Complete Transcripts from Don Kemper Podcast

We had the pleasure of interviewing Don Kemper, the CEO and founder of Healthwise the week before last.  You can click here to listen to the MP3 of the discussion which is about 40 minutes long or as promised here are the complete transcripts:

Steven Krein: Good afternoon. I want to welcome Don Kemper, who is the chairman and CEO of Healthwise, to a very unique conversation that we're going to have today. Unity Stoakes, the co-founder of OrganizedWisdom is here with me and we've got what a lot of people call the information therapy guru himself, Don Kemper on the call.

Don Kemper: Ohh!  That's nice Steven, to be here.

Steven: So anyway, we at OrganizedWisdom decided to integrate expert health content into our platform last year, and we went in search of what we consider to be the best health information online, both as a benchmark standard as well as the best tools for consumers to use. It was not even a question that Healthwise was the clear leader. So we actually decided to partner with Healthwise and include all of its content on OrganizedWisdom as a foundation of expert content to really supplement the really user generated content that we have available to consumers.

So Don, I want to welcome you, and perhaps you can give a little bit of an overview, you have been doing this a long long time, and most of the innovation in the health information space has really come from you and your team, but I'd love to hear in your own words a little bit about your background and how Healthwise came to be.

Don: OK, well it's an interesting story. It began when I was a lieutenant in the US public health service, this is 1970, and I heard a speech from an assistant secretary for health designation wealth saying that the greatest untapped resource in health care was the patient. And it was a new idea that you could actually build a better health care system by building a smarter patient. And I decided as a very young individual that I'll just develop my life to try and catch that resource, and build a better patient. So a few years later I ended up in Boise, Idaho, and had the chance to start an organization, Healthwise, 1975, who has a not-for-profit mission to help people make better health decisions. So we had a head start on most and we've now been working 31 years trying to find new ways to help people make their health decisions. It's been fun.

Steven: That's great. And it wouldn't be complete without at least giving a snapshot on what you've done with the "information therapy movement", and how you see that impacting the world, and I think maybe just a brief overview on what you've done there as well would be helpful for everyone.

Don: Oh you bet. So, when we first saw that Internet was moving into the consumer world, we thought boy, this is perfect, it's the perfect delivery of consumer health information, anybody can get to this information 24/7, it's going to just revolutionize the way health care is delivered. And then we watched to see what happened, we tried to create that content to do that, but what happened was that people would get good content, but they didn't have a good way to get it into their clinical decision making, because the docs didn't have time to look at the stuff that they had printed and brought with them into the clinic. And so we began to think that there needs to be a way to link these things together, and we came up with this idea of an information prescription, a vision that another clinician can actually prescribe information as part of the process of care. That way the patient doesn't have to hunt so much for information, and what they get is specifically relevant to their diagnosis and to their particular moment in care as we describe it.

Of course it requires a big infrastructure in the physician's office in order to do that, they have to have electronical medical records and so. During this interim period before the physician is able to seamlessly deliver this information to prescriptions, we are looking at lots of other ways to do that, often through the health plan. The health plan has information about the patient and can prescribe information relative to their diagnosis and their moment in care. We do think it's a revolutionary idea, and it just means that it will be almost unavoidable for patients to get good evidence based information about their care at the time they're making their decision.

Steven: That's a great overview. You've been in this since 1970, what do you think the biggest trends are that are taking shape over the coming years, that are going to impact people's ability to get better access to health information?

Don: I think it's pretty clear that the answer to that are the electronic medical records. The EMRs in the doctor's office, which then would be able trigger these information prescriptions, or the PHRs, the personal health records, which can be a variety of either health plan, or health portal websites. Both really have specific information about the individual, and a place for the individual to go and get secure messages and selected information that will help them make better decisions. I think those two things together are the infrastructure changes that will most impact the health care consumer.

Unity Stoakes: How do you see the web or Internet platforms sort of helping those trends along over the coming years? There's a lot of new startup companies in this space, how do you see these web companies and Internet platforms sort of helping these trends along?

Don: I think it depends on each one, so in general the kind of content that's on the big portals is information that the patients need to be able to go and search and find and use. Then I think most of these big portals are also looking for ways to implement an information therapy strategy, so they're trying to link their content with electronic medical records or personal health records so that the patient, the consumer doesn't have to do so much of the work if they can serve it up to the consumer based on the claims or the experience they're having with their doctors. I'm not sure I'm answering your question, you want to probe there further?

