The rise of the e-patient - Lee Rainie

THE RISE OF THE E-PATIENTTrends in the use of digital technologyfor health purposes

Lee RainieDirector – Pew Internet ProjectMedical LibrariansAtlantic City10.7.09

October 7, 2009 2Rise of the e-patient

New information ecosystem: Then and Now

Industrial Age

Info was:

Scarce

Expensive

Institutionally oriented

Designed for consumption

Information Age

Info is:

Abundant

Cheap

Personally oriented

Designed for participation


2000

46% of adults use internet

5% with broadband at home

50% own a cell phone

0% connect to internet wirelessly

<10% use “cloud”

= slow, stationary connections built around my

computer

The internet is the asteroid: Then and now

2009

77-79% of adults use internet

63% with broadband at home

85% own a cell phone

54-56% connect to internet wirelessly

>two-thirds use “cloud”

= fast, mobile connections built around outside servers

and storage


Media ecology – then (industrial age)Product Route to home Display Local storage

TV stations phone TV Cassette/ 8-track broadcast TV radio broadcast radio stereo Vinyl album

News mail

Advertising newspaper delivery phone paper

Radio Stations non-electronic

Tom Wolzien, Sanford C. Bernstein & Co


Media ecology – now (information age)Product Route to home Display Local storage

cable TiVo (PVR) VCRTV stations DSL TV Satellite radio playerInfo wireless/phone radio DVD“Daily me” broadcast TV PC Web-based storage content books iPod /MP3 server/ TiVo (PVR)Cable Nets broadcast radio stereo PCWeb sites satellite monitor web storage/serversLocal news mail headphones CD/CD-ROMContent from express delivery pager satellite player cell phone memory individuals iPod / storage portable gamer MP3 player / iPodPeer-to-peer subcarriers / WIFI cell phone pagers - PDAsAdvertising newspaper delivery non-electronic cable boxRadio stations camcorder/camera PDA/Palm game console

game console paperSatellite radio e-reader / Kindle storage sticks/disks

e-reader/Kindle

Adapted from Tom Wolzien, Sanford C. Bernstein & Co

Ubiquitous computing ageCloud computing

“Internet of things”


Information and media ecosystem changes

1.Volume of information grows2.Variety of information increases3.Velocity of information speeds up4.The times and places to experience

media enlarge5.People’s vigilance for information

expands AND contracts


Information and media ecosystem changes

6.The immersive qualities of media are more compelling

7.Relevance of information improves8.The number of information “voices”

explodes – and the voices become “louder” and more findable

9.Voting and ventilating are enabled10.Social networks are more vivid


Behold Networked Individuals … those with a different sense of …

• Expectation about access to, availability of, and pathways to information

• Place, distance, presence, intimacy – it’s all ambient • Time use• The possibilities of work, learning, and play• The scalability of conversation and community • The persistence of “digital me” and “digital you”• Personal efficacy and the payoff for personal effort• Boundaries and contexts – public and private• The rewards and challenges of networking for social,

economic, political, and cultural purposes – new layers and new audiences


A new pattern of communication and influence built around social networks and participatory media

The four A’s of searching and acting• attention• acquisition• assessment• action


Networked Individuals as e-patients• 61% of total population – 83%

of online population• 64% of women; 57% of men• 65% of whites; 51% blacks;

44% Hispanics• Age

– 72% of 18-29-year-olds– 71% of 30-49-year-olds– 59% of 50-64-year-olds– 27% of those 65 and older

• Skews upscale and educated• Parentshttp://e-patients.net/




Information about specific disease or medical problem

36%39%

45%49%

0%

10%

20%

30%

40%

50%

60%

Dec-02 Nov-04 Aug-06 Dec-08

% o

f adu

lts


Information about treatment or procedure procedure

27%30%

36%41%

0%

10%

20%

30%

40%

50%

60%


% o

f adu

lts


Information about exercise and fitness

21%25%

31%

38%

0%

10%

20%

30%

40%

50%

60%


% o

f adu

lts


Information about prescription or over-the-counter drugs

19%24% 26%

33%

0%

10%

20%

30%

40%

50%

60%


% o

f adu

lts


Information about alternative treatments or medicine

16% 18% 19%

26%

0%

10%

20%

30%

40%

50%

60%


% o

f adu

lts


Information about depression, anxiety, stress or mental health issues

12% 14% 15%21%

0%

10%

20%

30%

40%

50%

60%


% o

f adu

lts


Information about experimental treatments or medicines

10%14% 13% 15%

0%

10%

20%

30%

40%

50%

60%


% o

f adu

lts


Other e-patient activities

• 47% of adults have used the internet to get information about doctors or other health professionals

• 38% have gotten information about hospitals or other medical facilities

• 33% have gotten information about how to lose or control their weight

• 27% have gotten information about health insurance

• 12% have gotten information about how to stay healthy on an overseas trip


60% of e-patients engage with social media

• 41% have read someone else's commentary or experience about health or medical issues on an online news group, website, or blog.

