Brainstorming (10/30-31)

Multiple Group Brainstorm
We met with our pair group and began to brainstorm broad categories that interested us. We also tried using leading questions like "wouldn't it be great if..." to help generate problem areas and opportunities.

Single Group Brainstorm
We began our group brainstorming session by identifying 5 broad categories that we are interested in brainstorming concepts further":

• Scenario influence on presentation of information
• Integrating social network 
• Customize consumer experience based on their background/history
• Matchmaking 
• Reviews

We then brainstormed concepts/ideas individually to produce as many different ideas as possible (trying to reach the 50 benchmark). Once we felt we had generated enough concepts, we came back together and presented ideas for each broad category, placing sticky note concepts under each category.

Once all of our concepts were organized, we went back through each category and reviewed our ideas to identify themes across concepts. We wrote these basic themes in red to make it easy to consider concept areas we liked most. 

"Aha Moment": We liked the idea of having a "medical adviser", someone a patient could call, explain the situation, and they would provide individualized suggestions based on what they know about this. This idea was appealing because we felt patients would trust it much more than the current search tool. We then took a step back and realized that the "medical adviser" is really the role we would like the search tool to ultimately take, but what is missing is TRUST. We then identified trust as an overarching concept that we wanted our ultimate solution to integrate into a search tool. 

6 Major Concept Areas:

1) Category: designing how search information/data is presented based on the patient's situation

a. Start search by identifying situation, timeframe, etc. (generate search results)

b. Allow real-time re-ordering of search results based on patient's identified priority of care attributes (prioritizing search results)

2) Category: Integrating social network into search tool

a) Physicians in search results can have a badge indicating whether someone in your extended network (possibly via facebook) had used that doctor, provides way to reach out to them for more detailed feedback. (Irene)

b) Another way is to identify the situation and then generate connections in the social network from that, provide patient the option to connect with people.

3) Category: Reviews

Creating a review structure so that there becomes a consistent format of reviews to help consumers compare information, and also to ensure more rich information provided by reviews. Also would mitigate extreme reviews.

4) Category: reviews/data

Minimize information overload by only showing critical info up front, allow users to dig if they want to

5) Category: Reviews

Review input is abstract, paragraph style. System output (that consumers sees) is based on keywords

6) Category: Reviews (Irene)

Understanding reviewer background, compare to consumer preferences. Identify patterns in reviewer's review history. Prioritize reviewer's feedback based on shared values with the consumer. 

Pair Team Review (10-27)

Our group met with Acacio, Stewart, and Joy.

Going through their research findings was helpful to hear their thinking behind the project and see a different perspective on the information.

As we went through our frameworks we realized that we needed to break down our thinking behind each framework to make our presentation more clear and easy to follow. Joy had some suggestions on how to present our frameworks to emphasize the important information.

Influence of recent healthcare changes on searching for physicians

Guiding the next generation of public reports (see source)

• with insurance expansions under the Affordable Care Act, there has been an influx of newly insured people who now need to take control of their healthcare and make important decisions.
• additionally, previously insured consumers now covered under a new plan with a network of providers that does not include their previous providers not need to make decisions and would benefit from care information
• overall, the type and presentation of physician information is more critical than ever. 
• consumers now have more of a stake in the pricing of their healthcare plan, so being more transparent about the actual price information is important
• suggested gaps in information provided to consumers include:
• provider rates of success in helping patients maintain or restore health
• provider track record in ensuring continuity of patient care
• physician performance
• quality info that is paired with cost info
• is it possible to tailor the physician information to the individual consumer?
• look to these cited sources (Hibbard): 
• Best practices in public reporting NO.1
• Best practices in public reporting NO.2
• shaller consulting (2006)
• scan others for those that look interesting
• note keywords of this study

Supporting consumer healthcare decisions through data presentation (see source)

• recent changes in the healthcare system have made healthcare options more expensive but have given more control to consumers. Consumers are now more invested in their options and have increased motivation to making the right decision. This means that presenting choices in a way that helps consumers be better informed is increasingly crucial.
• an abundance of information does not necessarily lead to informed decisions
• current tools:
• include technical terms that are difficult for consumers to understand
• force consumers to compare multiple options on several variables
• require the consumer to differentially weight the options and factors

How do people shop online? What is the best way to report the information?