Unity: Well there's been the health portals that have really made a lot of progress, I think over the last ten years, really getting that information, that evidence based information out to patients and to consumers. But lately, especially over the last couple of years we're seeing social media solutions coming to play, which is sort of what we're trying to do, where the other patients are actually helping patients, either pass along this evidence based research as well.

Don: I think that's the missing link, I think that's really important. I like to describe an analogy between health care, health information and movies. There's a rating system for movies, you can see in the paper whether it's a G-rated movie or PG or R, or triple X I guess, and in some sense of some measure of the movie, but it doesn't really tell you whether it's a good movie or not. To learn of a good movie, you can go to the experts, whether it's two thumbs up or not, in terms of those people who have over time developed reputation for helping the public decide what's a good movie and what's not. Or you can go to sites where you actually see what people like you have rated it. I don't know if you want to name names here, but like Rottentomatoes.com is one I like. You get a cross-section of people and their response to the movie.

I think in health care you need the same three levels, you need some sort of a rating, it tells you if this website or information is playing by the rules. So is it transparent sponsoring this information? Are they updating it when they say they're updating? What is the source of the information that they're using? Those kinds of regulatory kinds of things, we need that and we have that in the health website accreditation programs and you're acting in other places.

You also need something that tells you whether this is evidence based information, so you need something that, from a medical point of view, this information is high quality and I think that it challenges that right now, except in very specific areas. I think people want to know where is the authoritative source, so it's the role that Healthwise tries to play, and we really try to vet out information against the medical research, and try to keep things up to date as much as possible.

And then the third pass on information is, we need to find something that's really helpful to the patient. And there really is no better way to measure that than to ask people that are using information, so I think that kind of social networking can really make a contribution, help people understand "yeah I want to have it authoritative, and I want to make sure it's legal and appropriately marketed. But I really want to know is it helpful to people like me, who are experiencing the same kind of problems I'm experiencing." I think it sort of fills in a third part of that triple ground.

Steven: It's interesting, Don, because that's exactly how we're approaching OrganizedWisdom, which is really to provide that top-grade health information that's been reviewed and is kept up to date by Healthwise. We're proud of the fact that we've got the same Healthwise content that WebMD and Yahoo and MSN and AOL have, and then we've laid on to that in this consumer generated content model, where people can share what happened to them, what worked, what didn't work, what they would do differently next time, some perhaps recommended doctors or other health professionals or products or prescription drugs that they should ask their doctors about, and while doing so, allowing it to be linked right back to the Healthwise information. So I'd love to get your take on what you think of us bringing all three of these pieces together, and how that can really complement each other for a more complete health information experience to the consumer.

Don: OK, well I think that the content is right on. We have to see how well it's delivered, if indeed people can go to this single source and get both the authoritative information and the patient experience, the consumer experience, and understand which is which. I think that's the key part.

Steven: Yeah, clearly labeling and being very transparent with the source of information has been part of our really key strategies. Transparency is so important.

Don: Right. I think that adds decent values. I've been encouraged in... I think it depends on where you're able to really get enough people to come in and put in their individual wisdom, put in their experience. It is an essential piece of the overall solution to the patient, but it's a piece that most people have to dig around in their families or their neighbours or people that work with them, to find that level of experience. What this social network adds is just to make it a lot easier to capt into that.

Steven: So obviously that begs the question, what do you think could or should be done to really get more people sharing the way you envision this working in a more tactful way?

Don: It's going to have to be word of mouth, I think it's the way that these things work. If it works for you, you're going to tell your friends. How do you get enough, what's the quantum level of effort you have to put in in order to get that ball rolling. I presume that you guys are the experts on that.

Steven: Yeah. It's definitely a very interesting challenge, and one that I think with some of the social networking tools hopefully we can continually adapt and modify over time. There's obviously a number of challenges just in this whole new world of kind of social media and participation by consumers, and like I said earlier, some of it is just laying on top of things like Healthwise, some tools to enable people to participate and share, and rate and rank etc.

But there's obviously this new paradigm where there's no longer an information lag between doctors getting information and consumers getting information. So that whole window has closed because of Google, and Yahoo, and the other search engines making all of the information available at the same time, so you no longer have that real lag time for a physician to get up to speed before a patient comes to them and starts asking them questions. How do you think doctors can be more prepared, given that consumers now have as good, if not better, information perhaps than they do, because they have the time to spend to get it?

