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Myth Busting and Data Gathering At Parks Connected Health

While Verona was abuzz with news of EPIC making patient-records available for research (and possibly without patient consent), a smaller group in San Diego was busy busting myths about seniors, remote monitoring, AI, and patient-generated data at Parks Connected Health Conference.

I had the pleasure of speaking about the positive clinical outcomes we’ve seen using Wellpepper for remote monitoring, in our case providing care plans that enable patients to self-manage, and letting care givers know when people need more help, on a panel with representatives from ResMed, Reflexion Health, AT&T, and Rapid Response Monitoring Systems. While a truly entertaining panel has some disagreement, we were largely in agreement that remote care is here to stay, value-based models support and enable it, and patient-generated data provides valuable insights. While the approach may have been different across companies from connected devices, to avatar coaches for home-based physical therapy, to our patient-focused interactive care plans, we all saw similar successes with a patient or consumer-centric approach.

It was refreshing to hear examples from AARP and United Healthcare recognizing the importance of walking, falls prevention, and gait speed in senior’s health. Our study with Dr. Jonathan Bean showed clinical improvements with gait speed and balance through a digital intervention based on the Live Long Walk Strong program. More programs based on prevention and activity for seniors rather than sensors that detect falls after the fact are needed, and it’s great to see such powerful and prominent organizations advocating for that as well.

Parks and Associates is a research-led analyst firm, so each panel started with results of market research they’d completed, and also real-time audience polls of key issues or drivers in connected health. The audience and most speakers were bullish on technology as an enabler and amplifier for humans, whether that’s enabling clinicians to see more patients, enabling caregivers to stay in touch with their charges, or enabling consumers or patients themselves to self-manage. Technology, and in particular machine-learning and AI were not seen as the be-all and end-all, but as ingredients to a successful human-led strategy. (With the exception of a keynote by CirrusMD who advocated for people-backed triage and staying away from chatbots and AI.)

With CMS announcing goals for 50% of reimbursement to be value-based, reimbursement was less of a topic at this conference than in previous years. However, the complexity and fragmentation of healthcare is still a challenge, whether that’s in care settings, the payer/provider divide, or consumer versus medical grade monitoring devices. Usability is key, with many speakers talking about the difficulty of setting up and managing devices, even the best designed consumer devices. And while the focus was on seniors, it seems that everyone has struggled with packaging, networking, and connectivity.

In addition to the “AI will replace humans” myth, my other favorite myth to be busted at this conference was the idea that sensors and sensor data alone will solve all the problems. During one panel an audience member referred to sensor data as superior to patient observations. (Actually referring to it as “the worst” type of data.) Thankfully both MDs on the panel he was addressing said “the best thing you can do is listen to what your patient is telling you.”

We couldn’t agree more.

Connected Health, Wellpepper results

Posted in: Adherence, Aging, Healthcare Policy, Healthcare Technology, machine learning, patient engagement, patient-generated data, Physical Therapy

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Study Results: The Rehabilitation Enhancing Aging Through Connected Health Prehabilitation Trial

In 2015, we announced a study with principal investigator Jonathan Bean, MD from Harvard Medical school to test his custom protocol for at-risk seniors using Wellpepper’s interactive care plan solution to deliver the intervention to patients, and for clinicians to monitor those patients. The intervention was based on a successful intervention that Dr. Bean delivered at Spaulding Rehab in Boston called “Live Long Walk Strong.” This intervention was aimed at improving strength and mobility in seniors to help prevent adverse events.  The project with Wellpepper, eventually called the REACH study, was to determine whether this type of intervention could be delivered remotely through a mobile interface, which would enable scaling the program to patients who weren’t able to attend in-person sessions (40% of the participants in the original Live Long Walk Strong Program deferred care due to travel requirements), and also decrease costs both for patients and providers. The REACH study used the following process. REACH study process

We’re pleased to report that the results of the study have now been published, with positive outcomes reported. This was designed as a quasi-experimental trial, where 75 participants were compared to a control group made up of a comparable sample of 100 people from the general population. Outcomes between groups were then compared, with clinically meaningful and statistically significant differences (as defined by P-values) observed in the study group.

Care Plan Intervention

Patients received a strength and conditioning program delivered first through in-person classes, and a mobile application, and then through the mobile application with remote messaging with a healthcare provider. During the last 4 months of the study, patients were left on their own and not monitored by a clinician. The study was designed to address not just physical health but incorporate aspects of motivational behavior change.