Word of Mouth Reviews in Hospitality and Tourism Management (see source)
-Discusses how hospitality services, like finding a doctor, is a distinct type of decision to finding and evaluating products.

• study asserts that for services that are intangible like hospitality, "interpersonal influence" is more important. This is the idea that consumers have a greater ability to influence eachother in decision-making.
• These types of decisions are high-risk

Information overload in e-commerce decision-making (see source)

• filters can help to alleviate perceived information overload
• individuals vary in their ability to process different levels of information
• more experienced online shoppers are able to process information more effectively and more efficiently

What makes a helpful online review (see source)

• for experience goods (those that require being experienced in order to be reviewed, like a doctor), extreme ratings (1 out of 5 stars, or 5 out of 5 stars) are less helpful than moderate ratings (3 out of 5 stars).
• taste plays a big role in ratings of experienced goods, therefore the majority of the ratings are extreme. However, consumers are often skeptical of the tastes of others, so these ratings aren't as helpful
• They find that lengthier, more detailed reviews are less helpful for experience goods versus "search goods" (things that don't need to be experienced to give a rating to, like cameras)

How to effectively present healthcare performance data to consumers (see source)

• the top 3 factors identified by consumers as most important are for quality of care:
• affordability of care
• doctor qualifications
• access to care for everyone
• too much information is counterproductive (even though consumers often report wanting more information)
• weighting or prioritizing different factors (of care) is difficult for consumers. Is this also true of physician factors??
• Currently, consumers must process large amounts of information, identify relevant factors and prioritize them, and bring all of this together into a choice. This is a difficult task for humans to do effectively. As a result, consumers aren't quick to use these tools, leading to low review/feedback rates (negative feedback loop). --> the problem
• proposed solution: make information more relevant to what consumers already understand and care about.
• avoid technical jargon, frame information clearly --> "physician is trusting and friendly"
• allowing users to drill down if they want can ease the burden of too much information up front. Make the specifics available but not in your face.
• make sure ratings metrics are consistent 
• summarizing and interpreting information for the consumer can be really helpful. This could mean visually organizing and ordering a list of physicians in a certain way
• use colors and symbols rather than numbers when possible
• The problem with cost information: Americans are biased to believe that higher cost indicates higher quality, which is not always the case. Because of this, cost information should be shown within quality strata.

Supporting consumer healthcare decisions through data presentation (see source)

• consumers tend to take shortcuts when there is an informational overload in the decision process. 
• overweight the factors they understand
• overweight one factor over other important factors to reduce the number of choices
• most current tools that help consumers compare options are based on the assumption that consumers know what is most important to them and can therefore weight the presented information effectively to make their choices. This has been shown to be an inaccurate assumption.
• when people are in a situation that is both complex and unfamiliar, they likely do not have fixed ideas about what is important to them. In this case, information presentation has a significant impact on what is attended to and used.
• even when information is understandable to a consumer at an analytic level (knowing what the numbers mean), it may not be understandable at an emotional level (how good is a 4/5 rating?).
• use symbols/colors instead of or in addition to numbers alone

Process Blog by 10/26/2014

This week we continued our secondary research by focusing on the following questions:

• What do patients care about when they search for physicians?

• What distinct categories of patients are there? How do their values differ when searching for doctors? 

• How do physicians interact with current tools, what do they care about?

• What are the shortcomings/issues associated with current physician-search tools?

• What are the main attributes that Premera competitors are focusing on? 

• How have the recent changes in the healthcare system altered who searches for doctors, what they care about, etc.?

• Research the way people shop online? What rating systems/metrics are most effective? Is there research that compares the way people shop online for products versus doctors/people/services?   

We recorded our finding for each topic in separate blog posts.

To construct our research framework, we first wrote down our research topics and findings on sticky notes, and organized them on the white board. 

After we talked through all of our findings, we picked out two research topics we found extremely exciting to construct our two research framework. 

We will meet with another group next Monday to have them review our frameworks and revised problem/ opportunity/ hypothesis.

How do physicians interact with current tools, what do they care about?

