the option with the highest likelihood of meeting it.
• Use the outcome of this experience to adjust your future goals and the
way in which you make future decisions.

6. Shared decision making process
choice talk option talk decision talk
D
E
C
I
S
I
O
N

7. “RELIABLE SOURCE. NL”

8. Traditional internet method
-Patient searching through engine
(usually Google)
-Get a selection based on popularity
instead of not reliability
-Not patiënt specific
-Sources not transparent
- often commercial
- often advertorials
-"Reliable Sources" not recognizable
-Small "Reliable Sources" difficult to
find because of small target audience
D
r
.
G
O
O
G
L
E

10. BetrouwbareBron Method
• The Patient is the core for information search
• Source-accreditation rather than content-confirmation
• No new content, but bundling and transparency
• Commerce and unknown sources excluded
Doctors
governmentpatiënts
non-profit
Patiënt

11. • “RELIABLE SOURCE.nl”
• Goals:
– To gather and bundle reliable patient information on the
internet
• Provide reliabel relevant information to patiënts
• Safe referral harbor voor doctors and health professionals
• Cross-sector and independent presentation
– Assumptions:
• Each Reliable Source is right (from their specific viewpoint)
• Every patient is unique (in disease and need for information)

12. What is a BetrouwbareBron (Reliablesource)?
• Nationwide
• Dutch language
• Non-commercial
• On diseases, symptoms, health care, education and prevention
• Information aimed at patients / consumers
• Approved by or part of accrediting health organization

13. Accreditation
• Professional associations: KNMG (doctors, AMA), KNMP
(pharmacists), NMT (dentists)
• Governmental and government-linked: RIVM(CDC), KiesBeter.nl
Patient organizations: member NPCF of CG-raad patiënt
association
• Non-profit organizations
– Comprehensive criteria such as objectives, association, funding,
partners

14. BetrouwbareBron (Reliablesource) websites
• Collection of content striaght to the relevant subject page
• Different sources with the same subject are bundled
• Bundles manually selected by medical volunteers
• Example

15. Betrouwbare Bron Base (database)
• Largest dutch database of non-profit public health information
• Since 2008
• 258 BetrouwbareBron organizations
• > 8000 relevant links
• Continuous medical maintenance
– > 30 medical volunteers
– BetrouwbareBron organizations (NPCF, ENT-surgeons, Child
and hospital foundation)

16. Betrouwbare Bron Base
• Available for patients
– Published on the internet www.BetrouwbareBron.nl
• Available for health professionals and institutions
– Integration in websites, portals
• Available for e-health applications
– “White-label”

17. How do we beat Dr. Google?

18. Why do people go to Dr. Google?
• Information in the doctors consult is:
– Too much
– Too fast
– Too difficult (words and content)
– Too little knowledge
– Too emotional
• Told only once!  Make information repeatable!

20. Doctor-patiënt communication
• 60 % of the information is forgotten instantly
• Of the remaining 40%,
– half the information is remembered incorrectly

21. But we have a website...

22. PATIENTS DO NOT VISIT YOUR WEBSITE
• Most people use Google or Yahoo for health information
• To publish information on your website is not enough
• Portals are too user unfriendly (for doctors and patients)
• The solution has to be easier than Dr. Google

23. KISS (Keep It Simple, Stupid) US Navy 1960
• The KISS principle states that most systems work best if they are
kept simple rather than made complex; therefore simplicity should
be a key goal in design and unnecessary complexity should be
avoided.

24. User friendly
• Easier for doctors
– Doctors/departments can manage the information themselves
– Doctors can choose Inforiums tailored to the patient
• Easier for managing information
– Easier content creation
– Responsibility to the proper persons
• Communication department in charge of readability, look and feel
• Doctor responsible for medical content
• Easier for patients!

25. What does Inforium®
do?
• Collects, makes and delivers tailored
content
– Local flyers and information
– Databases (eg BetrouwbareBron)
– Multimedia (video)
– Hyperlinks, questionnaires
• Straight to patiënt mailbox
– Privacy compliant (anonymous)
– No mail/IP addresses stored
– Secure site

26. • Easier for patients than Google !
–Tailored information in their own mailbox
–Multisource, multimedia information
–Privacy respected
–Environment friendly (no more prints)
–Always available
–Better information for shared decision making

27. How we do it at the Flevo hospital!
• Shared Decision Making in the ENT department with Inforium
• http://youtu.be/NPPptPFHEfM
• http://youtu.be/fxjswG6WFi0
• Examples:
– Shared decision making Grommets
– BPPV

28. Patient experiences
• Subjective: enthusiasm
• Questionnaires:
– Do you like Inforium in mail? Yes
– Do you like the content? Yes
– Easy to use? Yes
– Would you like to receive Inforiums
more often?
YES, please

29. Results
100%: Yes
What kind of information do you appreciate the most?
Do you understand the information?
Nomination
client award
2012

30. Make our own Inforium
• Keywords from the audience
• Slideshare
• Infogram
• Video
• Article
• Reliable source link

31. www.inforium.info
Code: ENG-montreal

32. Conclusions en future developments
• Shared decision making: Reliable information is a key element
• Bundling and sharing medical information
• Getting information to the patient is crucial, not making it.
• Tell the patiënts what to do!
• Websites get beat by Dr. Google, Inforium®
beats Dr. Google

33. Future developments
• Share our knowledge and resources !
– Patient organizations
– Professional associations
– Health institutions
– Health websites
• Connect our knowledge
– PHR Personal health records
– EHR Electronic health records
– Health portals

34. “How to start a movement”
• Lesson 1: Easy to follow
• Lesson 2: First follower is crucial
• Lesson 3: Followers are made public
• Lesson 4: Followers have to hurry to be part of the in-crowd
• Lesson 5: Late comers are ridiculed

35. • www.Flevoziekenhuis.nl
• www.Inforium.nl or www.Inforium.info
More info?