- Email: [email protected]
The ACC and Google
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
VOL. 68, NO. 8, 2016
ª 2016 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 0735-1097/$36.00
PUBLISHED BY ELSEVIER
http://dx.doi.org/10.1016/j.jacc.2016.07.711
LEADERSHIP PAGE
The ACC and Google Engaging Patients to Promote Guideline-Based Care Patrick T. O’Gara, MD, MACC, ACC Immediate Past-Presidenta Kapil Parakh, MD, MPH, PHD, FACC, Senior Program Manager, Googleb John S. Rumsfeld, MD, PHD, FACC, Chief Innovation Officer, American College of Cardiologyc
T
here is an increasing emphasis on longi-
participate in therapeutic decisions (e.g., about
tudinal, rather than episodic, management
cardiac procedures), and adhere to medication and
of patients in health care. Cardiovascular
life-style treatment recommendations. This latter
clinicians, hospitals, and health systems will be
point is critical, as studies consistently demonstrate
accountable for 1-year or longer patient outcomes.
large drop-offs in patient adherence to prescribed
Prescribing guideline-based medications will remain
medications over time. For example, approximately
an important quality-of-care metric, but it will be
one-third of patients stop at least 1 guideline-
joined by longer-term patient outcome measures,
indicated medication within 1 month after acute
including mortality, hospitalizations, and patient-
myocardial infarction, and less than one-half are still
reported outcomes.
taking their statin medication or beta-blocker 1 year
Despite the wide availability of clinical practice
after discharge (3). Medication noncompliance is a
guidelines, there remain significant gaps and variation
problem that increases mortality and costs the system
across practice settings in prescribing evidence-based
between $100 and $300 billion annually (3,4). Or
medications. For some cardiovascular cohorts, up to
more simply, as former U.S. Surgeon General C.
30% of patients are not prescribed recommended
Everett Koop said, “Drugs don’t work in patients who
therapies (1). Efforts to increase guideline-based care
don’t take them” (3). This highlights a clear need
have largely focused on providers and health systems.
to increase patient engagement to achieve best
Although these are important, patients represent an
outcomes—but how?
underutilized resource. For example, encouraging
The vast reach of the Internet and social media
patients to ask their care providers about prescription
suggest that they should be key platforms for the
medications can have powerful effects, as shown by
dissemination of health information and patient
direct-to-consumer advertising (2).
engagement (5). Unfortunately, the quality of health
Even when patients are prescribed appropriate
information available on the Internet varies widely,
medications, a critical factor in optimizing longer-
undercutting trust in the content for patients and their
term outcomes is patient engagement. Engaged
families. Many people search for information online,
patients are more likely to seek necessary care,
but health content is rife with subjective opinions, sources with unclear credibility, and lengthy technical pieces with incomprehensible jargon (6). Some
From the aBrigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; c
b
Google, Mountain View, California; and the
University of Colorado School of Medicine, Aurora, Colorado. The views
organizations—including the American College of Cardiology’s (ACC’s) CardioSmart.org—have created
expressed in this article are those of the authors, and do not necessarily
credible,
reflect the views of Google or the American College of Cardiology.
content. Many ACC members refer their patients to
patient-facing
websites
with
excellent
O’Gara et al.
JACC VOL. 68, NO. 8, 2016 AUGUST 23, 2016:868–70
Leadership Page
CardioSmart.org. However, it is challenging for orga-
Because this project is being done with the most
nizations like the ACC to have sufficient reach to the
widely utilized Internet search engine, it can bolster
broader public that may benefit from the content on
the availability of credible health information related
CardioSmart.org.
to cardiovascular disease for the public. Most impor-
As part of the College’s innovation strategy, the ACC
tantly, it is hoped that patients will find the ACC-
is seeking key partnerships to extend its reach, pro-
driven content on Google to be valuable, enhancing
mote guideline-based care, and engage patients to
their engagement and interactions with their cardio-
transform cardiovascular care and improve heart
vascular health professionals.
health. One new partner for the ACC is Google.
Of course, the effect of this endeavor is uncertain.