Motivational behavior change through an m-health intervention

Outcomes

  • Compared to the control group, participants in the program had a 73% decrease in emergency department visits during a 1-year period
  • Clinically meaningful improvements in mobility as recorded in the 6-minute walk test (+.8 meters/second) and Short Physical Performance Battery test (+.69 units)
  • 85% of patients were active at least twice per week
  • 89% rated application satisfaction at “good to excellent” and would recommend to a friend
  • 16-20 percentage point drop off in adherence during the last 4 unmonitored months

The REACH intervention shows positive outcomes in targeting functional decline and the avoidance of adverse event for older primary care adults. The potential benefits should be evaluated and confirmed on a larger scale. If your health system is managing a population that would benefit from an intervention like this, please be in touch.

More Information

If you are interested in deploying a solution in your organization based on the protocol used in this study, contact us.

Study Announcement Press Release

Study Methodology and Description

Published Study

Posted in: Healthcare Research, Outcomes, patient engagement, Patient Satisfaction, Physical Therapy, Prehabilitation, Research, Return on Investment

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Healthcare Summer Reading: Invisible Women

As artificial intelligence and machine-learning are increasingly touted as the solution for everything from shopping to healthcare, the need to better understand the data that goes into these solutions increases. We’ve written before about how trying to solve patient problems using only the EMR data delivers only half the equation because it leaves out everything that happened to the patient outside the clinic, and the patient’s own experience.

Machine Learning in Healthcare: How To Avoid GIGO

Self-Driving Healthcare

However, it turns out that this data may only deliver ¼ or less of the solution when it comes to women’s health, as the fact-packed “Invisible Women: Data Bias In a World Designed For Men” points out.

While Invisible Women tackles politics, healthcare, manufacturing, career, and finances, so many of the problem areas where key decisions are made without enough data result in population health and healthcare problems, even decisions about automobile manufacturing, snow shoveling, and portable cookstoves.

In example after example from every industry, the “normal” male is used as the standard, and women are seen as aberrations, resulting in health, safety, and finance inequality. One size fits all is actually one size fits average male.

If you need to make a case, either business or healthcare related, for the need for diversity of thinking, and for having the data for evidence-based decision making, this book will help you. You’ll also realize that in evidence-based decision making in healthcare, the data is missing for 51% of the population.

Examples include:

  • Crash test dummies that don’t approximate women’s bodies so that women are 17% more likely to die in a car crash.
  • Drug testing that does not require evaluation of outcomes by gender. (The UK does not require any gender evaluation for randomized control trials so researchers are advised to look at studies from other countries to ensure gender inclusion.)
  • Drug dosages that are not adjusted for size or hormones
  • Health trackers that underestimate women’s activities and don’t include menstruation tracking
  • Increased risk of hip fracture by making female solders match an arbitrary male gate length
  • Public transportation safety issues
  • Greater risk of women being misdiagnosed for heart failure because symptoms present differently
  • Portable cookstoves intended to decrease indoor pollution but aren’t used because they need constant tending, and mean that women can’t get other chores done.

The list goes on. Practically every paragraph in this book has a practical example where getting the right data, either qualitative or quantitative would have resulted in better quality of life for women (and everyone really.)

The good news is that this implicit bias that normal can be overcome with a contentious approach to collecting data and feedback, and a rigor of examining the data and outcomes by gender. Interestingly, when reading this book, I realized that this should be another way that we evaluate our Wellpepper care plans. We currently mostly segment our data analysis by age because there has been previous skepticism about older patients ability to use technology. Now I’m thinking that gender differences in care plan outcomes might be a really interesting source of insight. What might we learn about recovery? We know women experience pain and medication differently. Are their gender based clinical insights in our outcome data as well?

While Invisible Women is probably not beach reading, it’s still highly recommended book to add to your healthcare and data reading list.

Posted in: big data, Clinical Research, Healthcare Research, Healthcare transformation, machine learning, patient-generated data

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You Are Here: Voice Assistants In Healthcare

“We’re at the beginning of the end of the first phase of voice” said James Poulter, CEO of Vixen Labs.

The beginning of the end of the first phase might be optimistic for voice, but that did not dampen the enthusiasm at the second annual Voice.Summit in New Jersey this week. Another speaker likened voice to being at the same stage of technology as the release of the first iPhone. If you remember, at that time everyone else had feature phones, and Android didn’t exist. Voice Summit Keynote

Not surprisingly, this year’s summit reminded me a bit of the early days of mobile development: more talk about how than why, more developer content than business content, and just an inkling that we really don’t know what we don’t know about where voice will go. One of the great things about this conference is that it’s a cross-industry event, so was a specific healthcare track, with topics ranging from best-practices for designing voice care plans to ethical considerations of voice, AI, and bots in healthcare, there was also the opportunity to learn from other industries, and also directly from the key technology leaders in the space.

