A special tool – Mind Genomics In simple terms, Mind Genomics refers to a science which discovers what in our experience is important, to what messages we most strongly respond, and are we all similar in the foregoing. That is, do we all react to the different ‘aspects of experience’ in the same way? Or are there clear differences among people? If there are these differences, then what is the nature of these differences? It’s clear to anyone who is even somewhat ‘awake,’ that people differ from each other. So, we know that there are differences among people. These ‘differences’ are of interest. But the REAL interest is to create an easy method to understand the mind of people to the aspects of daily experience, doing so in a way which produces easy-to-understand results, specifically easy-to-understand data. Mind Genomics produces this knowledge about people using simple ‘experiments,’ these experiments conducted on the computer in an innocuous-looking way, resembling a traditional survey, but an experiment nonetheless. The experiments combine ideas into vignettes or combinations, presents these combinations to a respondent, and get ratings assigned to these combinations. That part looks like a regular survey. The analysis pulls apart the rating assigned to a set of vignettes, and shows the contribution of every single element to the rating. The foregoing may not sound like much, but when properly executed this simple study, or really this simple experiment, produces a great deal of insightful results on the way people think, what’s important to them in the way they make decision, and the nature of different minds within the same population.

1. Personalizing Medicine:
Revealing & optimizing the patient
experience through Mind Genomics
Glenn Zemel, MD
Gillie Gabay, PhD
Attila Gere, PhD
Howard Moskowitz, PhD
Personalized Medicine Conference
Chicago, October 2017

2. 2
Our night time story to ponder,
the pre-anesthetic visit
This essentially sums up the preoperative interview with the
Anesthesiologist
Two strangers meet.
They size each other up…
Talk for about 5 minutes.
Questions go back and forth.
One then consents to trusting the other with their life!

3. • “…the anesthetist should never underestimate the value of
the preanesthetic visit and discussion with the patient. The
establishment of rapport and confidence will do more to
allay fears and produce calmness than any amount of
narcotics or barbiturates, and it is far safer for the patient.”
• Eckenhoff, JE, Helrich, M Study of narcotics and sedatives for use in
preanesthetic medication.. JAMA. (1958). 167 415–22
3

4. 4
The anesthesiologist’s perspective
1. Efficiency = increased productivity
2. A great amount of information needs to be gathered by the
anesthesiologist and then conveyed to the patient in a time pressured
setting of the preoperative interview.
3. Every patient encounter is unique.
4. Anesthesiologists vary widely in their approach to the critical period of
patient care.
5. Of course…there is never a second chance for the anesthesiologist to make
a first impression.
6. It has been shown that patient anxiety before surgery negatively affects
healing, recovery, and patient satisfaction. Classic study from 19631!
1Egbert LD, Battit G,Turndorf H, Beecher HK.The value of the preoperative visit by an
anesthetist. A study of doctor-patient rapport. JAMA. 1963;185:553–555.

5. The patient’s perspective
1. Trust is central for a properly functioning health system.
2. Communication that creates trust is significantly associated
with positive objective clinical indicators and higher
adherence, quality of life and satisfaction, cooperation and
involvement. Extent of communication with patients to
address their emotional state found to be 7%; allowing
patients to ask questions was found to be 12% (Kindler et al.,
2005).
3. Trust is eroding which negatively affects clinical outcomes and
increases costs, organizational inefficiencies, a pervasive
pattern of litigation and investments in defensive medicine
(Blendon et al., 2014; Shore, 2007).
4. What will enhance trust in the patient-anesthesiologists’
communication?
5

6. 6
What could help?
1. Topics that were most important to the patient.
2. Topics that should be avoided because they may make the
patient more anxious.
3. Mannerisms that make the patient more comfortable or more
uncomfortable.
4. Amount of detail that needed to be conveyed in the interview
for each specific patient.
5. How best to relieve the patients anxiety.
6. Type of language to use that would allow the patient to feel
that the care they were receiving was “patient centered”.
What if the anesthesiologist knew some things about the patient
before the interview that were not found in the standard medical
record? Specifically, a glimpse into how the patient thinks.