Approximately 1 in 20 searches on Google are health-
There are strengths and limitations to providing such
related, and to improve user experience, the com-
simple questions and short answers, including the
pany has launched a health knowledge graph. This
balance between providing accessible, understand-
product aims to serve reliable health information
able information in a rapid manner versus providing
mined from the web and validated by medical pro-
more comprehensive information that may better
fessionals in an intuitive, comprehensible way. The
address clinically important aspects of cardiovascular
health knowledge graph provides a framework for
care. The information is not tailored to individual
users to do more research on other sites around the
patients, and thus the answers are general in nature.
web and promotes informed conversations with their
However, the answers do reflect current ACC/
care providers (7). Information in Google’s knowledge
American Heart Association guideline recommenda-
graph has been shown to positively affect health-
tions, and Google is pursuing this tact with multiple
related knowledge and attitudes (8).
professional health organizations. An overarching
Building on this effort, Google is now partnering
theme for Google is to encourage patients who search
with the ACC and other professional organizations to
these topics to have meaningful conversations with
present brief, condition-specific questions and an-
health care providers. Ideally, ACC members may see
swers on the basis of treatment guidelines that can
an “uptick” in their patients referring to Google’s in-
guide conversations between patients and their
formation, and can recommend it as a credible health
health professionals. This is intended not to provide
search site in addition to CardioSmart.org.
medical advice, but rather to be a trusted source for
Significant evaluation will be needed to assess this
valid health information for patients and to engage
endeavor, including the use by patients of the health
them in their care. It is hoped that providing access to
knowledge graph feature in Google, how patients find
credible health information can serve as 1 component
the information (e.g., organic searches, shared by
of increased patient engagement.
family, news, and so on), and whether they understand
As part of this new partnership, ACC members with
the content (e.g., readability, information architec-
subject matter expertise in ACC/American Heart As-
ture, and other factors that influence how the infor-
sociation guidelines for 5 topics recently helped
mation is processed). Of course, the ultimate metric of
develop an initial set of questions and answers to be
success will be whether the information on Google
embedded in Google’s health knowledge graph. The 5
Health Search and CardioSmart.org is acted upon,
topics and the lead member expert for each area
which would enhance health knowledge, medication,
include: acute myocardial infarction (Jacqueline
and life-style adherence and increase communication/
Tamis-Holland, MD, FACC), atrial fibrillation (Julia
engagement with health care providers.
Indik, MD, FACC), hypertension (Kim Eagle, MD,
This partnership serves as an example of the ACC’s
MACC), cholesterol management (Andrew Kates, MD,
commitment to innovation in health care. Yet, it is
FACC), and stable ischemic heart disease (Ben Scirica,
important to emphasize that provision of health in-
MD, FACC). For illustration, 2 sample questions for
formation, although important, is just 1 component of
acute myocardial infarction include: “Should I be
patient engagement. Working with Google and
taking an aspirin a day?” and “Should I be enrolled in a
through multiple other projects and partnerships, the
cardiac rehabilitation program?” Working with Goo-
ACC will continue to strive to provide tools to its
gle’s team that specializes in optimizing language for
members to engage patients, support longitudinal
public consumption, these first sets of questions and
medication and life-style adherence, and navigate the
answers have been incorporated into Google’s health
rapid changes in the health care environment.
knowledge graph. A link back to CardioSmart.org will also be included on Google, as part of referencing the
ADDRESS CORRESPONDENCE TO: Dr. Patrick T.
ACC as the source of the answers for the cardiovas-
O’Gara, 75 Francis Street, Boston Massachusetts
cular questions.
02115. E-mail: [email protected].
869
870
O’Gara et al.
JACC VOL. 68, NO. 8, 2016 AUGUST 23, 2016:868–70
Leadership Page
REFERENCES 1. Michaels AD, Spinler SA, Leeper B, et al. Medication errors in acute cardiovascular and stroke patients: a scientific statement from the American Heart Association. Circulation 2010;121:1664–82. 2. Gilbody S, Wilson P, Watt I. Benefits and harms of direct to consumer advertising: a systematic review. Qual Saf Health Care 2005;14:246–50. 3. Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: it’s importance in cardiovascular outcomes. Circulation 2009;119:3028–35. 4. Viswanathan M, Golin CE, Jones CD, et al. Interventions to improve adherence to
self-administered medications for chronic diseases in the United States: a systematic review. Ann Intern Med 2012;157:785–95. 5. Rumsfeld JS, Brooks SC, Aufderheide TP, et al. Use of mobile devices, social media, and crowdsourcing as digital strategies to improve emergency cardiovascular care: a scientific statement from the American Heart Association. Circulation 2016 Jun 22 [E-pub ahead of print]. 6. Benigeri M, Pluye P. Shortcomings of health information on the Internet. Health Promot Int 2003;18:381–6.
7. Ramaswami P. A remedy for your health-related questions: health info in the knowledge graph. Available at: https://googleblog.blogspot.com/2015/ 02/health-info-knowledge-graph.html. Accessed June 29, 2016. 8. Ludolph R, Allam A, Schulz PJ. Manipulating Google’s Knowledge Graph box to counter biased information processing during an online search on vaccination: application of a technological debiasing strategy. J Med Internet Res 2016;18:e137.