The following are some highlights, learnings, and implications for healthcare as well.

Amazon Alexa

Dave Isbitski, Alexa Developer Evangelist, kicked off the summit with a couple of announcements for Alexa, skill connections which enable one skill to invoke another skill, for example if you want to print content from a skill you can call another skill designed for printing, like the HP skill. While this is currently limited to named skills, it has huge value in healthcare where every skill shouldn’t have to recreate medication lists or a full lexicon of disease education, and it would be better to call on a proven authority like Mayo Clinic or WebMD to get more information.

Dave also announced Dialog Flow, which uses neural networks to develop skills with less coding, and less manual tagging, although admittedly we’re realistically still in the turn>multi-turn phase rather than full machine-learning and AI. This is probably okay for healthcare: let’s focus on getting patient feedback on structured conversations, like triage surveys, before trying to design a system that is completely responsive to any healthcare need.

Another announcement, the ability to have one skill that uses two languages, rather than installing a separate skill for each language would also be beneficial in healthcare to provide patient instructions, especially to family members who may have different “first” languages.

Samsung

Samsung has jumped into the voice fray with a voice assistant called Bixby, which is designed to be a developer platform for people to insert voice into any type of device. Microsoft has this strategy with Cortana, the difference is that Samsung themselves ship televisions and refrigerators that can be voice-enabled. Samsung is also in the “voice and” category with screens being key part of their delivery. This has some really interesting implications for healthcare if you think about the television as the focal point of the living room. Health reminders and actions delivered there could have great impact. We’re working on a mobile version of the MIND diet, which would have huge impact if delivered through voice and visual reminders on the refridgerator door. The challenges with these modalities though are that it may take generations for the technology to become ubiquitous, versus the $39 Echo Dot. Samsung sees a world where your voice assistant knows you across all your devices, which would definitely be helpful in maintaining health context.

Microsoft

Voice as an ingredient, and part of an iOT and AI strategy was echoed by Microsoft. No surprise since Cortana doesn’t have a body or even a hockey puck. This strategy could be very interesting in healthcare if you think about the talking EPI pen. Why wouldn’t all devices and complex equipment have voice prompts for both patients and providers? There was also a meetup group at the conference demonstrating voice running on an ARM chip, which could be very interesting for the cheaper medical devices.

Designers and Developers

The tradeshow floor was full of mostly developer tools for building, testing, and securing voice applications, and the rallying cry in sessions was for the platform providers (Amazon, Google, Apple, Samsung, Microsoft) to standardize on their approach to voice, if not for the developers, then for the end-users. One of the key areas for some standardization is in the lack of standard interface, just as the APIs from platform vendors use different terminology, there’s no standard interface or reusable components aside from the idea of a wake word, to help users navigate. Mobile had the same problem in the early days, and still does to some extent, something that was solved with on-boarding experiences and tours built into apps, something voice has yet to do, but if done consistently could really improve usability.

“Complexity and ecosystem lock-in are threats to ubiquity and frictionless experience. Let’s not build an ecosystem that locks that in.” James Poulter, CEO of Vixen Labs

There was also an admonition to not build apps for the sake of building apps, but to focus on user need, and understand that what users want most of all is convenience, and that they will use the most convenient interface for the task (web, mobile, TV, phone, voice).

What does this mean in healthcare? Context is very important. Make sure your users know exactly what your skill can and can’t do so they don’t expect the full canon of medical knowledge from your one skill. At Wellpepper, we are firmly in the “Voice and” category, (and yet I still get invited to speak at these events): our voice interactions are a subset of the patient’s care plan, and just as they don’t expect the mobile app to do more than deliver the care plan prescribed by their physicians, the same holds true for the voice experiences for Wellpepper interactive care plans.

Ethics

Ethics in designWhile I didn’t hear anyone talking specifically about the ethical issues of both the eavesdropping scandals, and the need for humans to manually tag voice snippets in order to improve machine learning, I did attend a great session by Brooke Hawkins on ethics and design implications in healthcare. Issues tackled included considerations for disclosure of the exact conditions for the efficacy of an app, whether A/B testing on patients can even be done, and understanding the implications of focusing on specific measures in a care plan. On this last one, she suggested that care plans that include weight, like our Sugarpod diabetes care plan

Brand

Along the same lines of not building voice apps for the sake of it, there was also a lot of talk of how your brand is reflected in your app. Not all healthcare systems think of their brand impact, although they should, and the voice skill is an extension of that. Interestingly David Ciccarelli from Voices.com which has voice talent, mentioned that most developers use the standard Alexa voice. It’s not surprising, as it’s expensive to have someone record every possible response for your application, although it’s interesting to think about a world where your healthcare app is speaking in the voice of your own doctor. Given what we’ve seen with the correlation between adherence and healthcare provider engagement, this could give a huge boost to patient outcomes. The technology is not that far off to synthesis voice from other recordings, so it wouldn’t require that your doctor record everything. Or perhaps it would make more sense to have a specific doctor be the voice of all of your apps, which might be more credible than Alexa dispensing healthcare information. Ciccarelli provided a nice matrix of when to use synthetic voice and when to use real humans that applies well in healthcare.

