#MDigitalLife is a WCG program designed to learn from and to showcase physicians who are blazing new trails in the digital world – changing the way that medicine is practiced and better health is realized. You can find previous posts here.
“The use of mobile and social technology have come into prominence at a wonderful point in time. They’re allowing us as physicians to connect with minority populations who have already adopted those technologies at a significantly higher rate than the average American. It’s my hope that we can leverage the confluence of those trends to leapfrog minority families – for the first time – into a position of empowerment relative to their health.”
Ivor Horn is a pediatrician at the Children’s National Medical Center in Washington, DC. That institution, for those who aren’t familiar with it, serves kids and families in our nation’s capitol, many of whom are members of traditionally underserved populations such as black americans and latino americans.
Children’s National cares for patients through more than 360,000 visits each year and is the regional referral center for pediatric emergency, trauma, cancer, cardiac, and critical care as well as neonatology, orthopaedic surgery, neurology, and neurosurgery. Children’s National is ranked among the best pediatric hospitals in the United States by U.S. News & World Report and The Leapfrog Group.
It also serves as a research center of note for doctors and other scientists who are working to address the health needs of these populations. While Dr. Horn started her career as a full-time practitioner, her role has now evolved to about 90% research.
“I love seeing patients, and I’d never give that up. I know that I can make a difference through that interaction with a kid and their parents, but I wanted to see how I could multiply that influence beyond the 1×1 interaction.”
Ivor Horn, MD
Dr. Horn believes that the exam room is the right place to help families work through solving their specific health issues. But there are also system health issues that can’t really be addressed from the exam room – and that’s where a lot of her research is focused. Over the last several years there has been a significant push in the US to ensure that physicians are regularly applying “evidence-based medicine” – in other words, that they’re diagnosing and treating patients based primarily on proven methods. Dr. Horn is a strong advocate for the consistent application of those clinical guidelines, but she’s also identified that they rarely go far enough She sees that the communication that wraps around that evidence-based medicine is significantly more important for minority populations – both for doctors and patients.
Many doctors have a hard time translating clinical messaging into lay terms that are easily understood and actionable by their patients (some studies have shown that the average patient understands less than 50% of what their doctor tells them). For a physician to learn to communicate with minority populations is particularly difficult – and its not just because of language or education issues. There are cultural norms around health in minority populations that most doctors are unfamiliar with, which can further complicate the communication process.
A significant amount of Dr. Horn’s work is focused on finding ways to increase the impactfulness of physicians’ communication with their patients. Dr. Horn wants give physicians and patients the tools and techniques they need in order to “use the 15 minutes they have together to EMPOWER and ENABLE patients in the greatest way possible – to increase the odds that patients will be willing and able to follow treatment protocols, and ultimately to improve their health outcomes.”
A good example of that work is in progress now, in the form of a protocol designed to help kids with asthma – and their families – to keep that asthma under control, and avoid acute attacks that put a child’s health at risk and force an emergency room visit. The program was developed as an exam-room process that enables patients’ families to actively question their doctor about the kind of care their child needs in order to avoid asthma attacks.
One of the common problems in minority populations is that they don’t necessarily think that they have the right to have all of their questions answered by their treating physician. Dr. Horn’s program tells them – and teaches them how – to effectively do so. She always tells her patients – explicitly – no matter where I am, PLEASE ASK ME!! She is their primary care doctor and therefore their advocate. When she refers patients to specialists she tells them the same, and lets them know that it is their right and their obligation to ensure that they fully understand their doctors diagnosis and treatment.
It turns out that asthma serves as a great example of how this scenario plays out in real life. In the hospital they have a clinic in the ER for kids who are at risk for asthma issues. Those kids are admitted because their asthma frequently gets out of control. At the clinic they get intensive education about how to manage asthma (environmental, social, and medical). And a big part of that program is helping patients’ families to work with their primary care providers (PCPs) to continually manage their asthma so that they STAY out of the ER. The problem was that their PCPs weren’t necessarily equipped to work with them on that kind of proactive management. The PCP would say “your asthma is under control – why are you here?” And they’d say “because I’m am supposed to be!” Basically, Dr. Horn’s patients weren’t always getting what they needed from the PCP. So her program is about treating asthma – but mostly about arming parents to communicate effectively with PCPs. Her patients learn things like:
- What are the components of a healthcare visit?
- What do they need to tell their doctors?
- What do they need to ask?
- What do they need to walk out the door with?