VOL. 68, NO. 8, 2016
ª 2016 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 0735-1097/$36.00
PUBLISHED BY ELSEVIER
http://dx.doi.org/10.1016/j.jacc.2016.07.711
LEADERSHIP PAGE
The ACC and Google Engaging Patients to Promote Guideline-Based Care Patrick T. O’Gara, MD, MACC, ACC Immediate Past-Presidenta Kapil Parakh, MD, MPH, PHD, FACC, Senior Program Manager, Googleb John S. Rumsfeld, MD, PHD, FACC, Chief Innovation Officer, American College of Cardiologyc
T
here is an increasing emphasis on longi-
participate in therapeutic decisions (e.g., about
tudinal, rather than episodic, management
cardiac procedures), and adhere to medication and
of patients in health care. Cardiovascular
life-style treatment recommendations. This latter
clinicians, hospitals, and health systems will be
point is critical, as studies consistently demonstrate
accountable for 1-year or longer patient outcomes.
large drop-offs in patient adherence to prescribed
Prescribing guideline-based medications will remain
medications over time. For example, approximately
an important quality-of-care metric, but it will be
one-third of patients stop at least 1 guideline-
joined by longer-term patient outcome measures,
indicated medication within 1 month after acute
including mortality, hospitalizations, and patient-
myocardial infarction, and less than one-half are still
reported outcomes.
taking their statin medication or beta-blocker 1 year
Despite the wide availability of clinical practice
after discharge (3). Medication noncompliance is a
guidelines, there remain significant gaps and variation
problem that increases mortality and costs the system
across practice settings in prescribing evidence-based
between $100 and $300 billion annually (3,4). Or
medications. For some cardiovascular cohorts, up to
more simply, as former U.S. Surgeon General C.
30% of patients are not prescribed recommended
Everett Koop said, “Drugs don’t work in patients who
therapies (1). Efforts to increase guideline-based care
don’t take them” (3). This highlights a clear need
have largely focused on providers and health systems.
to increase patient engagement to achieve best
Although these are important, patients represent an
outcomes—but how?
underutilized resource. For example, encouraging
The vast reach of the Internet and social media
patients to ask their care providers about prescription
suggest that they should be key platforms for the
medications can have powerful effects, as shown by
dissemination of health information and patient
direct-to-consumer advertising (2).
engagement (5). Unfortunately, the quality of health
Even when patients are prescribed appropriate
information available on the Internet varies widely,
medications, a critical factor in optimizing longer-
undercutting trust in the content for patients and their
term outcomes is patient engagement. Engaged
families. Many people search for information online,
patients are more likely to seek necessary care,
but health content is rife with subjective opinions, sources with unclear credibility, and lengthy technical pieces with incomprehensible jargon (6). Some
From the aBrigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; c
b
Google, Mountain View, California; and the
University of Colorado School of Medicine, Aurora, Colorado. The views
organizations—including the American College of Cardiology’s (ACC’s) CardioSmart.org—have created
expressed in this article are those of the authors, and do not necessarily
credible,
reflect the views of Google or the American College of Cardiology.
content. Many ACC members refer their patients to
patient-facing
websites
with
excellent
O’Gara et al.
JACC VOL. 68, NO. 8, 2016 AUGUST 23, 2016:868–70
Leadership Page
CardioSmart.org. However, it is challenging for orga-
Because this project is being done with the most
nizations like the ACC to have sufficient reach to the
widely utilized Internet search engine, it can bolster
broader public that may benefit from the content on
the availability of credible health information related
CardioSmart.org.
to cardiovascular disease for the public. Most impor-
As part of the College’s innovation strategy, the ACC
tantly, it is hoped that patients will find the ACC-
is seeking key partnerships to extend its reach, pro-
driven content on Google to be valuable, enhancing
mote guideline-based care, and engage patients to
their engagement and interactions with their cardio-
transform cardiovascular care and improve heart
vascular health professionals.
health. One new partner for the ACC is Google.
Of course, the effect of this endeavor is uncertain.