Users

There’s no question that voice spans all ages. Dave Isbitski opened the conference by saying that his kids and his parents were equally excited by voice applications. Speakers at on the Best Practices for Developing Voice Care Plans panel (myself included) were developing specialized care plans for children, seniors, and everyone else. While there are definite generational differences in usage patterns for voice assistant, and there is also a “voice-first” generation coming. One speaker mentioned how his child who had Alexa from birth knew the limitations of the device, and didn’t ask more than Alexa was capable to deliver, however a 6-year-old family friend who didn’t have that experience wanted to ask things like “do you know my teacher.”  In our testing we found similar differences between generations as well, with seniors more likely to try to have a conversation, and younger people sticking to the script of the care plan a bit more. I heard one developer say that they track slang used by end user to determine age and adjust the interactions accordingly.

Wrapping It Up For Healthcare

We’ve written before about the use cases for voice in healthcare, and there are many, from documenting clinic visits, transcribing physician notes, to medication adherence, education, and patient care plans, as well, voice biomarkers, which my fellow panelists called a huge pool of untapped diagnostic data. If we’re at the early days of voice apps, we’re also at the early days of voice data. There’s a ton to be discovered, and the research, especially in healthcare, is just starting.

Our expectations for voice are high. Let’s hope it delivers.

If you’re interested in learning more about voice in healthcare here are some great resources:

Posted in: Adherence, alexa, Behavior Change, big data, Healthcare Technology

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Summer Reading: “Get Well Soon: History’s Worst Plagues and the Heroes Who Fought Them”

Summer Reading: Get Well Soon: History’s Worst Plagues and the Heroes Who Fought Them, by Jennifer Wright

At Wellpepper, we’re huge proponents of evidence, and have worked for years with researchers from Boston University and Harvard University to prove that the things that seem like common sense, like providing help outside the clinic in a digital format, will truly improve patient outcomes. Given today’s focus on evidence-based medicine, and even the sometimes dismissal of common sense if there’s no randomized control trial (even chicken soup is subject to peer review), it’s amazing to remember that we once knew so little about what makes us sick, or the difference between correlation and causation.

If you don’t think you’re interested in plagues, think again. This book is a rollicking journey through a history of plagues that is both funny, sarcastic, and tragic. It reminds us that things that seem obvious today might not have been in the past, and that we’re never that far from mass hysteria when we don’t understand the root cause of a new healthcare epidemic.

While there is a chapter dedicated to each historical epidemic, Wright does not talk about the AIDs epidemic of the 1980s. She believes that history needs to be shared by the ones who were there, while her job is to amplify the voices of history so that we stop making the same mistakes. By uncovering how society, medical professionals, or government either did or didn’t cope with a particular epidemic, Wright offers valuable lessons for today.

For example, when exploring leprosy (which by the way, was a required medical test to get a Russian visa when I moved there in 2008 with Microsoft: spoiler alert, I don’t have it), Wright says:

“Diseases don’t ruin lives just because they rot off noses. They destroy people if the rest of society isolates them and treats them as undeserving of help and respect.”

When people blame others for their diseases, or treat them differently, we are not acting better than our ancestors.

Wright also puts into perspective why all types of people fall for information that now may seem ridiculous, with this analogy:

“If you were a peasant and someone said, “If you live in a sewer, the bubonic plague won’t kill you,” your reaction likely wouldn’t be, “I am curious to hear the science behind that.” Your response would be, “Point me to the nearest sewer.”

It’s up to medical professionals to understand why someone believes what they believe, and then try to provide alternate evidence, rather than dismiss it out of hand. It doesn’t mean that you can’t debunk the value of living in a sewer, but do it by understanding where the information came from in the first place. (And also don’t forget that the fake healthcare information is much easier to access than medical journals locked behind firewalls.

Stories of the Spanish flu, and government-sanctioned and media campaign to downplay (aka ignore or bury) the seriousness of the illness so as to not divert energy and enthusiasm for the war effort, versus the example of Marcus Aurelius during the Antonine Plague taking care of business by offering government burials and time off to go to funerals, which both kept bodies from piling up and acknowledged there was a serious problem.

