Presentation to Hillman Cancer Center (University of Pittsburgh) 2013

Bradford W. Hesse, PhD
Chief, Health Communication and Informatics Research
Harnessing the Power of An
Intelligent Health Environment
Friday, September 27, 2013

Founded: February 14, 2005
Entries: 48 hours / minute
8 years / per day
Available in: 54 languages
Reach: 37 % global Internet*
Founded: January 15, 2001
Registered Users: 35,000,000
Available in: 285 languages
* Total Global Internet Users (December 31, 2011): 2,267,233,742

Founded: September 4, 1998
Revenue: $37.905 billion
Distribution:World wide
* Total Global Internet Users (December 31, 2011): 2,267,233,742
Founded: February 4, 2004
Registered Users: 955,000,000
Distribution:World wide

March 1876:The ﬁrst telephone call
•“Youngest and most wonderful development in means
of communicating” -Watson
•“A means for overcoming the limitations of
geography”*
1876
Learning
from
History:
Diﬀusion
of
Telephone
First telephone call
1889
First public pay phone
installed at a bank in
Hartford, Conn.
1891
First Automatic
Dialer
*See: Brooks, J. (1975).Telephone:The First HundredYears.. Harper & Row.

What did the prognosticators say?
•“Really a technological toy; no business application”
• “too depersonalized” … word ‘phony’ introduced to
describe the dangers of telephone anonymity.
1876
Learning
from
History:
Diﬀusion
of
Telephone
First telephone call
1889
First public pay phone
installed at a bank in
Hartford, Conn.
1891
First Automatic
Dialer
*See: Brooks, J. (1975).Telephone:The First HundredYears.. Harper & Row.

The
ques9on
was
no
longer

technical,
it
was
sociotechnical.

How
could
telephones
make
a

diﬀerence
in
business
and

rela9onships?
1900
Source: www.visualizationeconomics.com
1925 1950 1975 2000

!"
#!"
$!"
%!"
&!"
'!"
(!"
)!"
*!"
+!"
#!!"
#*+!" #*+'" #+!!" #+!'" #+#!" #+#'" #+$!" #+$'" #+%!" #+%'" #+&!" #+&'" #+'!" #+''" #+(!" #+('" #+)!" #+)'" #+*!" #+*'" #++!" #++'" $!!!" $!!'" $!#!"
!"#$"%&'()'*+,+'-(./"0(12/'
3"4#'
5"1"60(%"'72(68(%'Telephone
Adop9on
in
the
U.S.
1900
1925 1950 1975 2000

!"
#!"
$!"
%!"
&!"
'!"
(!"
)!"
*!"
+!"
#!!"
#*+!" #*+'" #+!!" #+!'" #+#!" #+#'" #+$!" #+$'" #+%!" #+%'" #+&!" #+&'" #+'!" #+''" #+(!" #+('" #+)!" #+)'" #+*!" #+*'" #++!" #++'" $!!!" $!!'" $!#!"
!"#$"%&'()'*+,+'-(./"0(12/'
3"4#'
5"1"60(%"'72(68(%'Telephone
Adop9on
in
the
U.S.
1900
1925 1950 1975 2000
Experiments in value-
added “use cases:”
e.g., replace couriers

!"
#!"
$!"
%!"
&!"
'!"
(!"
)!"
*!"
+!"
#!!"
#*+!" #*+'" #+!!" #+!'" #+#!" #+#'" #+$!" #+$'" #+%!" #+%'" #+&!" #+&'" #+'!" #+''" #+(!" #+('" #+)!" #+)'" #+*!" #+*'" #++!" #++'" $!!!" $!!'" $!#!"
!"#$"%&'()'*+,+'-(./"0(12/'
3"4#'
5"1"60(%"'72(68(%'Telephone
Adop9on
in
the
U.S.
1900
1925 1950 1975 2000
Post War Consumerism
• “Reach out touch someone”
• “Let your ﬁngers do the walking”