Approximately 1 in 20 searches on Google are health-
There are strengths and limitations to providing such
related, and to improve user experience, the com-
simple questions and short answers, including the
pany has launched a health knowledge graph. This
balance between providing accessible, understand-
product aims to serve reliable health information
able information in a rapid manner versus providing
mined from the web and validated by medical pro-
more comprehensive information that may better
fessionals in an intuitive, comprehensible way. The
address clinically important aspects of cardiovascular
health knowledge graph provides a framework for
care. The information is not tailored to individual
users to do more research on other sites around the
patients, and thus the answers are general in nature.
web and promotes informed conversations with their
However, the answers do reflect current ACC/
care providers (7). Information in Google’s knowledge
American Heart Association guideline recommenda-
graph has been shown to positively affect health-
tions, and Google is pursuing this tact with multiple
related knowledge and attitudes (8).
professional health organizations. An overarching
Building on this effort, Google is now partnering
theme for Google is to encourage patients who search
with the ACC and other professional organizations to
these topics to have meaningful conversations with
present brief, condition-specific questions and an-
health care providers. Ideally, ACC members may see
swers on the basis of treatment guidelines that can
an “uptick” in their patients referring to Google’s in-
guide conversations between patients and their
formation, and can recommend it as a credible health
health professionals. This is intended not to provide
search site in addition to CardioSmart.org.
medical advice, but rather to be a trusted source for
Significant evaluation will be needed to assess this
valid health information for patients and to engage
endeavor, including the use by patients of the health
them in their care. It is hoped that providing access to
knowledge graph feature in Google, how patients find
credible health information can serve as 1 component
the information (e.g., organic searches, shared by
of increased patient engagement.
family, news, and so on), and whether they understand
As part of this new partnership, ACC members with
the content (e.g., readability, information architec-
subject matter expertise in ACC/American Heart As-
ture, and other factors that influence how the infor-
sociation guidelines for 5 topics recently helped
mation is processed). Of course, the ultimate metric of
develop an initial set of questions and answers to be
success will be whether the information on Google
embedded in Google’s health knowledge graph. The 5
Health Search and CardioSmart.org is acted upon,
topics and the lead member expert for each area
which would enhance health knowledge, medication,
include: acute myocardial infarction (Jacqueline
and life-style adherence and increase communication/
Tamis-Holland, MD, FACC), atrial fibrillation (Julia
engagement with health care providers.
Indik, MD, FACC), hypertension (Kim Eagle, MD,
This partnership serves as an example of the ACC’s
MACC), cholesterol management (Andrew Kates, MD,
commitment to innovation in health care. Yet, it is
FACC), and stable ischemic heart disease (Ben Scirica,
important to emphasize that provision of health in-
MD, FACC). For illustration, 2 sample questions for
formation, although important, is just 1 component of
acute myocardial infarction include: “Should I be
patient engagement. Working with Google and
taking an aspirin a day?” and “Should I be enrolled in a
through multiple other projects and partnerships, the
cardiac rehabilitation program?” Working with Goo-
ACC will continue to strive to provide tools to its
gle’s team that specializes in optimizing language for
members to engage patients, support longitudinal
public consumption, these first sets of questions and
medication and life-style adherence, and navigate the
answers have been incorporated into Google’s health
rapid changes in the health care environment.
knowledge graph. A link back to CardioSmart.org will also be included on Google, as part of referencing the
ADDRESS CORRESPONDENCE TO: Dr. Patrick T.
ACC as the source of the answers for the cardiovas-
O’Gara, 75 Francis Street, Boston Massachusetts
cular questions.
02115. E-mail: [email protected].
869
870
O’Gara et al.
JACC VOL. 68, NO. 8, 2016 AUGUST 23, 2016:868–70
Leadership Page
REFERENCES 1. Michaels AD, Spinler SA, Leeper B, et al. Medication errors in acute cardiovascular and stroke patients: a scientific statement from the American Heart Association. Circulation 2010;121:1664–82. 2. Gilbody S, Wilson P, Watt I. Benefits and harms of direct to consumer advertising: a systematic review. Qual Saf Health Care 2005;14:246–50. 3. Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: it’s importance in cardiovascular outcomes. Circulation 2009;119:3028–35. 4. Viswanathan M, Golin CE, Jones CD, et al. Interventions to improve adherence to
self-administered medications for chronic diseases in the United States: a systematic review. Ann Intern Med 2012;157:785–95. 5. Rumsfeld JS, Brooks SC, Aufderheide TP, et al. Use of mobile devices, social media, and crowdsourcing as digital strategies to improve emergency cardiovascular care: a scientific statement from the American Heart Association. Circulation 2016 Jun 22 [E-pub ahead of print]. 6. Benigeri M, Pluye P. Shortcomings of health information on the Internet. Health Promot Int 2003;18:381–6.
7. Ramaswami P. A remedy for your health-related questions: health info in the knowledge graph. Available at: https://googleblog.blogspot.com/2015/ 02/health-info-knowledge-graph.html. Accessed June 29, 2016. 8. Ludolph R, Allam A, Schulz PJ. Manipulating Google’s Knowledge Graph box to counter biased information processing during an online search on vaccination: application of a technological debiasing strategy. J Med Internet Res 2016;18:e137.