7. Picking out a specific area: Surgery
7
The potential of Mind Genomics:
1. Increased patient satisfaction
2. Provide better “patient centered” care
3. Better outcomes
4. Helping to exceed the MACRA/MIPS requirements
5. Better job satisfaction for the physician…decrease physician
stress/burnout
6. Improved efficiency of the highest income generating area of
the hospital
7. Help decrease the waste of resources by giving care tailored
to the patient
Why look at the experience of the patient having surgery?
Why start our endeavor here?

8. Goals
1. Profound understanding of the mind
2. In a way that allows us to create a real science of
experience in medicine.
3. Goal 1 – Contribution to medicine
4. Goal 2 – Better outcome for patient
5. Goal 3 – Create a tool to mind-type patients across
the medical experience … engineer better
outcomes
8

9. Mind Genomics ... cuts across
traditional segmentation and
detects hidden preferences
9

10. Identify topic to study
Segmentation What should we tell
Develop survey question
INTERNET
IdeaMap
~17 min survey
Qualified
respondents
from online
panels
Analyzed results
Typing Tool
Personal viewpoint identifier 10

11. Doing the study- Focus
Making this approach virtually ‘formulaic’

12. Measures based on published measures that
were worded in day-to-day language
12

13. The questions… see how they create a story
Six Silos:
A. Professionalism - Why should I trust you?
B. Safety - How will you keep me safe?
C. Communication - What can you expect from us in the way
we talk with you?
D. Literacy - What will you learn from our discussion and
how will his allay your concerns?
E. Environment - What type of setting will we provide that
makes you feel more relaxed and comfortable?
F. Physical - How will you physically interact with me during
the visit?
13

14. SiloA Professionalism - Why should I trust you?
A1 We have an unwavering sense of duty
A2 We care about you
A3 We are your faithful companion throughout surgery
A4 We acknowledge your concerns
A5 You can trust us
A6 We acknowledge your fears
Silo B Safety - How will you keep me safe?
B1 We will keep you safe
B2 We are your advocate and protector in the operating room
B3 We have a commitment to excellence
B4 We always do the right thing for you
B5 Safety is our #1 priority
B6 We balance the risks and benefits of your treatment
Silo C Communication - What can you expect from us in the way we talk with you?
C1 You are an active participant in the pre-operative discussion
C2 We sit down and talk to you at eye level
C3 We are clear and concise when discussing your anesthesia
C4 We will deliver to you a great bedside manner
C5 We will help ease your anxiety
C6
We will answer all of your questions about anesthesia, the process, risks, and possible
after effects

15. 1
5
Silo D
Literacy - What will you learn from our discussion and how will his allay your
concerns?
D1 We make sure that you thoroughly understand the anesthetic choices
D2 You know who will care for you throughout the day of surgery
D3
You understand the risks and benefits of your anesthesia plan before signing the consent
form
D4 We make sure you are well prepared to make informed decisions
D5 We ease your concerns about nausea after surgery
D6 We ease your concerns about pain after surgery
Silo E
Environment - What type of setting will we provide that makes you feel more relaxed
and comfortable?
E1 We maintain a quiet and calm setting
E2 We ensure minimal interruptions while you speak to us
E3 We make sure you are in a private, confidential setting
E4 Our staff provides a comfortable waiting area
E5 We keep you informed of any delays
E6 We offer you a warm blanket to increase your comfort
Silo F Physical - How will you physically interact with me during the visit?
F1 We greet you with a handshake
F2 We look you in the eye
F3 We have a calm disposition
F4 We respect your privacy
F5 We have a groomed and neat appearance
F6 We will clearly identify ourselves...hand you a business card

16. Combining answers into vignettes
1. Elements are used to create vignettes, short stories … by
experimental design
2. Each participant evaluates 48 unique combinations.
3. Each vignette shows 3-4 elements, each element from different silo.
a. 12 vignettes comprise three elements each
b. 36 vignettes comprise four elements each
4. Participants read the vignettes and answer two questions:
a. When considering your anesthesiologist and pre-surgical
experience … How RELEVANT TO YOU are these statements?
(1 – meaningless, 9 – extremely relevant)
b. How do these statements affect your LEVEL of ANXIETY about
undergoing anesthesia? (1 – reduce my anxiety … 5 – no effect
… 9 – increase my anxiety)
16

