Author + information
- Patrick T. O’Gara, MD, MACC, ACC Immediate Past-Presidenta,∗ (, )
- Kapil Parakh, MD, MPH, PhD, FACC, Senior Program Manager, Googleb and
- John S. Rumsfeld, MD, PhD, FACC, Chief Innovation Officer, American College of Cardiologyc
- aBrigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- bGoogle, Mountain View, California
- cUniversity of Colorado School of Medicine, Aurora, Colorado
- ↵∗Address correspondence to:
Dr. Patrick T. O'Gara, 75 Francis Street, Boston Massachusetts 02115.
There is an increasing emphasis on longitudinal, rather than episodic, management of patients in health care. Cardiovascular clinicians, hospitals, and health systems will be accountable for 1-year or longer patient outcomes. Prescribing guideline-based medications will remain an important quality-of-care metric, but it will be joined by longer-term patient outcome measures, including mortality, hospitalizations, and patient-reported outcomes.
Despite the wide availability of clinical practice guidelines, there remain significant gaps and variation across practice settings in prescribing evidence-based medications. For some cardiovascular cohorts, up to 30% of patients are not prescribed recommended therapies (1). Efforts to increase guideline-based care have largely focused on providers and health systems. Although these are important, patients represent an underutilized resource. For example, encouraging patients to ask their care providers about prescription medications can have powerful effects, as shown by direct-to-consumer advertising (2).
Even when patients are prescribed appropriate medications, a critical factor in optimizing longer-term outcomes is patient engagement. Engaged patients are more likely to seek necessary care, participate in therapeutic decisions (e.g., about cardiac procedures), and adhere to medication and life-style treatment recommendations. This latter point is critical, as studies consistently demonstrate large drop-offs in patient adherence to prescribed medications over time. For example, approximately one-third of patients stop at least 1 guideline-indicated medication within 1 month after acute myocardial infarction, and less than one-half are still taking their statin medication or beta-blocker 1 year after discharge (3). Medication noncompliance is a problem that increases mortality and costs the system between $100 and $300 billion annually (3,4). Or more simply, as former U.S. Surgeon General C. Everett Koop said, “Drugs don’t work in patients who don’t take them” (3). This highlights a clear need to increase patient engagement to achieve best outcomes—but how?
The vast reach of the Internet and social media suggest that they should be key platforms for the dissemination of health information and patient engagement (5). Unfortunately, the quality of health information available on the Internet varies widely, undercutting trust in the content for patients and their families. Many people search for information online, but health content is rife with subjective opinions, sources with unclear credibility, and lengthy technical pieces with incomprehensible jargon (6). Some organizations—including the American College of Cardiology’s (ACC’s) CardioSmart.org—have created credible, patient-facing websites with excellent content. Many ACC members refer their patients to CardioSmart.org. However, it is challenging for organizations like the ACC to have sufficient reach to the broader public that may benefit from the content on CardioSmart.org.
As part of the College’s innovation strategy, the ACC is seeking key partnerships to extend its reach, promote guideline-based care, and engage patients to transform cardiovascular care and improve heart health. One new partner for the ACC is Google. Approximately 1 in 20 searches on Google are health-related, and to improve user experience, the company has launched a health knowledge graph. This product aims to serve reliable health information mined from the web and validated by medical professionals in an intuitive, comprehensible way. The health knowledge graph provides a framework for users to do more research on other sites around the web and promotes informed conversations with their care providers (7). Information in Google’s knowledge graph has been shown to positively affect health-related knowledge and attitudes (8).
Building on this effort, Google is now partnering with the ACC and other professional organizations to present brief, condition-specific questions and answers on the basis of treatment guidelines that can guide conversations between patients and their health professionals. This is intended not to provide medical advice, but rather to be a trusted source for valid health information for patients and to engage them in their care. It is hoped that providing access to credible health information can serve as 1 component of increased patient engagement.
As part of this new partnership, ACC members with subject matter expertise in ACC/American Heart Association guidelines for 5 topics recently helped develop an initial set of questions and answers to be embedded in Google’s health knowledge graph. The 5 topics and the lead member expert for each area include: acute myocardial infarction (Jacqueline Tamis-Holland, MD, FACC), atrial fibrillation (Julia Indik, MD, FACC), hypertension (Kim Eagle, MD, MACC), cholesterol management (Andrew Kates, MD, FACC), and stable ischemic heart disease (Ben Scirica, MD, FACC). For illustration, 2 sample questions for acute myocardial infarction include: “Should I be taking an aspirin a day?” and “Should I be enrolled in a cardiac rehabilitation program?” Working with Google’s team that specializes in optimizing language for public consumption, these first sets of questions and answers have been incorporated into Google’s health knowledge graph. A link back to CardioSmart.org will also be included on Google, as part of referencing the ACC as the source of the answers for the cardiovascular questions.
Because this project is being done with the most widely utilized Internet search engine, it can bolster the availability of credible health information related to cardiovascular disease for the public. Most importantly, it is hoped that patients will find the ACC-driven content on Google to be valuable, enhancing their engagement and interactions with their cardiovascular health professionals.
Of course, the effect of this endeavor is uncertain. There are strengths and limitations to providing such simple questions and short answers, including the balance between providing accessible, understandable information in a rapid manner versus providing more comprehensive information that may better address clinically important aspects of cardiovascular care. The information is not tailored to individual patients, and thus the answers are general in nature. However, the answers do reflect current ACC/American Heart Association guideline recommendations, and Google is pursuing this tact with multiple professional health organizations. An overarching theme for Google is to encourage patients who search these topics to have meaningful conversations with health care providers. Ideally, ACC members may see an “uptick” in their patients referring to Google’s information, and can recommend it as a credible health search site in addition to CardioSmart.org.
Significant evaluation will be needed to assess this endeavor, including the use by patients of the health knowledge graph feature in Google, how patients find the information (e.g., organic searches, shared by family, news, and so on), and whether they understand the content (e.g., readability, information architecture, and other factors that influence how the information is processed). Of course, the ultimate metric of success will be whether the information on Google Health Search and CardioSmart.org is acted upon, which would enhance health knowledge, medication, and life-style adherence and increase communication/engagement with health care providers.
This partnership serves as an example of the ACC’s commitment to innovation in health care. Yet, it is important to emphasize that provision of health information, although important, is just 1 component of patient engagement. Working with Google and through multiple other projects and partnerships, the ACC will continue to strive to provide tools to its members to engage patients, support longitudinal medication and life-style adherence, and navigate the rapid changes in the health care environment.
The views expressed in this article are those of the authors, and do not necessarily reflect the views of Google or the American College of Cardiology.
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