Wright admonishes us to choose leaders well.

“When we are electing government officials, it is not stupid to ask yourself, “If a plague broke out, do I think this person could navigate the country through those times, on a spiritual level, but also on a pragmatic one? Would they be able to calmly solve one problem, and then another one, and then the next one? Or would bodies pile up in the streets?”

As we start to repeat the mistakes of the past (measles anyone?)Wright makes sure to remind us that with our natural human instinct to lean away from bad news, we often forget how bad things were. Measles, anyone?

“Polio was effectively eliminated throughout the world. And then people just … kind of forgot all about polio. This seems to be the human response to any disease. People forget diseases ever existed the minute they are no longer being affected by them. Maybe that’s understandable. Maybe if we all thought about all the potential diseases the world is teeming with, and the extent to which we are, every day, dancing on the edge of a volcano, the world would seem too terrifying to walk around in at all. Or we’d just vaccinate our kids.”

If you’re interested in medical history, policy, or historical epidemiology this makes a light summer read. I’m not kidding. Also, the chapter on Spanish flu should be made into a dystopian/future past film. It’s got everything: media and government cover up, bodies in the street, a mystery, and a hero fighting against the status quo.

Posted in: Behavior Change, Clinical Research, Healthcare motivation, Healthcare transformation, population health, Rare disease

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Partnership Announcement: eVideon and Wellpepper

eVideon and Wellpepper Announce Partnership to Deliver Comprehensive Patient Experience Across Care Settings

 

eVideon, a leader in hospital patient experience, and Wellpepper, a leader in interactive patient care plans, today announced a partnership to deliver comprehensive patient experiences across inpatient and outpatient settings. Both companies work with health systems to deliver a better patient experience. The partnership enables health systems to deploy integrated solutions from best-of-breed vendors. eVideon and Wellpepper are integrating their solutions so providers can deliver a consistent experience across care settings from hospital to home.

 

“Increasingly, health systems are looking for patient experiences that span inpatient and outpatient settings,” said Wellpepper CEO Anne Weiler. “The patient journey begins before a patient enters the hospital and continues long after discharge. This partnership enables an engaging and usable experience for patients across their entire journey of care.”

Wellpepper’s clinically validated digital treatment plans guide users through all the activities they need to do outside the clinic to manage an episode of care: from preparing for a clinic or hospital visit, to managing a chronic condition or recovering after hospital discharge, via patients’ preferred mobile, web, or voice devices. eVideon enhances the inpatient experience, providing personalized interactive bedside capabilities that empower patients to control their environment, learn about their conditions, access hospital services, order meals or watch movies on demand. Both companies are passionate about improving the patient experience while providing data and analytics to streamline clinician workflows and improve outcomes.

“eVideon and Wellpepper share a passion for bringing long overdue self-service to healthcare through personalized, engaging systems,” said Jeff Fallon, CEO of eVideon. “Interoperability is vital, and the value of better outcomes and streamlined workflows is undeniable – not just for patients, but for clinicians and staff too. We’re excited about the new possibilities this comprehensive solution will bring across care environments for our customers.”

The partnership enables health systems to own the end-to-end patient care pathway. Health systems can deploy eVideon’s and Wellpepper’s solutions simultaneously or sequentially. Solution architects from eVideon and Wellpepper are available to consult with healthcare technology and patient experience groups to determine the best approach for rolling out a comprehensive solution.

About eVideon

eVideon digitizes hospitals with a suite of bedside engagement systems, hospital TV, digital signage, and other interactive displays. Patients enjoy the convenience of self-service at the bedside with access to meal ordering, entertainment, education, hospital services and more, while staff enjoy streamlined, paperless workflows. Interactive surveys and patient feedback help patients communicate immediate needs, and help hospitals respond to those needs quickly. The platform leverages integrations with EHRs, building management systems, food service systems, real-time location systems and more. Data analytics provide valuable insights into patient behaviors and pain points, letting hospitals improve service and outcomes. Learn more at www.evideon.com.

About Wellpepper

Wellpepper is a healthcare technology company with an award-winning and clinically validated patient engagement platform used by major health systems to improve outcomes and lower costs of care. Wellpepper treatment plans can be customized for each health system’s own protocols and best practices and personalized for each patient. Wellpepper’s patented adaptive notification system helps drive over 70 percent patient engagement with treatment plans. Wellpepper was founded in 2012 to help healthcare organizations lower costs, improve outcomes and improve patient satisfaction. The company is headquartered in Seattle, Washington. Visit www.wellpepper.comfor more information.