17. Example of a 4-element vignette
Question 1 at the bottom
17
Relevance

18. Anxiety
The same vignette
Question 2 at the bottom
18

19. Results

20. Who participated
• Online questionnaire, about 17-20 minutes.
• 103 participants.
• At least 55 years old.
• Undergone an operation under anesthesia.
• Afterwards stayed post-op overnight.
20

21. Stats - How to analyze the data
1. Rectangular matrix
a. Vignettes go into rows, elements go into columns
b. Each vignette is a row (48 x 103 rows)
c. Each element is a column (36 columns)
d. Element is present 1
e. Element is absent 0
2. Each vignette has two answers (Question 1 and 2)
a. Code the ratings 1-6 0 , 7-9 100 (Q1, Q1Top3) – relevance
b. Code the rating 1-6 0, 7-9 100 (Q2, Q2Top3) – increases anxiety
c. Code the rating 1-3 100, 3-9 0 (Q2, Q2Bot3) – decreases
anxiety
3. Ordinary least squares regression
a. Ŷ=b0+b1A1+b2A2+…+b35F5+b36F6+e
b. b0 – additive constant
c. b1,b2…b36 coefficients
21

22. How the elements score -Total
Q1Top3 - Relevance
22

23. What does this mean in light of what’s
known by research
• We are filling the existing gap on patient-anesthesiologist
verbal and non-verbal communication from patients’
perspective.
• Putting the patient in the center as called for by medical
professionalism.
• Enhancing positive clinical indicators to promote healing.
• A realistic intervention in a complex process of
hospitalization.
23

24. Different mindsets
Or to crack a poor joke – different strokes for
different folks
• Averaged data may hide
existing differences.
• Segmentation – looking
for respondents having
the same way of
thinking
• K-means clustering
 fast, effective, well-
proven method
2
4

25. 2
5

26. Segment 1 (54%)
Not critical thinking,
everything is relevant

27. 27
Base 56
Additive constant 90
B3 We have a commitment to excellence 3 15 -7 5
C1 You are an active participant in the pre-operative discussion 3 2 -5 2
C6
We will answer all of your questions about anesthesia, the
process, risks, and possible after effects 3 0 21 5
E6 We offer you a warm blanket to increase your comfort 3 4 1 3
F5 We have a groomed and neat appearance -4 3 4 -1
Base 56
Additive constant 43
C1 You are an active participant in the pre-operative discussion 3 4 2 3
C6
We will answer all of your questions about anesthesia, the
process, risks, and possible after effects 3 1 3 3
E1 We maintain a quiet and calm setting 1 7 3 3
F4 We respect your privacy 1 2 2 2
A3 We are your faithful companion throughout surgery 0 4 -1 1
Base 56
Additive constant 43
B3 We have a commitment to excellence 6 -1 -11 1
B1 We will keep you safe 5 0 1 3
B6 We balance the risks and benefits of your treatment 5 0 -8 1
D4 We make sure you are well prepared to make informed decisions 5 -4 7 2
D2 You know who will care for you throughout the day of surgery 4 -4 4 1
Segment 1 - Decreases anxiety
S2 S3 Total
Panel
Segment 1 - Relevance
S2 S3 Total
Panel
Segment 1 - Increases anxiety
S2 S3 Total
Panel

28. • They don't want to delve into anything.
• Anxiety greatly increases when the Anesthesiologist discusses
the anesthesia (when things get serious).
• Among three segments of the sample, people in Segment 1
are easiest to relieve anxiety.
• Possibly don't want to be isolated and bothered with continual
updates.
• They really just want to know who will be taking care of them
and value their privacy.
28