!"
#!"
$!"
%!"
&!"
'!"
(!"
)!"
*!"
+!"
#!!"
#*+!" #*+'" #+!!" #+!'" #+#!" #+#'" #+$!" #+$'" #+%!" #+%'" #+&!" #+&'" #+'!" #+''" #+(!" #+('" #+)!" #+)'" #+*!" #+*'" #++!" #++'" $!!!" $!!'" $!#!"
!"#$"%&'()'*+,+'-(./"0(12/'
3"4#'
5"1"60(%"'72(68(%'Telephone
Adop9on
in
the
U.S.
1900
1925 1950 1975 2000
Post War Consumerism
• “Reach out touch someone”
• “Let your ﬁngers do the walking”
Global competition:
Launch of Sputnik

1982 1988
Socioetechnical
Perspec9ve:
Mediated
Communica9on

* Hesse BW,Werner CM,Altman I.Temporal aspects of computer-mediated communication.
Computers in Human Behavior. 1988;4(2):147-165.
.
Irwin Altman, PhD
Vice President, University of Utah
CarolWerner, PhD
Psychology, University of Utah

* Hesse BW,Werner CM,Altman I.Temporal aspects of computer-mediated communication.
Computers in Human Behavior. 1988;4(2):147-165.
.
1982 1988
Can technology
bridge spatial
constraints (e.g.,
telemedicine)?
Can asynchrony be
used to overcome
temporal restraints?
How do we create a
better ﬁt between
information environment
and healthy behavior? How do we improve
human factors: i.e.,
safety, effectiveness,
patient-centeredness,
equity?

19901988
* Hesse BW, Sproull L, Kiesler SB,Walsh JP. Returns to science: computer networks in oceanography. Commun.ACM. 1993;36(8):90-101.
** Sproull L, Kiesler S. Connections : new ways of working in the networked organization. Cambridge, Mass.: MIT Press; 1991.
Studies
of
Change
in
Communica9on

Environment
(Non
Medical)
Found:
1.Geographic benefits: e.g., land-
locked oceanographers who were
online gained in papers written,
funding obtained, and collaborations
reported.
2.Temporal benefits: Shift workers in
state governments and commercial
business gained differential benefits
in productivity over day workers.
3.Social benefits: Minority factions in
decision groups participated more
equally online.

19961989
Motorola’s Consumer
Cell Phone
Consumer Internet
See: Boyle, L.F. (1993). Averting PC Headaches: Usability Tests Aim To Find Design Bugaboos Before They Find
You. San Jose Mercury News, April 4, 1993,1F & 7F. San Jose, CA.
Apple’s Newton
Cogni9ve
Laboratory:
User-‐Centered
Design
(Commercial)

!"
#!"
$!"
%!"
&!"
'!"
(!"
)!"
*!"
#++#" #++$" #++%" #++&" #++'" #++(" #++)" #++*" #+++" $!!!" $!!#" $!!$" $!!%" $!!&" $!!'" $!!(" $!!)" $!!*" $!!+"
,-./01"2345"67.34/08"
934:.;"
,-./01"</4/08"
=438>4;;"?8;4-18"
@>.-4"
?-1.4"
<4.-/"A.B8"4-1"C0D.8"
Source: http://data.worldbank.org/indicator/IT.NET.USER.P2 (through www.gapminder.org)
Internet
Users
(per
100
people)
Rapid
Diﬀusion

!"
#!"
$!!"
$#!"
%!!"
%#!"
$&'(" $&')" $&''" $&'&" $&&!" $&&$" $&&%" $&&*" $&&+" $&&#" $&&(" $&&)" $&&'" $&&&" %!!!" %!!$" %!!%" %!!*" %!!+" %!!#" %!!(" %!!)" %!!'" %!!&"
!"#$%&'(&%%)%*+',)#,(+$-."/,'0-&+'122'-&"-%&3''
,-./01"2345"67.34/08
,-./01"9/4/08"
:438;4<<"=8<4-18"
=-1.4"
>;.-4"
?34@.<"
94.-/"A.B8"4-1"C0D.8"
Mobile
Cellular
Subscrip9ons
(per
100
people)

How
do
we
accelerate

successes
against
cancer
using

the
aﬀordances
of
this
new

environment?