Full press-release available at PRWeb.

Contact:

eVideon
info@evideon.com
616-588-8109

Wellpepper
Jennifer Allen Newton
Bluehouse Consulting Group, Inc.
jennifer@bluehousecg.com
503-805-7540

Posted in: Healthcare Technology, Patient Satisfaction, Press Release

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Transforming Health at Montana HIMSS Annual Spring Conference

Possibly the most interesting thing in healthcare technology is the breadth of scope that health tech needs to cover, and the talks at the HIMSS Montana annual spring conference represented that with talks about security, how to find money for projects, consumer engagement, and how to create a state-wide initiative for healthcare IT. Just like the state of Montana, talks covered a lot of territory.

 

 

 

Here’s a small review of what attendees experienced:

Voice Technology

I had the honor of kicking off the HIMSS Montana Chapter “Transforming Healthcare” conference with an introduction to how voice technologies show promise in patient care. There’s still a lot of concern in the industry about what these voice assistants are tracking, and the speaker immediately after me talked about a surgeon using Alexa to play music in the operating room (a non-compliant use as Alexa might be ‘listening’ to the conversation). However, today’s news that Comcast is also getting into the voice healthcare game shows that there is real promise and high stakes. If you’re interested in this topic you might want to check out our white paper on considerations for designing voice interfaces for patient care, or join me at Voice Summit in Newark this fall for a workshop.

Security

Not surprisingly security remains a hot topic in healthcare, probably because of the surface area of devices and IOT devices. While bad actors and hackers remain a constant threat, people and process are as important, and speakers stressed that often breaches are not malicious but when people don’t follow proper process like the backup company driver who left a van full of backup tapes in his driveway overnight where it was broken into.

Interestingly according to Fred Langston, CISSP, CCSK Executive VP of Professional Services CI Security, imaging systems account for almost 50% of security alerts, possibly because the systems involve both hardware and software, and have often been installed for years. EMRs are seen as relatively safe, and other risks come from devices, attached to the hospital network, where manufacturers have stopped upgrading or patching devices, or simply stopped support for them. The reason is that any sort of software or firmware upgrade requires new FDA certification, which may be cost prohibitive on a discontinued product. There are startups trying to solve this problem, however the FDA may also want to reconsider the unintended consequences of their certification program.

Generally, it takes 205 days within a hospital system until a compromised asset is detected. Decreasing this time and the time from the realization of the compromise and fix (known as dwell time), should be the goal of all IT departments. Hiring a security consultant organization may be the best bet for the broad scope of monitoring that needs to happen.

Finding Money for Innovation

Dianna Linder, MPA, FACHE Director of Grants and Program Development, Billings Clinic is a grant-writer who has been successful at finding funding sources for innovative projects. Much like targeting sales, donor targeting involves figuring out the value proposition you can offer to a particular donor. The Billings Clinic has a shark-tank day where everyone comes with their projects to request funding. Projects are stack-ranked and budget is applied. For those that don’t get budget, Linder looks for other sources like grants. She warns that grants are best used for projects that are new experiments and where the headcount is not part of the spend since they cannot ensure someone of a job when the grant money runs out. A great example of a use of grant money was for building an intake facility for mental health, so that people did not languish in the ED. This program used staff that were already at the system and proved successful enough that it became operationalized the following year.

At Wellpepper, we’ve seen a few projects start with grants, like the one that the Schultz Foundation provided to EvergreenHealth to kick off a patient engagement project that has since been operationalized. Grants for research projects like the one with Harvard are also interesting.

Consumer Experience

Ben WanamakerHead, Consumer Technology & Services from Aetna made us promise not to blog or tweet about his session where he shared some results from Aetna’s partnership with Apple’s smart watch. So, go see for yourself how the application uses behavioral economics and design principles to reward people for healthy behavior.

Building a State-Wide Healthcare IT Strategy

Did you know that 10 states have a state-wide healthcare IT strategy? No? Neither did I. These strategies, when aligned with Medicare and Medicaid initiatives can help drive adoption and support for healthcare technology, innovation, and modernization initiatives. The benefits of the roadmaps are to focus on healthier residents, and freeing information. Another important benefit is funding that is matched by the federal government. While this type of program may be out of reach for the average healthcare technology enthusiast, knowing that they exist can offer opportunities to align with larger initiatives.