29. Segment 2 (31%)
Critical thinking
I am afraid. Nothing will help me
…"Just do your job the best you
can"

30. 30
Segment 2 - Relevance
S1 S3
Total
Panel
Base 32
Additive constant 23
B3 We have a commitment to excellence 15 3 -7 5
B2 We are your advocate and protector in the operating room 12 -1 3 4
D4 We make sure you are well prepared to make informed decisions 11 1 9 5
A5 You can trust us -5 -2 17 0
F1 We greet you with a handshake -8 0 1 -3
Base 32
Additive constant 7
D3
You understand the risks and benefits of your anesthesia plan
before signing the consent form 14 0 -1 4
E5 We keep you informed of any delays 13 -3 6 3
B4 We always do the right thing for you 11 -2 5 3
D4 We make sure you are well prepared to make informed decisions 11 -4 4 2
C2 We sit down and talk to you at eye level 10 -2 13 5
Base 32
Additive constant 32
C4 We will deliver to you a great bedside manner 4 1 2 2
A1 We have an unwavering sense of duty 2 1 9 2
A2 We care about you 1 1 -2 0
B1 We will keep you safe 0 5 1 3
B6 We balance the risks and benefits of your treatment 0 5 -8 1
Segment 2 - Increases anxiety
S1 S3 Total
Panel
Segment 2 - Decreases anxiety
S1 S3 Total
Panel

31. • Nothing that the staff members say will relieve their anxiety. ..
Their anxiety is a bit harder to relieve.
• They have strong expectations
• People in this segment want safety and high quality care.
• They want to know the Anesthesiologist is a professional.
• They are not basically nervous, but get frightened by the
procedural reality of the surgery.
• The message to anesthesiologists: "Just do your job the best
you can"
31

32. Segment 3 (15%)
Very critical thinking
Let me trust you!
“ look at me, talk to me, understand how it would
feel if you were In my shoes."

33. 33
Segment 3 - Relevance
S1 S2
Total
Panel
Base 15
Additive constant 18
C6
We will answer all of your questions about anesthesia,
the process, risks, and possible after effects 21 3 0 5
D3
You understand the risks and benefits of your anesthesia
plan before signing the consent form 17 0 6 5
A5 You can trust us 17 -2 -5 0
B3 We have a commitment to excellence -7 3 15 5
E1 We maintain a quiet and calm setting -7 1 6 2
Base 15
Additive constant 3
C2 We sit down and talk to you at eye level 13 -2 10 5
F6
We will clearly identify ourselves...hand you a business
card 11 0 5 4
A5 You can trust us 10 -3 7 2
F1 We greet you with a handshake 9 -1 0 1
B6 We balance the risks and benefits of your treatment 8 -1 6 2
Base 15
Additive constant 31
D3
You understand the risks and benefits of your anesthesia
plan before signing the consent form 15 -1 -1 1
C6
We will answer all of your questions about anesthesia,
the process, risks, and possible after effects 13 1 -1 2
A1 We have an unwavering sense of duty 9 1 2 2
C3
We are clear and concise when discussing your
anesthesia 8 1 -1 1
A5 You can trust us 7 1 -1 1
Segment 3 - Increases anxiety
S1 S2 Total
Panel
Segment 3 - Decreases anxiety
S1 S2 Total
Panel

34. • People in this segment want trust-building
communication.
• They have a strong emotional expectation for high
professionalism.
• Not everyone wants professionalism.
• Their message to anesthesiologists: "Do your job
but look at me, talk to me, understand how it would
feel if you were In my shoes."
34

35. Observations on three mind-sets
1. Outcomes of patient involvement are promising. Health systems
around the world aspire for patient involvement.
2. Barriers of involvement fall into several categories (Physician’s conduct,
patient demographics, patient knowledge, beliefs and perception and
the setting of care).
3. Before surgery, 54% of the sample population does not want to
become an active participant.
4. 46% divide into two:
a. Those that want empathy from the anesthesiologists
(15%).
b. Those who want to be assured of a high professional
conduct.
35

36. Putting it into Clinical Practice
36
1. Segment 1
Interaction with this segment will involve “reading the patient”.
Deliver the necessary information and then let the patient lead the
interview. The more depth your explanation the more anxious they may
become. Be an active listener.
2. Segment 2
The “safe and comfortable” segment. Repeat this phrase to them.
They are the segment that will remember that you were there for them.
Maybe the segment that we can affect the most with reassurance of our
professionalism and them knowing that you will be vigilant.
3. Segment 3
Need to spend a little more time with this segment. Make sure that
they receive detail in the answers to their questions. Don’t necessarily
need to worry about saying too much. Be empathetic.