After completing the asthma intervention, she and her research partners surveyed the group of families who’d participated. When the families were asked what had been the most valuable aspects of the program, they got responses like, “It gave me the ability to ask questions – I didn’t know I could.” “I knew I couldn’t give my child that medicine because of my work schedule.” “I didn’t know that I could let Grandma pick up the medicine.” All of those are things that, once identified, can easily be worked around.
The problem was that the program was successful in the short term, but that it was hard to sustain. People were tending to drift back into their old habits. Now, their challenge is to take the program and make it both evidence-based AND sustainable. Dr. Horn believes that the answer may lie with a mobile intervention – perhaps leveraging SMS text messaging. A mobile intervention would allow patients to access the information they need at the right time (i.e., when they’re about to visit their primary care doctor) – but also allow them to call it up whenever they need it, easily. They’ll get refresher reminders over a period of time – and it guides them towards the next visit.
Hopefully the mobile solution will prove to be effective enough in sustaining successful treatment that it will stick around – and have a side benefit as well. If it works, it’ll be able to take Dr. Horn’s research and techniques and allow them to scale to the point that they’re available for pediatric asthma patients all over the country.
There is tremendous momentum building around eactly this kind of mobile health innovation. Dr. Horn wants to be sure that the companies and organizations involved don’t forget underserved populations as they’re designing and testing their inventions – and encourages such companies to partner with those underserved populations and the doctors who serve them. That’s not necessarily easy to do directly today, but Dr. Horn suggested that interested companies should start with the “safety net” organizations to see how they could engage to determine how their solution could be applied to a specific population.
Organizations like the National Medical Association, the Association of Black Cardiologists and the Hispanic Medical Association are focused on black and latino populations, and can often provide great resources and insights in terms of taking things forward. Medical schools are also great partners for that kind of innovation; Childrens National frequently partners with Howard Medical School and works on child health disparities funded through NIH.
I came to know Dr. Horn through twitter, while she was visiting Austin for the SxSW interactive festival last year. Just as we saw recenty from Wendy Sue Swanson, the way Dr. Horn uses social media to communicate with a broader population came through traditional media. Dr. Horn found that she was doing interviews in local media on a relatively recent basis, but wanted to find a way to access that same broad population on a more regular and controlled basis.
She thought about starting her own blog, but decided that it’d make more sense to start leveraging a social property that already had a foothold in her desired audience group – and would be regularly maintained in the event that she wasn’t able to keep a frequent enough publication schedule. As it happens, she had a friend who already had a blog for parents of color – Denene Millner’s My Brown Baby.
As is fitting for a scientific researcher, Dr. Horn decided to attack blogging systematically, and conduct it as a kind of experiment. She and Ms. Millner agreed that she would blog monthly for six months. Before, during and after the experiment, they measured the conversation on and around the blog. Ms. Millner had already provided a forum that had proved to be effective in engaging families in healthcare and childhood development, and was interested in adding more detailed medical information – effectively raising the level of conversation from a purely “lifestyle” conversation to a true health conversation. Dr. Horn presented the results of that study at last month’s National Conference on Health Communication, Marketing, and Media (Use of Social Media for Engaging Communities of Color In Child Health Dialogue). Dr. Horn feels confident that they measurably achieved their goal – in fact, the blog was nominated as a Best Health and Wellness blog in 2011. She’ll be presenting it again this month at the Medicine 2.0 Conference in Boston.
The key learning from that experience for Dr. Horn was that when a physician comes into the right conversations online, it can make a measurable difference in parenting. That positive experience proved to be a launchpad for Dr. Horn to expand more deeply into social media, and Twitter was the next logical step for her. Blogging can take a LOT of effort and time (which as an academic she doesn’t have in abundance). Dr. Horn joined Twitter looking for the same target population she’d accessed through Ms. Millner’s blog (minority parents). She’s been successful in doing so, but also managed to find another community that she wasn’t necessarily expecting: There is a small (but active and growing) group of folks on Twitter who are focused on finding new ways to address the needs of underserved populations. Not surprisingly, she mentioned how much she appreciates the work and approach of Andre Blackman (Pulse + Signal; creator of the Fast Forward film festival for health innovation) and Alisa Hughley of enBloomMedia, who’s focused on transplants/organ donorship in minority populations.
Dr. Horn’s vision for the power of digital and social media to help reduce some of the health disparities in underserved communities is an inspiring and powerful one – and one well worth following. You can keep up with them through Dr. Horn’s twitter account – and also by following these hashtags: #meded #hcsm #minorityhealth #disparities