Posted in: Adherence, Behavior Change, Health Regulations, Healthcare costs, Healthcare Disruption, Healthcare Policy, Healthcare Research, Healthcare Technology, Healthcare transformation, HIMSS, M-health, patient engagement

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Way Way Beyond HCAHPs: Cleveland Clinic’s Patient Experience Summit

It was the 10th year for the Cleveland Clinic’s innovation & empathy conference, a journey at Cleveland Clinic which started from a question from an MBA student to then CEO Toby Cosgrove asking if the Clinic’s physicians learned empathy.

You can hear him tell the story himself, and it’s personal for him.

And, if you haven’t seen Cleveland Clinic’s quintessential video on empathy, be sure to check it out.

Dr Toby Cosgrove at Cleveland Clinic

This year, Dr Cosgrove was back to talk about what Google could learn from healthcare and visa versa, as he is a newly appointed advisor to Google Health. As a surprise, he was interviewed by the same student who asked the question so many years ago. Not surprisingly, Dr. Cosgrove believes that healthcare needs to embrace big data, and care outside the clinic. He didn’t have much to offer about what Google could learn, but we’d say protecting personal data would be the biggest thing.

Possibly because he’s no longer running a physician organization and yet he is a physician himself, Dr Cosgrove was pretty blunt about the biggest barrier to transform an organization to deliver empathetic care: the doctors themselves.

Dr Victor Montori at Cleveland ClinicAnother notable keynote came from Mayo Clinic’s Dr. Victor Montori, an endocrinologist, and author of Why We Revolt: A Patient Revolution for Kind and Careful Care. Dr Montori asks us to question our biases, assumptions, and language. He decries “industrial healthcare” where we “provide care.” Care is already a verb. He advocates a person-centered approach where the goals and needs of the individual, not billing or the organization are center. Dr. Montori talked about the phenomenon of doctors doing volunteer travel vacations in other countries because it gets them back to why they became physicians: to care for people.

 

The example of a woman struggling to understand her medication, and make good food choices while being aware of her culture reminded me of visiting my mom when she was in a rehabilitation hospital. When we started bringing homecooked meals and even restaurant takeout, she ate. Physicians couldn’t understand her weight loss and hair loss, blaming it on medication. The problem was the terrible nutritional value and taste of the food.

Patient Stories

Patient stories were a key feature in the conference, while backing research up with data is important, it’s the stories that people remember.

How Walmart Started a Movement of Engagement

The power of human stories was prevalent in the presentation from Walmart’s David Hoke, who has created a movement of better health activities within the Walmart employee base, a challenging job when some stores have 100 per cent employee turnover. To create a movement that inserted a healthy virus into stores, David turned to military strategy:

  • Compelling reason to join
  • Place to join
  • Have to have something to do
  • Have something to share with people they love
  • People follow people

Instead of going directly to digital health, the program was designed to be analog to have the broadest reach, and to overcome people’s fears of being tracked. The program featured story booklets in breakrooms that highlighted other employees journey’s to health. Participants described thinking “well if that person can do it, so can I” after reading the stories, and seeing videos of successful program participants.  By the way, if you’re a Walmart customer, you can also join the program, which is now available digitally as well as analog.

Nebraska Medicine’s Situational Interviewing

Observational patient interviewingIn order to find the patient stories, you have to ask the right questions, and HCHAPs isn’t doing that. We see this all the time at Wellpepper: You need to talk to patients to get the story behind the data points. In this example, a patient had rated Nebraska Medicine highly for caring about her. Rather than just accepting this as praise, researchers dug deeper and asked how the patient perceived this, and the patient’s example was of a nurse who noticed she had dry skin and applied lotion. Another patient rated the facility high on cleanliness because he saw a physician pick up some garbage in the patient’s room. The key takeaway from this session was that patients infer intent.

Geisinger Longitudinal Patient JourneyGeisinger’s Longitudinal Patient Record

Chanin Wendling from Geisinger talked about their implementation of a CRM to be able to track a longitudinal patient experience. Knowing when and where patients are interacted with by the health system will go a long way towards understanding their overall experience.

Wellpepper Digital Intervention for Seniors

Dr. Jonathan Bean from Harvard, talked about why interventions for seniors are so important, and how design impacts whether someone is considered “able” by sharing an example of a cross walk timer being decreased so that slower people could no longer get across the street. Dr. Bean the Director of the New England GREC at the VA, professor at Harvard, and our research partner at Wellpepper, and we were extremely proud when he presented results of the REACH digital intervention using Wellpepper that reduced ED visits in seniors by 73%. We’ll share more when the study outcomes are published in the journal of PM&R.