37. Science perspectives, how the segmentation and mind-
set add to our knowledge and solves some problems
Findings highlight the ability of anesthesiologists to make
a big difference in patient experience by focusing on five
elements:
1. Sitting at eye level and providing patients with
information to understand procedures before
signing the consent form.
2. Assure patients’ of a high professional conduct.
3. Be empathetic.
4. Talk about nausea.
5. Preserve a quiet and calm setting.
37

38. Additional benefits to the
anesthesiologist
• Having the additional information of Mind
Genomics would:
• Give the physician a “crib sheet” to the patients mindset
just prior to meeting.
• Help focus the interview.
• Optimize the time spent with the patient.
• Be one that cares about their patient in body and mind.
• Become a more humanistic practitioner.
38

39. “Attention to the human factor must be retained as a
requisite component of the anesthesiologist’s
armamentarium for our specialty to survive as a
profession. Without adherence to the humanistic
aspects of the practice, the patient becomes just
“another case,” and the anesthesiologist devolves into
simply a technician”
Lawrence D. Egbert, M.D., Stephen H. Jackson, M.D.; Therapeutic Benefit of the
Anesthesiologist–Patient Relationship. Anesthes 2013;119(6):1465-1468.
Schnapper, N What preanesthetic visit? Anesthesiology. (1961). 22 486–8
39
The Human Factor - 1961

40. 40
“In this modern era of cost-containment and production
pressures, the practicalities for achieving a humanistic
preanesthetic interaction with patients faces an
enlarging number and complexity of challenges that,
importantly, demand efficient and effective emotional as
well as cognitive communication skills."
Lawrence D. Egbert, M.D., Stephen H. Jackson, M.D.; Therapeutic Benefit of the
Anesthesiologist–Patient Relationship. Anesthes 2013;119(6):1465-1468.
Halpern, J From Detached Concern to Empathy: Humanizing Medical Practice. (2011).
New York Oxford University Press
Kopp, VJ, Shafer, A Anesthesiologists and perioperative communication. Anesthesiology.
(2000). 93 548–55
The Human Factor - Now

41. Finding these mindsets
in the population

42. Personal viewpoint identifier:
Hopefully, a better experience and outcome for
each person
1. How - Use the segment results from the small ‘experiment’.
a. Define the most discriminating elements.
b. Create discriminating vignettes between segments.
c. Present the vignettes to new patients and assign a patient
based on the pattern of responses.
2. Why – Advantages of profoundly ‘knowing’ the patient
a. Fast
b. Affordable
c. Knowledge-driven
d. Know how to approach the patient within ONE MINUTE of
his/her arrival.
e. Collected data can be saved, to create a profile of the patient
across many medical experiences.
42

43. PVI – personal viewpoint identifier
Rate 3 vignettes
• Find the most
discriminating
vignettes
between each
pair of mindsets
• The pattern of
ratings identifies
the likely mind-
set
43

44. Deploying the
identifier
Present three
vignettes, get ratings,
estimate likely mind-
set segment
4
4

45. Results – Patient Daniella
• Daniella rated the three vignettes just after admission
• The PVI came back suggesting Daniella is a Mind-Set #1
person, and recommended the language
45

46. Three Mindsets,Three Messages
1. You belong to the First Mindset.
a. Care about ME, it is important to know who cares about
you.
b. You prefer to have the proper amount of information
about the procedure, anesthetic choices and want to be
sure that your fears are understood by the staff.
2. You belong to the Second Mindset.
a. You prefer peace and quiet, comfortable waiting areas
and objective staff.
b. No need for friendly talks. Everyone should do their
tasks.
3. You belong to the Third Mindset.
a. Communicators, who need up2date information, great
bedside manner and clear talks.
b. You prefer to be in a friendly, warm environment
surrounded by kind staff.
46

47. Try it for yourself!
http://bit.ly/2fiXGG0

48. A vision of the future
• What happens when this information can be done for the ‘personal
experience’ across the entire health-wellness-illness –hospitalization.
• Make the typing exercise and the results a part of a person’s
permanent electronic health record, available on the person (no
HIPPA issues here, for example attitude and perceptions.
• Use health plans and insurers to deploy the typing tool(s) to increase
the positive outcomes.
• Decrease cost of readmissions to hospital by linking patient
understanding, comfort with cooperation and better healing.
• Understand the patient by ‘knowing’ in general the type of
experience that the patient needs to have in a situation.
48