This latest phase of the information
revolution will change the way we create
health and deliver health care … if we
are smart enough to know how to use it.
— Francis Collins, Director NIH

Cognitive
Sciences
Cogni9ve
Evalua9on
Methods
User-Centered Design Process
Source: Brinck T, Gergle D, Wood SD. Designing Web sites that work : usability for the Web. 1st ed. San Francisco: Morgan Kaufmann Publishers; 2002.
Requirements
Analysis
Conceptual
Design
Mockups and
Prototypes
Production Launch
User Evaluation
1 2 3 4 5
!

Requirements
Analysis
Conceptual
Design
Mockups and
Prototypes
Production Launch
1 2 3 4 5
•Market scan
•Goal setting
•Audience analysis
•Interviews
•User panels
•User survey
•Contextual inquiry
•Usage log analysis
•Search log analysis
•Usability tests
•Expert review
•Site Mapping
•Brainstorming
•Card sorting
•Task analysis
•Storyboarding
•Info. architecture
•Function specs
•Integrate with
marketing plans
•Design
guidelines
•Expert review
•Templates
•Paper prototypes
•Wire frames
•Focus groups
•Interviews
•Usability testing
•Behavioral coding
•Usability checklists
•Design guidelines
•Template use
•User testing
•Bounce-back
Surveys
•Remote usability
Testing
•Expert review
User-Centered Design Process
!
Cogni9ve
Evalua9on
MethodsCognitive
Sciences
•Market scan
•Goal setting
•Audience analysis
•Interviews
•User panels
•User survey
•Contextual inquiry
•Search log analysis
•Usability tests
•Expert review
•Site Mapping
•Brainstorming
•Card sorting
•Task analysis
•Storyboarding
•Info. architecture
•Function specs
•Integrate with
marketing plans
•Design
guidelines
•Expert review
•Templates
•Paper prototypes
•Wire frames
•Focus groups
•Interviews
•Usability testing
•Usability checklists
•Design guidelines
•Template use
•User testing
•Bounce-back
Surveys
•Remote usability
Testing
•Expert review
CDC Web 2001
National Breast & Cervical Cancer
Early Detection Program
Source: Hesse BW, Shaikh A, R., Toward JI, Edgar T. Final Report of the CDC Main Web Site Evaluation. Atlanta, GA: Centers
for Disease Control and Prevention; April 2002.

ANTICIPATED
Percent
Consumers
to
CDC
Web
Cognitive
Sciences

ANTICIPATED
ACTUAL
Percent
Consumers
to
CDC
Web
Cognitive
Sciences

Bounceback Survey
Health care providers
16%
Policymakers
7%
Scientists
7%
Media reps
1%
Student
22%
Librarian
1%
Educator
7%
Not related to Occupation
15%
Other
24%General Consumers
Bounceback Survey
Health care providers
16%
Policymakers
7%
Scientists
7%
Media reps
1%
Student
22%
Librarian
1%
Educator
7%
Not related to Occupation
15%
Other
24%General Consumers
Who
were
visitors?

How
referred?Cognitive
Sciences

Email Analysis
Public health
3%
Policymakers
0%
Scientists
5%
Consumers
18%
Educators
7%
Other
24%
General Consumers
CDC
0%
Media reps
1% Students
20%
Providers
22%
Email Analysis
Public health
3%
Policymakers
0%
Scientists
5%
Consumers
18%
Educators
7%
Other
24%
General Consumers
CDC
0%
Media reps
1% Students
20%
Providers
22%
Who
were
visitors?