• 24% have consulted rankings or reviews online of hospitals/other medical facilities.

• 24% have consulted rankings or reviews of docs or other providers.

• 19% have signed up to receive updates about health or medical issues.

• 13% have listened to a podcast about health or medical issues.


20% of e-patients are e-participators• 6% have tagged or categorized

content about health issues. • 6% have posted comments about

health issues in an online discussion, listserv, or other online group forum.

• 5% have posted comments about health on a blog.

• 5% have reviewed a doctor. • 4% have reviewed a hospital. • 4% have shared photos, videos or

audio files online about health or medical issues.


A handy tech-user typology

http://www.pewinternet.org/Reports/2009/5-The-Mobile-Difference--Typology.aspx


What we measured

• Assets• Actions• Attitudes

Overall picture39% are motivated by

mobility5 groups that are being

drawn into deeper use thanks to mobile connections

Wireless connections prompt them to use the internet more and feel better and better about its role in their lives

Self expression and networking matters to them, but some have mixed feelings

61% are tied to stationary media

5 groups that do not feel the pull of mobility – or anything else – drawing them deeper in the digital world

Some have lots of technology, but it is relatively peripheral in their lives

They have plateaued in internet use and enthusiasm -- or are on the outskirts of digital life


Motivated by mobility – Group 1Digital collaborators (8% of population)

Tech lifestyle attributes

With the most tech assets, Digital Collaborators use them to work with and share their creations with others.

The lead the pack in every dimension of our analysis: assets, actions, attitudes towards technology.

Always-on broadband and always-present cell connection is key to their lives.

These veteran users are enthusiastic about how ICTs help them connect with others and confident in how to manage digital devices and information.



Demographics• Male: 56%• Median age: 39• Race: Diverse• Education: 61% college +• Household income: 53% make > $75K• Employment status: 70% employed FT• Community type: 52% suburb; 36% urb.• Funky facts: 12 years online

73% married 51% parents minor children



Important because

• They are your most consistent, primary users

• They are early adopters• They are most potent influentials;

they are evangelists and their word of mouth really, really matters

• When you want to explore new services, they will give you feedback


Motivated by mobility – Group 2Ambivalent networkers (7% of population)


Ambivalent Networkers have folded mobile devices into how they run their social lives, whether though texting or social networking tools online.

They tie for first or take second in all assets and actions categories.

They also rely on ICTs for entertainment. But they also express worries about

connectivity; and some find that mobile devices are intrusive.

Many think it is good to take a break from online use.

Their keyword about technology might be “obligation” – can’t afford to be off the grid, even though they want to be.



Demographics• Male: 60%• Median age: 29 (youngest)• Race: Little more minority than DigCollab.• Education: 23% college +• Household income: 44% make < $50K• Employment status: 64% employed FT• Community type: 44% suburb; 45% urb.• Funky facts: 30% are students

34% are NOT email users 83% are cell texters



Important because

• They are tomorrow’s primary e-patients and library-service users and influencers

• They have seen change in libraries and liked it


Motivated by mobility – Group 3Media movers (7% of population)


Media Movers have a wide range of online and mobile habits, and they like to find or create an information nugget, such as a digital photo, and pass it on.

These social exchanges are central to this group’s use of ICTs – rather than work-related uses.

Cyberspace as a path to personal productivity or an outlet for creativity is less important.

They are not into online content creation the way Digital Collaborators are, yet they are big-time sharers.



Demographics• Male: 56%• Median age: 34 (second youngest)• Race: Diverse• Education: 32% college+ (average)• Household income: 56% make > $50K• Employment status: 70% employed FT• Community type: 55% suburb; 30% urb.• Funky facts: 31% record video on cell

87% own dig. camera 90% online health seekers



Important because

• They are least intense e-patients, though lots of them have sought medical information online

• They are eager social networkers who pass along your material

• They add to the diversity of your audience


Motivated by mobility – Group 4Roving nodes (9% of population)


Roving Nodes are active managers of their social and work lives using their mobile device.

They get the most out of basic applications with their assets – such as email or texting – and find them great for arranging the logistics of their lives and enhancing personal productivity.

They love email and texting, but are too busy to blog or create other content.

Think “working Little League mother”, or caregiver for aging parent when you think of Roving Nodes



Demographics• Female: 56%• Median age: 39• Race: Diverse > Latino• Education: 44% college+ (2nd highest)• Household income: 52% make > $50K• Employment status: 68% employed FT• Community type: 48% suburb; 39% urb.• Funky facts: 100% have cell phones

heavy internet use at home and work – hard to give up

say tech gives them control



Important because

• They are kin-keepers and caregivers

• They will appreciate you if you help them be efficient and thorough


Motivated by mobility – Group 5Mobile newbies (8% of population)


This group rates low on tech assets, but its members really like their cell phones.

Mobile Newbies, many of whom acquired a cell in the past year, like how the device helps them be more available to others.

The act of getting a cell phone was like a conversion experience for them in the way it opened up the world.

They would be hard pressed to give up the cell phone. And they express general support for the role technology can play in people’s lives even though most do NOT use the internet.



