Inforium® opens the internet

for shared decision making2013 Planetree Annual Congress,

Montreal Octobre 7

Dr. M.L.Y.M. Oei, Dr. M. Vleming

MD, PhD, ENT-surgeons

Flevoziekenhuis, Almere, The Netherlands

Introduction

Contents

• Shared decision making (SDM): How can we help to choose?

• Reliable medical information in SDM: BetrouwbareBron.nl

(Reliabesource.nl)

• How do we get knowledge to our patiënts (and beat Dr. Google)?

• “How we do it” in the Flevo Hospital

• Conclusions and future developments

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

How do we make choices?

• Determine your goal.

• 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.

Shared decision making process

Information and knowledge

Doctor Patiënt

Options and verbal explanation

Support information (Local info,Betrouwbare Bron)

Inforium (paper, video, decision aids)

Wishes and feelings

Patiënt doctor

Verbal

Non-verbal:Reactionsand interpretation

Explanation

Process and Decide

Doctor and patient

Evaluatie the options

Shared decision

choice talk option talk decision talk

D

E

C

I

S

I

O

N

“RELIABLE SOURCE. NL”

Traditional internet method

Patiënt

Website Organization 1

(doctor, reliable)

Content 1Links to

organizations likeorganization 3

Website 1

(commercial)Content 2

No links

Links to otherorganization

Website Organization 3

(patiënt,reliable)

Content 3Links to manyorganizations

Website 2

(unknown)Content 4

-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

Doctors

governmentpatiënts

non-profit

Patiënt

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

• “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)

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

Accreditation organizations

• Professional associations: KNMG (doctors, AMA), KNMP

(pharmacists), NMT (dentists)

• Governmental and government-linked: RIVM (CDC)

• Patient organizations: member NPCF of CG-raad patiënt

association

• Non-profit organizations

– Comprehensive criteria such as objectives, association, funding,

partners

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 (click to view)

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)

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

– For example “Inforium”

Start a movement (click to view)

How do we beat Dr. Google?

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!

Doctor-patiënt communication

• 60 % of the information is forgotten instantly

• Of the remaining 40%,

– half the information is remembered incorrectly

Kessels, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE Volume 96 May 2003

But we have a website...

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

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.

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!

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 addresses stored

• Easier for patients than Google ! –Tailored information in their own mailbox

–Multisource, multimedia information

–Privacy respected and environment friendly

–Information can be shared easily

–Better information for shared decision making

What did you say?

• Video (click to view)

How we do it at the Flevo hospital!

• Shared Decision Making in the ENT department with Inforium

• In the doctor’s office (click to view)

• At the reception desk (click to view)

• Example doctor screen (click to view)

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 Inforiumsmore often?

YES, please

Results

100%: Yes

What kind of information do you appreciate the most?

Do you understand the information?

Nomination

client award

2012

Make our own Planetree presentation Inforium

www.inforium.infoUse this code: ENG-montreal

( Dutch live Inforium: www.inforium.nl Code: FZA-SDMMOD )

Conclusions en future developments

• In Shared decision making, is reliable information a key element

• Make it easy for the patiënt and yourself

• Getting information to the patient is crucial, not making it.

• Websites get beat by Dr. Google, Inforium® beats Dr. Google

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