Stimulating the Adoption of Health Information Technology
http://www.nejm.org/doi/full/10.1056/nejmp0901592

Congress apparently sees HIT — computers, software, Internet connection, telemedicine — not as an end in itself but as a means of improving the quality of health care, the health of populations, and the efficiency of health care systems.

The Impact of the Internet and Its Implications for Health Care Providers: Findings From the First Health Information National Trends Survey
http://archinte.jamanetwork.com/article.aspx?articleid=766849

As a result, data entry and review systems are becoming ubiquitous in hospital settings and health care technologists are crafting applications in medical informatics to improve the quality of health care.

The implication for physicians is that patients may come into the office with printouts that they did not personally collect; the implication for Web site designers is that health information seekers may be looking for easy-to-print materials to give others.

Those who searched online the most tended to be younger, women, and better educated, and tended to have higher incomes than those who searched the least.

What Does It Cost Physician Practices To Interact With Health Insurance Plans?
http://content.healthaffairs.org/content/28/4/w533.full

An approximate calculation can be made by multiplying the number of physicians in U.S. office-based practice by the $68,274 per physician annual cost we found.

Health plans claim to have taken steps to reduce the administrative burden they place on physicians; our data suggest that physicians continue to be discontented with this burden.

The average physician reports spending nearly three weeks per year on these interactions (nearly two weeks if the median value is used); twenty-three weeks per physician per year are spent by nursing staff, and forty-four weeks, by clerical staff.

A small fraction of this time—two hours per year by the average physician, and little more by their staff—is devoted to providing quality data to health plans or to reviewing quality data generated by plans about the physicians’ practice. Primary care physicians, especially those in small practices, spend larger amounts of time interacting with health plans than physicians in other specialties.

What distinct categories of patients are there? How do their values differ when searching for doctors?

Peer-to-Peer Health

http://www.pewinternet.org/2011/02/28/peer-to-peer-health-care-2/

When finding recommendation for a doctor or a specialty, 52% of adult say they think health professionals are more helpful than peer sources when it comes to getting a recommendation for a doctor or specialist, 27% of adults prefer to ask friends family and fellow patients for this type of advice. Order adults are much more likely than younger ones to say health professionals’ opinions are more helpful. Generation X internet users (34-45) are the most likely age group to look online for information about health professionals.

When finding recommendation for a hospital or medical facilitates, 62% of adult say they think health professionals are more helpful than peer sources when it comes to getting a recommendation for a doctor or specialist, 27% of adults prefer to ask friends family and fellow patients for this type of advice. Older adults are considerably more likely than younger adults to turn to health professionals for this type of information

Online Health Seeking: How Social Networks Can Be Healing Communities

http://www.pewinternet.org/2010/10/25/online-health-seeking-how-social-networks-can-be-healing-communities/

1.  Internet

Adult: 61% get health info online (80% are internet users)

E-Patients: 60% consume social consume social media; 29% have contributed content; 19% consult rankings of providers (5% post them); 18% consult reviews of hospitals (4% post them)

2.  Other Data

60% of e-patients say the info found online affected a decision about how to treat an illness or condition.

53% say it lead them to ask a doctor new questions, or to get a second opinion from another doctor.

38% say it affected a decision about whether to see a doctor.

On Going to See the Doctor, the Contributions of the Patient to the Decision to Seek Medical Aid: A Selective Review
http://www.sciencedirect.com/science/article/pii/0021968163900997 

Features
1. Most participation and utilization studies, while seemingly similar to the initial process of seeking medical advice, are really the repeated use or reuse of the doctor-patient relationship. 

2. It is the choice between types of medical service, between public or private care, general practitioner or specialist, clinic group or solo practice, Doctor X or Doctor Y-choices in medical service about which there is great debate on what is good, better or best.

Factors influencing the decision to seek medical aid: the perceptions of and beliefs about symptoms, the expectations of medical personnel, and the rationale of the need for medical care. 

The decision is not necessarily idiosyncratic but often rooted in the patient’s social background.

Complexity, Public Reporting, and Choice of Doctors: A Look Inside the Blackest Box of Consumer Behavior
http://www.ncbi.nlm.nih.gov/pubmed/23999489

The quality of choice erodes dramatically as choice sets incorporate more options and more performance metrics, even though the information on SelectMD was far simpler than on websites that also include cost measures, safety metrics, and assessments of electronic access.