Don: Ok. Well, I think that the physicians that are able to take advantage of this newly informed patient, and in fact actually support their information, are going to have a significant advantage over those who don't. Right now, if you talk to most docs, the thing that's just hammering them is what they call a work-flow crisis. They just have too many patients and not enough time, so they just have to run through their patient list, and they're hardly able to do the quality job that they've been trained to do, because of the economics of the current situation.

I think that with good information to the patient, the patient can do a lot more of the work in advance, so that by the time they get to the doctor, the doctor doesn't have to spend a lot of time asking ten-dollar questions, ten-dollar-an-hour questions.  The patient could have done all that in advance, and then the doctor can really talk with them about the value judgments, about how they value this particular treatment and its risks and benefits against another treatment.

And that's where you really need the expertise of the physician, to help you put the evidence in relation to your own values and preferences. So I think the doctor able to do that will be able to more effectively see patients, feel better at the end of the day, and in fact probably go home a little earlier.

Steven: What do you think happens with pharmaceutical companies in this arena? Obviously, there is both established regulation and guidelines around providing information to consumers well after they do the doctoring. What do you think pharmaceutical companies can do to be better prepared?

Don: Well, I think that could: 1.) Establish some industry regulations. And I think they have taken advantage of the huge opportunity that was given them to do direct-to-the-consumer marketing by really having a poor level of industry policing, of what's really in the best interest of the patient. And therefore, we've seen some drugs, before they were really proven, advertised inappropriately, even to the point where they had to be pulled off the market.

I think I would worry about the pharmaceutical contributions to sites like this, if there's not some real strict guidelines on what they do. But obviously they have a huge interest in getting information to the consumer, so the consumer can at least consider buying their drugs.  They also have that same financial interest in getting people who don't need the drug to take it. So there needs to be some good policing within the industry, I'd say.

Steven: It's an interesting challenge and an opportunity. Obviously, all the content that comes from a lot of the pharmaceutical companies has benefited their own internal departments, and I think it's just this realization that - I was starting to think about this - we were recently at a pharma conference, a pharma marketing conference in Philadelphia, and this whole issue came up about the pharmaceutical industry not really wanting to get involved with the conversation that's actually taking place online about health information and some of these other things, because of all the regulations.

So one of the questions just became, "How does everybody really have a collaborative conversation?" That means the doctors, the consumers, the pharma industry, in a productive way without anyone being too scared to step into that conversation. Obviously, the day of the ignorant consumer walking into a doctor's, those days are numbered as people get more and more educated with great information from Healthwise and great information from user content on OrganizedWisdom and places like that.

So, from your perspective, if the goal is to truly help the patient, how do we all as an industry, that was, the doctors, the pharma, you, me, how do we help people and make sure that we're always serving - as you said, what got you into this business to begin with - serving the needs of the patients?

Don: Right. Well, I'm not quite sure I have the formula for how we all sit down at the table and figure that out. I think it's following a couple of basic rules, that whatever you're doing, you're doing for the best interests of the patient. What that generally requires is a separation from the people who are charged with marketing something from the people that are charged with optimizing the interests of the people that would use it.

So I think the large pharma organizations recognize that and they probably know how to do it. They haven't always done it. Although I'm involved with a number of groups in which we do have those kinds of discussions, and it's very rewarding. I think it's moving in the right direction.

Unity: What are some of the challenges that are associated with all of this access to health information being available now, and really how can the industry help resolve these challenges so that consumers and patients and physicians benefit?

Don: Ok. I suppose some of the challenges you're talking about is that when you go on the web, you don't really know if the information you're getting is great. And it's very easy to go on the web and get information that's completely contradictory. So I think consistency and accuracy are probably the two biggest things to focus on in terms of resolving those problems. You need to have agreement on a general evidence base and then you need to have a way of making sure that things that are added and available to the patient are relatively consistent in that regard, or at least that there's a description of the differences of opinion. Rather than reading one site that says, "Do this", and something else that says, "Don't", you need to be able to say, "Here are the pros and cons, and here's what we know and don't know about this."

Unity: One of the other issues we're seeing is, clearly all of the studies are showing everyone's going online, or eight out of ten internet users are now searching for health information online. But other studies are indicating lots of consumers and patients aren't finding the information that they actually need. What can we do, what can organizations like Healthwise, what can new companies like OrganizedWisdom, what can we be doing to change this so there's all this great information out there, but how can we help them find it?