How
referred?Cognitive
Sciences

WHO
4% (n=58,147)
travel.state.gov
4% (69,247)
News Sites
5% (n=88,772)
hss.state.ak.us
0% (n=7,029)
NLM
1% (n=19,606)
Search Engines
86% (n=1,406,964)
WHO
4% (n=58,147)
travel.state.gov
4% (69,247)
News Sites
5% (n=88,772)
hss.state.ak.us
0% (n=7,029)
NLM
1% (n=19,606)
Search Engines
86% (n=1,406,964)
Who
were
visitors?

How
referred?Cognitive
Sciences
Content
Analysis

How
did
this
change
strategy?
20
Internet is Transformational
•  Demassified
•  Decentralized
•  Adaptable
•  Asynchronous
•  Interactive
•  Interconnected
Traditional CommunicationTraditional Communication
ChannelsChannels
CDC
State and Local
Health Officials
Media
Policymakers
Researchers &
Practitioners
Public
CDC
State and Local
Health Officials
Media
Policymakers
Researchers &
Practitioners
Public
CDC
State and Local
Health Officials
Media
Policymakers
Researchers &
Practitioners
Public
Internet Enabled ChannelsInternet Enabled Channels
Cognitive
Sciences
See: Hesse BW. Harnessing the power of an intelligent health environment in cancer control.
Stud Health Technol Inform. 2005;118:159-176.

CDC
adapts
“CDC used to be in the wholesale
business of providing information to
state and local health departments.
We are now in the business of
providing health information directly
to individuals.”
- Dr. J. Gerberding, 2003
CDC Director
Julie Gerberding, MD MPH
Cognitive
Sciences
2012 Statistics:
• 746,222,316 page views
• 2,970,449 views - CDC en Español
Most Popular Topics on CDC.gov
• STD FACTS
• CDC Homepage, Search, A-Z
• Vaccines
• Health Statistics
• Travelers' Health
• Seasonal Flu

25
Redesigned with
Consumer Appeal,
2004
Link to live
help
Link to
Clinical Trials
Front Page
Access to
Descriptions
Communicating
Science to the Public
Spanish Site
Launched
2006
NIH
-‐
NCI
AdaptsCognitive
Sciences

Surveillance
July 27, 2012
Cognitive
Sciences
See also: Hesse BW, Nelson DE, Rutten LF, Moser RP, Beckjord EB, Chou W-YS. National Health Communication Surveillance Systems. In:
D. K. Kim ASGLK, ed. Global Health Communication Strategies in the 21st Century: Design, Implementation, and Evaluation. New
York, NY: Peter Lang; In Press.
.
Health
Situa9onal

Awareness

Surveillance
Cognitive
Sciences
*NIH Nominee to White House for “Open
Science Champion,” May 14 2013.
Data Briefs
Statistical
Guides
Peer Reviewed
Publications
Web Platform for Participation*
Health
Informa9on
Na9onal

Trends
Survey
(HINTS)

Surveillance
Cognitive
Sciences
HINTS
Brief
#1:
Trust
in
channels

and
cancer
informa9on
seeking
Source: Hesse BW, Nelson DE, Kreps GL, et al.Trust and sources of health information: the impact of the Internet and its implications for health care
providers: ﬁndings from the ﬁrst Health Information NationalTrends Survey.Arch Intern Med. Dec 12-26 2005;165(22):2618-2624.

Surveillance
Cognitive
Sciences
Where
would
you
prefer
to
go

for
cancer
informa9on?

Surveillance
Cognitive
Sciences
Where
did
you
go
for
cancer

informa9on?