49. PVI data will lead to better patient
centered care throughout the entire
set of medical experiences.
• Other experiences that would benefit from the PVI:
• Patient interaction with the PCP, surgeon or any other
specialist
• Patients with specific medical issues i.e. breast cancer, CHF,
diabetes, etc.
• Obese patients
• Elderly patients
• Outpatient surgery
• Inpatient nursing care 49

50. Where can Mind Genomics fit in with The
Centers for Medicare and Medicaid Services
(CMS(
• Where can Mind Genomics help? What is the
CAHPS survey? What is MIPS?
• The CAHPS for 2017 survey has12 summary survey measures.
How does Mind Genomics address these measures?
• What are the CMS initial priorities for measure development
by quality domain? Can Mind Genomics also relate to these
issues?
50

51. The Potential Use of Mind Genomics in
Medicine as Relative to Centers for
Medicare and Medicaid Services (CMS)
• 2017 Consumer Assessment of Healthcare Providers and Systems (CAHPS)
for the Merit based Incentive Payment System (MIPS)
• The CAHPS for MIPS survey measures patients’ experiences with care.
• The CAHPS for MIPS survey is appropriate for practices that provide
primary care services
• By using the CAHPS survey Medicare physicians and clinicians have a
chance to be rewarded for better care.
• Mind Genomics will greatly enhance the patient’s experience with care,
thereby increasing the CAHPS survey scores 51

52. Where can Mind Genomics fit in with The
Centers for Medicare and Medicaid Services
(CMS(
• Where can Mind Genomics help? What is the CAHPS survey? What
is MIPS?
• The CAHPS for 2017 survey has12 summary
survey measures. How does Mind Genomics
address these measures?
• What are the CMS initial priorities for measure development by
quality domain? Can Mind Genomics also relate to these issues?
52

53. 53
Mind Genomics and The Centers for
Medicare and Medicaid Services (CMS(
• The CAHPS for 2017 survey has12 summary survey measures to
assess:
1. Getting Timely Care, Appointments, and Information
2. How Well Providers Communicate
3. Patient’s Rating of Provider
4. Access to Specialists
5. Health Promotion and Education
6. Shared Decision Making
7. Health Status and Functional Status
8. Courteous and Helpful Office Staff
9. Care Coordination
10. Between Visit Communication
11. Helping You to Take Medications as Directed
12. Stewardship of Patient Resources

54. Where can Mind Genomics fit in with The
Centers for Medicare and Medicaid Services
(CMS(
• Where can Mind Genomics help? What is the CAHPS survey?
What is MIPS?
• The CAHPS for 2017 survey has12 summary survey measures.
How does Mind Genomics address these measures?
• What are the CMS initial priorities for measure
development by quality domain? Can Mind
Genomics also relate to these issues?
54

55. Centers for Medicare and Medicaid Services
(CMS) Initial Priorities for Measure Development
by Quality Domain
• Clinical Care
• Safety
• Care Coordination
• Patient and Caregiver Experience
• Patient reported outcome measures (PROMs)
• Additional topics that are important to patients and
families/caregivers (e.g., knowledge, skill, and confidence for self
management)
• Population Health and Prevention
• Affordable Care
Source: Centers for Medicare & Medicaid Services. CMS Quality Measure
Development Plan: Supporting the Transition to the Merit-based Incentive
Payment System (MIPS) and Alternative Payment Models (APMs). Baltimore,
MD: Centers for Medicare & Medicaid Services; 2016.
55

56. Affiliations and access
• Glenn Zemel, M.D., M.S., Chicago, IL, USA
• gzemel@mac.com
• Gillie Gabay, Ph.D, College of Management, Israel
• Gillie.gabay@gmail.com
• Attila Gere, Ph.D, Szent István University, Hungary
• gereattilaphd@gmail.com
• Howard Moskowitz, Ph.D, Mind Genomics Advisors, White
Plains, NY, USA
• mjihrm@sprynet.com