Don: The studies are mixed, in most cases people find stuff that is valuable. In our own internal side, if you get to the Healthwise information, I think it's something like 74% of people find what they're looking for.

Steven: Which is why we wanted to partner with you guys for our expert health information.

Don: Good!  I think if you go to a doctor, probably about 75% of the time you get what you want, and some of the times you don't, so I don't think you'll ever get to being perfect there. I think the sense is that you really need to have a health information home, a place where you can go that you're pretty sure the information is going to be easy to find, easy to use and accurate, up to date. All those things are really necessary to be helpful. I think over time people will find their way to those sites.

Unity: We're also hoping that we can sort of tap into the collaborative aspects of people. You mentioned word of mouth before, and some of the trends are, in addition to people going online, the other place they turn to is their friends and family, so if we can sort of connect the two and patients can now sort of learn from each other, and they path along "oh here's a great article from Healthwise" and connect the dots for their friends and family or people who they know that are trying to find that information. We're hoping to use sort of social search and other collaborative tools to really help in this area.

Don: You bet. When we wrote the information therapy book, we identified three types of information therapy. One would be physician or clinician prescribed, the other system prescribed, like from the help plan, and the third is consumer prescribed, just what you're saying, prescribing it either to yourself or to someone you know and care about. Because you've information you think is going to be helpful for them. So I think that is what your social networking approach really activates, which you could lock on.

Steven: Thank you. We're looking to obviously continue innovating on what we've already with the Healthwise data by enabling it to be ranked, rated, reviewed, emailed, shared, and actually saved. But we really think that we're just in the beginning of this whole thing, and there's a lot to do to help people find the great information and the great advice and the great just insight and wisdom from each other. Do you have, if you were sitting in a situation where you could have anything happen with the Healthwise content possible, if you had your dream for how people used it, what would you love to see happen that hasn't already been done with your information?

Don: Well, I'll just tell you how my life goes. Whenever I have a health problem, I don't have a problem, I just pull up the knowledge based on my computer and push a button on my phone and my chief medical officer comes in, Steve Snyder. And he guides me through the information in a very caring and supportive way, and with a great deal of medical expertise. So that's kind of the perfect world, you can see the information but you also have that friend and guide to help you go through it. So I think in a perfect world if you can't have Steve, and he's not even available in the nights for me, you ought to be able to have something like a virtual coach, or a virtual doctor. They can help sit through and point out the information as you go along. I think in the future you'll see that kind of technology that almost mimics the conversation with a trusted advisor, that brings that kind of information to us.

Steven: That's a great way to end this conversation. I obviously want to get any last words you have. I'll throw out this kind of question to you, being the last question, which is, three years from now, how does Healthwise look different, what's different about Healthwise and what we can expect from the Healthwise knowledge base and Healthwise as an organization, and perhaps even the information therapy, new organization that you have set up recently? What can we expect over the coming years?

Don: The average patient... in, I don't know, three years is enough, but if you stretch that a little further, the things they're doing now, will increasingly be available for the average patient so that they don't have to go look for things. They will have information prescribed to them as part of the care they get, and that it will arrive most likely in secure messages on their computers or maybe on their digital phones or possibly on their regular phones. But it will be almost unavoidable to get good information. And then I think what you're adding is a sense of being able to vet that information not only against the medical experts, but against patients like them, who have used the information or experienced the treatments, and be able to respond to that.

So I'm quite clear on the vision that in the future, the patient will be given tools to really revolutionize the health care experience. No different than what we've seen in people doing their own travel planning. They're their own travel agent, they're their own stock broker, they can even do and edit their own movies now, so the same kind of experience that gives patients tools to do so much more than they could do in the past will be here for the average person. It'll be a little at a time over the next three years, and then I think the momentum will really begin to come.

Steven: That's a great way to end, because obviously OrganizedWisdom helps to provide a lot of those tools for people to be able to do what you've just described and hopefully sooner rather than later. But this was really a terrific conversation, we really enjoyed it. Do you have any last questions for us or anything to say before we end?

Don: No, I've enjoyed it and looking forward to the partnership!

Steven: We are as well. Don, thank you and I really look forward to speaking again. Hopefully we'll be able to check back in with you and do another interview in the coming months.

Don: Thank you.

Unity: Thank you so much.

Don: Bye.

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