How
do
Survivors
get

their
cancer
informa9on?
Surveillance
Cognitive
Sciences
Source: Hesse BW,Arora NK, Beckjord EB, Finney Rutten LJ. Information Support for Cancer Survivors. Cancer. 2008;112(11S):2529-2540.
Neeraj Arora
NCI
Cancer Survivors

How
do
Survivors
get

their
cancer
informa9on?
Surveillance
Cognitive
Sciences
Source: Hesse BW,Arora NK, Beckjord EB, Finney Rutten LJ. Information Support for Cancer Survivors. Cancer. 2008;112(11S):2529-2540.
Neeraj Arora
NCI
Cancer Survivors
Patient to Survivor:
Lost in Transition?

Source: Hesse BW, Moser RP, Rutten LJ. Surveys of physicians and electronic health information. N Engl J Med. Mar 4 2010;362(9):859-860.
Surveillance
Cognitive
Sciences
Trends:
2002-‐2003,
2005,
2008

Surveillance
Cognitive
Sciences
HITECH*
Act
passed
in
2009
*Health
I.T.
for
Economic
&
Clinical
Health
Act
Health I.T. as Foundation
for Evidence
Implementation
Source: Hesse BW, Ahern DK, Woods SS. Nudging best practice: the HITECH act and behavioral medicine Translational Behavioral Medicine. 2011;1(1):175-181.

Source: Jamoom E, Beatty P, Bercovitz A, Woodwell D, Palso K, Rechtsteiner E. Physician adoption of electronic health record systems:
United States, 2011. NCHS data brief. Jul 2012(98):1-8.
Surveillance
Cognitive
Sciences
Supply
Side

Source: Jamoom E, Beatty P, Bercovitz A, Woodwell D, Palso K, Rechtsteiner E. Physician adoption of electronic health record systems:
United States, 2011. NCHS data brief. Jul 2012(98):1-8.
National Ambulatory Medical Care Survey
Surveillance
Cognitive
Sciences
Supply
Side

Health Information National Trends Survey
Demand
SideSurveillance
Cognitive
Sciences

Surveillance
Cognitive
Sciences
Understanding
the
digital
divide
Did you use the Internet to look for medical information for yourself?
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Less than high school High school graduate Some college (AA) College graduate
(BA/BS)
Education Level
Percentage
2003
2005
2008
The Digital Divide
See: Rutten LF, Moser RP, Beckjord EB, Hesse, BW, Croyle RT. Cancer Communication: Health Information
National Trends Survey. Washington DC: National Cancer Institute. 2007.
Lila Rutten
Mayo Clinic
Rick Moser
NCI
Ellen Beckjord
U of Pittsburgh
Med School

Understanding

knowledge
or
belief
gaps
Surveillance
Cognitive
Sciences

What
about
“Web
2.0?”Surveillance
Cognitive
Sciences
Source: Chou WY, HuntYM, Beckjord EB, Moser RP, Hesse BW. Social media use in the United States:
implications for health communication. J
Med
Internet
Res.
2009;11(4):e48.
Wen-Ying (Sylvia) ChouWeb 2.0: Platforms for Participation

Surveillance
Cognitive
Sciences
Wen-Ying (Sylvia) ChouWeb 2.0: Platforms for Participation
What
about
“Web
2.0?”

Surveillance
Cognitive
Sciences
Gary Kreps Paula Kim
Agreement between NCI (Bradford Hesse) and Health
Ministry of China (Mao Qu’nan) to cooperate in areas
of Health Communication & Informatics Research
-George Mason University, March 29
Can
we
learn
from
comparisons

across
cultures?
Wen-Ying (Sylvia) Chou

HINTS
China
AllianceSurveillance
Cognitive
Sciences
U.S. Death Rates
ACS Cancer Facts & Figures

HINTS
China
Alliance:
PilotSurveillance
Cognitive
Sciences

Surveillance
on

Communica9on

Environment
44

Iden9fying
System

Level
Needs
/
Strategies
State of the Science & Practice
February 14, 2011
Synthesis of Systematic Reviews
August 20, 2012
Blueprint: Uniting Systems
through Communication Science
Late summer, 2013
• Health Impact Framework (CDC)
• Targets across continuum
• Affordable Care Act
• Health Information Technology for
Economic & Clinical Health:HITECH
• Technology Mediated Social
Participation (Health 2.0)
• Dissemination and Implementation
Science
• Agenda-aligning communications
Surveillance
System
Sciences
Cognitive
Sciences