Second, certain types of consumers are more susceptible than others to the challenges of complexity. Some of these susceptibilities relate to decision skills, others to decision styles.

Third, incorporating patient comments into public reporting clearly displaces consumers’ attention from standardized performance metrics, leading to choices that are suboptimal on those measures.

Use of  filters helps relieve cognitive burden by reducing the size of a choice set to one that seems manageable. In so doing, consumers often exclude the best clinicians 

What are the shortcomings/issues associated with current physician-search tools? What are the main attributes that Permira competitors are focusing on?

Search attribute	ZocDoc	UPMC	WebMD	Vitals	DoctorDirectory
Specialty	yes	yes	yes	yes	yes
Zip code	yes	yes	yes	yes	yes
Insurance	yes			yes
Doctor name		yes	yes	yes
Doctor Condition			yes	yes
Procedure			yes

Search Results:

http://www.zocdoc.com/

http://findadoc.upmc.com/FindADocSearch.aspx

http://doctor.webmd.com/

http://www.healthgrades.com/landing/dcp/sea-20140910?s_tnt=184566:5:0

http://www.doctordirectory.com/findadoctor/

http://www.vitals.com/

The pros are you can make an appointment with a Doctor online, and easy. The cons not many Doctors use Zoc Doc service. So you will have a very shallow network of Doctors to go to.

http://www.quora.com/What-are-the-pros-and-cons-of-using-ZocDoc-to-make-doctors-appointments

What do patients care about when they search for physicians?

How Are People Choosing a Doctor These Days? Who is using the online process?

http://www.hcbhealth.com/health-blog/2011/03/how-are-people-choosing-a-doctor-these-days/

• 90% of people looking for health-care information go online first
• These casual users read a couple reviews, give their doctors a thumb up or down, and move on in the search

How to choose a doctor

http://consumerreports.org/cro/2014/09/how-to-choose-a-doctor/index.htm

1. Check your insurance: Search for doctors in your network
2. Consider hospital affiliation
3. Look for board certification: Doctors being certified through the American Board of Medical Specialties
4. Watch out for red flags: someone who has had a lot of malpractice claims
5. Consider compatibility: More than half of Americans focus on personality and relationship when choosing a physician
6. Ask about drug reps: Many doctors let representatives from pharma­ceutical companies into their offices to pitch their drugs  influence doctors choice of drugs
7. Find out about office policies: how long it takes to make an appointment for a routine visit and how long patients are kept in the waiting room
8. Scrutinize the staff: a staff that’s friendly, efficient, and respectful. 
9. Factor in technology: Electronic health records, book and track doctor appointments

A 2014 survey from The Associated Press and the NORC Center for Public Affairs Research

http://www.apnorc.org/Pages/default.aspx

• When it comes to defining provider quality, most Americans tend to focus on certain aspects of quality relating to doctor-patient interactions and doctors’ personality traits, rather than the effectiveness of the care provided or the patient’s own health outcomes.

• Most people are not very confident they could find provider
  quality information they can trust on their own, including direct comparisons of physicians.
• Americans report that they would trust word-of-mouth and personal recommendations from doctors far more than provider quality data coming from the government or third parties.
• Getting information on the cost of provider care is even more challenging for Americans than finding information about provider quality.

 

 

Physician Marketing: How Do Patients Research Doctors and Procedures?

http://www.screwpilecommunications.com/screwpile-marketing-blog/bid/256090/Physician-Marketing-How-Do-Patients-Research-Doctors-and-Procedures

People are indeed using the internet to make decisions on procedures, choosing doctors and managing their diseases. 

80% of Internet Users Seek Online Health Information. 

48% said they search for online health information on behalf of someone else

36% said they use the Internet to look up health information for themselves

80% of internet users, or 59% of U.S. adults, look online for health information.

55% of internet users look online for information about a certain medical treatment or procedure.

47% of internet users look online for information about doctors or other health professionals.

57% of e-patients who say their most recent search had an impact on their own health care or the way they care for someone else.

38% of internet users look online for information about hospitals or other medical facilities.

41% of Americans are comfortable using websites to check health symptoms.

25% of people trust online symptom checkers, mobile apps and home-based vital sign monitors as much as they trust their doctor.