Demographics• Female: 55%• Median age: 50 (oldest MBM group)• Race: A bit weighted to minorities• Education: 72% HS or less• Household income: 45% make <$40K• Employment status: 53% employed FT• Community type: 24% rural• Funky facts: just 39%=internet users

46% use computersnone create internet content

love new connectedness



Important because

• They are very unlikely to be e-patients and quite unaware of the wealth of material available online

• They greatly diversify your audience

• They are traditionally under-served customers


Stationary media majority – Group 1Desktop veterans (13% of population)


This group of older, veteran online users is content to use a high-speed connection and a desktop computer to explore the internet and stay in touch with friends.

They are happy to be connected with they are stationary and sitting. So, they place their cell phone and mobile applications in the background.

For them, online life hit its zenith about 3-5 years ago when they first got broadband connections.

And their 2004 cell phone still serves its primary purpose for them – making phone calls.



Demographics• Male: 55%• Median age: 46• Race: Skews white• Education: 41% college+ (3rd highest)• Household income: 32% make >$75K• Employment status: 56% employed FT• Community type: 52% sub.; 30% urb.• Funky facts: just 77% have cells

int. user 10.5 years heavy int. users at home

and work average content creators



Important because

• They are relatively intense e-patients

• They already know about the things you do

• They are influencers, too


Stationary media majority – Group 2Drifting surfers (14% of population)


Many have the requisite tech assets, such as broadband or a cell phone, but Drifting Surfers are infrequent online users.

They also are not big fans of mobile connectivity.

When they use technology, it is for basic information gathering.

It wouldn’t bother the typical Drifting Surfer to give up the internet or cell phone.

Likely to be secondary user of technology in household.



Demographics• Female: 56%• Median age: 42• Race: Diverse• Education: 33% college+; 33% HS• Household income: 46% make >$50K• Employment status: 66% employed FT• Community type: 46% sub.; 35% urb.• Funky facts: 85% have home broadbd

86% have cells below aver. tech user tech doesn’t help much

46%=“good to take break”



Important because

• They are not aware of the material that is available online and through other resources

• They will need you some day


Stationary media majority – Group 3Information encumbered (10% of population)


Most people in this group suffer from information overload and think taking time off from the internet is a good thing.

Their attitudes about the role of technology in the world have worsened since 2006 and they see no great benefits from technology in their personal lives.

The Information Encumbered are firmly rooted in old media to get information and communicate.



Demographics• Male: 67% (highest)• Median age: 53• Race: Skews white• Education: 33% college+; 37% HS• Household income: 42% make <$40K• Employment status: 40% employed FT• Community type: 48% urb; 20% rural• Funky facts: 99% are int. users

75% are cell users only 52% online typ. day 52%

feel overloaded 62% need help new gad.



Important because

• They are the alienated and society functions better with their participation and involvement


Stationary media majority – Group 4Tech indifferent (10% of population)


Members of this group are not heavy internet users.

Although most have cell phones, they don’t like their intrusiveness.

The Indifferent could easily do without modern gadgets and services. They are too much trouble with too little payoff.



Demographics• Female: 55% • Median age: 59 (2nd oldest)• Race: Diverse (little higher Af-Am)• Education: 73% HS or less• Household income: 59% make <$50K• Employment status: 34% employed FT• Community type: 26% rural• Funky facts: just 39% are int. users

46% computer users but 86% are cell users

least likely users of everything



Important because

• They are on the far side of the digital divide even though they have some relationship to technology

• Very few e-patients


Stationary media majority – Group 5Off the net (14% of population)


Members of this group have neither cell phones nor online access, and tend to be older and low-income.

Some have experience with ICTs. They used to have online access and as many as one in five used to have a cell phone.

But it broke, or didn’t provide much enhancement to their worlds, so they did not return to using the technology.



Demographics• Female: 57% (highest)• Median age: 67 (oldest)• Race: Skews to minorities• Education: 80% HS or less• Household income: 38% make <$20K• Employment status: 17% employed FT• Community type: 30% rural• Funky facts: just 16% have desktop or

laptop they see no lifestyle

improvements with technology



Important because

• These are often the people who most need medical information

• Their caregivers need you, too


8 tips on how to be a node in a social network

• Think like a friend• Remember your strengths and play to them by

being an expert, a filter, and a recommender (linker) • Be aware that your audience is bigger than the

available evidence provides – lurkers and future arrivals are part of the mix

• Look for opportunities to provide support to users and chances to build communities with your material


8 tips on how to be a node in a social network

• Help people cope with technology• Participate in the Web 2.0 world• Embrace the move towards mobility,

constant connectivity, perpetual contact – This changes the realities of time and

space and presence• Ask for help/feedback


Thank you!

Lee RainieDirectorPew Internet & American Life Project1615 L Street NWSuite 700Washington, DC 20036Email: [email protected]: http://twitter.com/lrainie 202-419-4500

mailto:[email protected]

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Health & Medicine

The rise of the e-patient - Lee Rainie