NSF:
Technology
Mediated

Social
Par9cipa9on
Surveillance Health 2.0
Cognitive
Sciences
Source: Hesse BW, Hansen D, Finholt T, Munson S, Kellogg W, Thomas JC. Social Participation in Health 2.0. IEEE
Computer. 2010;43(11):45-52.
Surveillance
System
Sciences
Cognitive
Sciences

Courtesy of Oracle Systems
See: *Nelson DE, Hesse BW, Croyle RT. Making Data Talk: Communicating Health Data to the Public, Policy, and the Press. New York, NY: Oxford; 2009.
**Shneiderman B, Plaisant C, Hesse BW. Improving Healthcare with Interactive Visualization. In: Catherine P, Bradford WH, eds. IEEE Computer. Vol
462013:58-66.
May 2013**
Surveillance
System
Sciences
Cognitive
Sciences
May 2009*
Communica9ng
Evidence


Transforming
Cancer

Research
and
Prac9ce
Bill Chismar Abdul Shaikh
Source: Chismar W, Horan TA, Hesse BW, Feldman SS, Shaikh AR. Health cyberinfrastructure for collaborative use-inspired
research and practice. Am J Prev Med. May 2011;40(5 Suppl 2):S108-114.
Surveillance
System
Sciences
Cognitive
Sciences

ASCO’s
Blueprint,
2011
Oncology as information
science: “The Learning
Health Care System”
Hospital Based
EHR Data
Hospital Based
EHR Data
Health Information Exchange
Medical
Team
Patient
&
Family
Hospital
System
Decision
Support
Needs
Subjective
• Chief complaint
• Patient Reported Outcomes
• Risk modeling
• Diagnostic support
• Treatment selection
• Guideline adherence
• Error detection/correction
Medical
Researcher
• Situational awareness
• Population health
• Continuity of care
• Identify side effects
• Inform discovery
Objective
• Clinical measures
• Laboratory findings
• Sensor data
Assessment
• Diagnosis
• Categorical reporting
• Prognosis
Plan
• Treatment planning
• Self-care planning
• Post treatment
• Surveillance
See: Hesse BW, Ahern DK, Woods SS. Nudging best practice: the HITECH act and behavioral medicine Translational Behavioral Medicine. 2011;1(1):175-181.
Hesse BW, Croyle RT, Buetow KH. Cyberinfrastructure and the biomedical sciences. Am J Prev Med. May 2011;40(5 Suppl 2):S97-102.
Hospital Based
EHR Data
Hospital Based
EHR Data
Health Information Exchange
Medical
Team
Patient
&
Family
Hospital
System
Decision
Support
Needs
Subjective
• Chief complaint
• Patient Reported Outcomes
• Risk modeling
• Diagnostic support
• Treatment selection
• Guideline adherence
• Error detection/correction
Medical
Researcher
Objective
• Clinical measures
• Laboratory findings
• Sensor data
Assessment
• Diagnosis
• Categorical reporting
• Prognosis
Plan
• Treatment planning
• Self-care planning
• Post treatment
• Surveillance
Surveillance
System
Sciences
Cognitive
Sciences

Are
we
really
partnering

with
pa9ents?
Hugo

Campos
Hospital Based
EHR Data
rmation Exchange
Patient
&
Family
Medical
Researcher
Surveillance
System
Sciences
Cognitive
Sciences

Pa9ents
Char9ng
the
Way
Dr. Susan Love Jamie Heywood
Patients Like Me
Surveillance
System
Sciences
Cognitive
Sciences

Partnering
Against
Cancer
Today

Presentation to Hillman Cancer Center (University of Pittsburgh) 2013

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