Monday, March 31, 2008

The Whole-Person Integrated-Care (WPIC) Wellness Solution: Part 6

In the first five parts of this series on the Whole-Person Integrated-Care (WPIC) Wellness Solution, I discussed how particular personality characteristics -- i.e., one's cognitions (thoughts), emotions, knowledge, and coping strategies -- determine whether or not people take good care of their health. On one end of the spectrum are the self-motivated "Activists" who are eager to attain and maintain excellent health. On the other end are the "Ignorer/Deniers," who, for a myriad of reasons, strongly and consistently resist self-managing their health.

I now begin to answer the question: What's necessary for people to change the way they think, feel and act in a way that promotes healthy living?

I assert that AWARENESS is the place to start. It's obvious that people have little incentive to change if they are unaware that they have health problems, risks, or are managing chronic conditions poorly. Whether due to ignorance or self-deception, the first thing these people need is greater awareness of their health status and probable future. Becoming aware of their health problems, risks and poor self-management tends to give rise to fear. This fear is based on their belief that they will experience pain, become disabled, or die. For some, such fear a motivator. For others, the fear leads to denial, so it's wise for them to "reframe" the situation in terms of "joy of life" rather than "fear of death," as I discussed in an earlier post. Nevertheless, awareness is essential.

Things that can promote self-awareness are other people, media, and information technology. These people may be sick-care professionals (e.g., doctors, nurses and therapists); well-care coaches and counselors; family and friends; and even "virtual acquaintances" through Internet-based social networking (see Web 2.0). Media include web sites, TV, movies, newspapers, books, etc. Information technology includes health information systems, such as personal health records (PHRs) and online health data repositories.

In this post, I'm going to focus on the good and bad of health information technology for consumers since there is great debate about their usefulness. See, for example, this recent article in Business Week about Google and Microsoft's Internet-based products for electronic healthcare information storage and access, and the Robert Woods Johnson blog for their Project HealthDesign PHR development initiative.

I content that we are in the "Stone Age" of health information technology. Current day products are not very useful to the typical consumer, and could be much more useful to professionals. That's because the greatest value information is not obtained by simply having a place to store personal health data. Instead, value comes from using these data to help consumers and their healthcare professionals prevent physical and mental health problems, treat acute illnesses, and self-manage chronic conditions.

So, what about search Internet engines such as Google? Well, they're not of great value either since only 16 percent of online consumers find what they were looking for since search engines tend to focus on breadth rather than on content quality, which means they usually provide an overwhelming number of generic "hits" that are often of questionable validity. This is particularly true for searches on health topics such as alternative medicine, herbal and nutritional supplements, prescription drugs, disease cures, and nutrition. In fact, 70 percent of scientific studies show that quality of online health information is a major problem.[1]

Things have been improving, however, with web sites such as Helia Health, Organized Wisdom, , Revolution Health, and WebMD. The problem is that they all focus on providing general rather than personalized information. This means people must scan through pages of information and links, the vast majority of which have nothing to do with their needs. And when they finally navigate to where relevant information is located, it tends to be generic, not specific to each individual, which can lead to information overload, knowledge underload, and inaccuracies.

What's needed is an easy, low-cost way for data from health care providers and consumers, no matter where they are stored, to be transformed into useful information. This information should not only increase people's awareness of their current health status and risks through comprehensive holistic assessments, but also provide targeted personalized information that increases their knowledge and understanding about the most cost-effective ways to deal with troubling health-related issues. These issues may include such things as coping with a stressful life situation, changing unhealthy lifestyles, adhering to one's plan of care, making valid diagnosis, and deciding wisely about which treatment option and insurance plan to choose. As I discussed in a previous post, these capabilities go way beyond data storage and access and enter into the realm of personalized, holistic (mind-body-spirit) decision-support and self-help assistance. Today's PHRs are very immature regarding these types of capabilities.

I've long been recommending the creation of disruptive (radical, discontinuous) technologies that are able to achieve the lofty goals I described above. By way of full disclosure, I've been developing such a system, called the Personal Health Profiler™, for over two decades. It is a major departure from the kinds of PHRs and web sites in use today in that it promotes rapid and more complete understanding of a person's:

  • Current physiological, psychological and mind-body functioning and risks
  • Wellness interventions and self-management plans
  • Sick-care treatments
  • Changes in health status (trends over time)
  • Clinical outcomes and costs of care received.

This information is presented in a personal health profile and yields better (deeper and broader) understanding of a person's problems and needs, thereby improving diagnostic and treatment/intervention decisions. It comes from analyses of detailed data about the relationships between one's:

  • Internal factors--including problematic physical signs and symptoms, illnesses, emotions, and cognitions (thoughts, attitudes, perceptions, beliefs, "self-schemas," attributions & appraisals, expectations, memories, etc.), and knowledge & understanding.
  • Behaviors--including diet, exercise, alcohol and substance use, risky activities, sleep, mobility, etc.
  • External influences/causes--including stressful interpersonal relationships, stressful and unhealthy physical (e.g., work, living) environments, economic pressures, etc. on the one hand, and supportive conditions that promote good health on the other hand.
  • Medications and abnormal lab test results --to identify possible interactions (e.g., how certain drugs being taken may be causing one's white blood cell count to drop and interfering with one's sleep).
  • Mind and body-- such as medication side-effects and physical illnesses that present as mental health problems, as well as physical symptoms that may be due to (or exacerbated by) stress.

In addition, this next-generation application provides these essential functionalities:

  • "Pushes" targeted information to consumers and professionals to fill knowledge gaps and increase understanding, instead of requiring that the information be "pulled" by them. This means exceptional "findability;" that is, navigating to and accessing relevant information is a breeze compared to the complex and often convoluted process required to obtain and filter desired information from typical web portals and search engines
  • Identifies key stressful/distressing life issues and health risks, which help focus wellness-counseling efforts.
  • Identifies how a person's underlying beliefs (cognitions) and related emotions foster or hinder healthy behaviors and wellbeing, which also help focus counseling efforts and helps break through resistance and denial.
  • Delivers warnings and alerts essential to effective prevention.
  • Delivers ongoing feedback to the consumers and professionals as to their progress, so any necessary adjustments to the wellness plan can be made efficiently and good continuity of care can be maintained.
  • Uses a structured, personalized coping & problem-solving methodology that helps a person achieve positive results as quickly as possible by targeting the most problematic situations first and applying a proven method for resolving them.
  • Supports well-care/sick-care integration.
  • Continually evolves using flexible software modules, data sets and algorithms that are all transparent and easily modifiable.
  • Accommodates any current and future data and technology standards
  • Continually feeds a knowledge base with de-identified treatment and outcomes data to support research efforts.

These capabilities not only increase consumer awareness, but they cut the time the health professionals have to spend trying to understanding a person's problems, needs, and cognitive-emotional blocks, which speeds the creation and improves the accuracy of their care plans. And the targeted information, self-help tools, warnings & alerts, structured coping & problem-solving methods, and continuous knowledge base feeds offer a cost-effective way to help improve outcomes, including better health, wellbeing and overall quality of life, increased productivity, and workplace safety.

Note that such a paradigm-busting disruptive technology need not make conventional technologies obsolete since they can work together.

In subsequent posts, I'll explain how the Personal Health Profiler™ works and offer an opportunity for collaboration in its continued evolution.


[1] "Health Information Search Engines Emerge; Growing Consumer Demand for Health Information Increases Need for Better Quality, More Personalized Searches, Says Expert at 11th World Congress on Internet in Medicine." Internet Wire (Oct 18, 2006).

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