1. Utilizing three important screens to improve health: the computer, cell phone and television James Kahn MD Professor of Medicine, UCSF AHRQ HS017784; NIH grants RR024369 and MH088341 and DA032057

7. Do vs. know Transformative technology Real world Incentives for the process Hypothetical growth with knowledge and resources Pay for results Empower Consumers Do Know

8. Sources used to find information

10. Information Systems Financial Information Demographics Notes, Immunizations Labs, Medications Images Consults, Reports Important Documents Financial Information Demographics Diagnosis, Immunizations Labs, Medications Images Consults, Reports Important Documents EMRs populated with data from “reliable” sources PHRs populated with data from patient sources Systems owned Patient owned

16. Architecture for myHERO at SFGH

17. Total number of PHR users Kahn J S et al. JAMIA 2010;17:224-228 ©2010 by BMJ Publishing Group Ltd

18. Number of sessions /user / time Kahn J S et al. JAMIA 2010;17:224-228 ©2010 by BMJ Publishing Group Ltd

20. Study Design Investigators: Joan Hilton Urmimala Sarkar Dean Schillinger David Thom Ricardo Munoz Neda Ratanawongsa Screen all clinic patients to participate Obtain consent from all willing participants Control group—deferred myHERO access but with internet training, free email address Experimental group –immediate myHERO access with internet training, free email address Provide access to all participants Randomize 12-months 12-months

23. Mental Health Diagnoses

24. Substance use Diagnoses

31. All Whites (75%) All Blacks (59%) English-Speaking Hispanics (80%) 73%* of the population reports using the internet or email. Here is a breakdown of use among different online groups. (shown as a percentage of population online) 18-29 Years Old (90%) 30-49 Years Old (85%) 50-64 Years Old (70%) 65+ Years Old (35%) No High School Degree (44%) College Graduates (91%) <$30K Income (53%) >$75K Income (95%) Men (73%) Women (73%) *Source: Pew Internet & American Life Survey, May 2008. http://www.pewinternet.org ** This statistic comes from the Pew Internet Project’s Latinos Online data, collected June-October, 2006. High School Graduates (63%) Urban (74%) Rural (63%) Suburban (77%) Spanish-Dominant Hispanics (32%)** 12-17 Years Old (94%)

32. 55%* of the population reports using a high-speed connection (e.g., DSL, cable, wireless) when accessing the internet from home. Here is a breakdown of use among different online groups. (shown as a percentage of population using a high-speed connection from home) Whites (56%) Blacks (41%) English-Speaking Hispanics (55%) 18-29 Years Old (69%) 30-49 Years Old (68%) 50-64 Years Old (49%) 65+ Years Old (19%) No High School Degree (29%) College Graduates (78%) <$30K Income (31%) >$75K Income (82%) Men (57%) Women (52%) High School Graduates (39%) Urban (56%) Suburban (59%) Rural (38%) *Source: Pew Internet & American Life Survey, May 2008. http://www.pewinternet.org 12-17 Years Old (66%)

33. Whites (79%) Blacks (73%) English-Speaking Hispanics (80%) 78%* of the population reports owning a cell phone. Here is a breakdown of use among different online groups. (shown as a percentage of population owning a cell phone) 18-29 Years Old (86%) 30-49 Years Old (87%) 50-64 Years Old (77%) 65+ Years Old (55%) No High School Degree (59%) College Graduates (89%) <$30K Income (63%) >$75K Income (92%) Men (78%) Women (78%) High School Graduates (73%) Urban (75%) Suburban (81%) Rural (73%) *Source: Pew Internet & American Life Survey, may 2008. http://www.pewinternet.org 12-17 Years Old (71%)

34. Mobile Phones In 2007, worldwide mobile telephone subscriptions reached 3.3 billion -- equivalent to half the global population 26 years after the first cellular network was launched 100% mobile phone penetration in the US by 2013

36. Study Design Investigators: Joan Hilton, Monica Gandhi Team members: Tracy Nunnery Lindsay Halperin, Kelly Bryant Screen all clinic patients to participate Obtain consent from all willing participants Control group—No SMS messages SMS messages for medication adherence and lifestyle Randomize Run in SMS texting check

37. Automating SMS --closing the loop

38. It is complex…

44. New model of work Managing a clinic population Patients who can use technology to help manage their care Patients who need human navigators to help with technology and care Patients who need human navigators to help with care and are not ready for technology Patients who totally self manage their care Patients who need more assistance Patients who need assistance Patients who need human navigators to help with care and are not ready for technology

46. Utilizing three important screens to improve health: the computer, cell phone and television

50. An example of merging technology

54. Medical Informatics Team 09/22/11 Supported by AHRQ HS017784; NIH: RR024369 and MH088341 NIDA R01DA032057 Jackie So Kelly Bryant Lindsey Halperin Skip Leasure Mitch Roberts Tracy Nunnery Olivia Chang Raeni Miller Robert Thawley Joan Hilton Monica Gandhi Adam Carrico Leslie Wilson

56. Thank you and Questions Jim Kahn 415-699-1118 [email_address] http://profiles.ucsf.edu/ProfileDetails.aspx?Person=4999786