Financial Impact of Care

Another theme that bubbled up in so many sessions at the conference is the financial impact of care, and the intertwined aspects of financial and physical health. A few key points:

  • Walmart has introduced a banking/payday loan application for employees so that they don’t have to pay the exorbitant rates of quick loan companies.
  • People cut back in other areas of their lives to pay for healthcare
  • 95% of patients want to talk to their provider about healthcare costs but providers aren’t equipped to do so. They don’t want to talk to the health plan or billing/collections department.

This was my first time at the summit, but it won’t be the last, especially as it evolves to encompass more aspects of patient experience outside the clinic, and through non-traditional methods like chatbots, virtual assistants, and virtual reality.

It’s hard to encapsulate all the learning at the conference, and no one person can attend all the sessions, but MobiHealth News has a great recap of the keynotes and individual sessions as well.

https://www.mobihealthnews.com/content/patients-more-vulnerable-other-consumers-technology-must-keep-human-empathy-center

https://www.mobihealthnews.com/content/north-america/without-co-design-technologys-healthcare-potential-wasted

https://www.mobihealthnews.com/content/north-america/providence-st-joseph-patient-engagement-begins-call-center

https://www.mobihealthnews.com/content/patient-stories-inspire-new-digital-tools-singapore-health-systems-sutter-health

Posted in: Adherence, Healthcare costs, Healthcare Disruption, Healthcare Research, Healthcare Technology, Healthcare transformation, HIMSS, M-health, Outcomes, patient engagement, Patient Satisfaction, patient-generated data, physician burnout

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Reading for Healthcare Disrupters: In Shock, by Rana Awdish, MD

May 13-15, I’m heading to the Patient Experience Conference at Cleveland Clinic where Dr. Jonathan Bean, our research partner from Harvard Medical School will be presenting the results of a study using Wellpepper to deliver an interactive care plan for people between 65 and 85 who are at risk of adverse events. We’re excited about the positive clinical outcomes he saw, but more importantly, about the ability for technology to deliver empathy in patient care.

in shock book coverThe ultimate in empathy is to “walk a mile in someone’s shoes.” While this is often not physically possible, if you can emotionally understand someone else’s view this is the beginning of empathy. Research shows that reading fiction increases empathy, but I can imagine that non-fiction like Dr Rana Awdish’s compelling and gripping “In Shock” would do the same. Dr Awdish chronicles her near-death experience and subsequent recovery at the hospital where she practices. By becoming a patient with the mind of a doctor, she is able to deeply experience and understand both sides of a situation: the doctor who sees a case, and the patient who is so much more than a collection of symptoms. As a patient she experiences incorrect diagnoses, not being believed or listened to, arrogance, and condescension. As a physician, she struggles with her training to not get involved emotionally involved with patients and to shrug off traumatic events with her newfound understanding that experiencing pain is the only way to really empathize and connect with each other, and the only thing that will enable physicians to truly deliver care.

The book can be read as case study of experiences from both sides of the equation as Dr. Awdish struggles to make sense of her experiences, and learn how well-meaning instructions can result in the wrong outcome. For example, Dr Awdish reflects on her medical school and residency training and how it was designed to search for diagnosis not for meaning.

“We weren’t trained to listen. We were trained to ask questions that steered people to a destination”

When she’s taken to emergency and immediately steered to OB despite her protestations that the problem is not the pregnancy it’s something else, she directly experiences the impact of this training.

When Awdish is admitted to the hospital for bed rest during later pregnancy, her room becomes a defacto support group for medical professionals who need somewhere to properly process and sometimes grieve patient outcomes. This community defies their training which was to shrug off the emotions, and it’s during this period that Awdish comes to her hypothesis that switching communication may have the most powerful impact of all.

“This way of questioning, this recommendation built on empathy and a patient-centered narrative has the potential to heal everyone involved.”

Awdish is full of hope that the medical community can change. She’s a frequent lecturer and has won awards for building empathy and communication programs. The book also includes a study guide, and is being included in medical school curriculum.

You can hear Dr Awdish read from her book in this clip, or follow her on twitter @RanaAwdish

If you’re looking for more great reads check out these recommendations from our blog. Or, if podcasts are more your style, we’ve got those too.

Posted in: Behavior Change, Healthcare Disruption, Healthcare Research, physician burnout, Uncategorized

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HIPAA Compliant Voice Interfaces: Amazon Alexa Team Announcement

As an early adopter of voice interfaces, and winner of the Alexa Diabetes Challenge, we couldn’t be more excited by today’s announcement from the Amazon Alexa team about HIPAA compliance. You can read about it on the Alexa Developer Blog.

We’ve been working with voice prototypes, and have over developed voice interfaces for most of our interactive care plan building blocks, including things like tracking medication, food diaries, and hearing quick tips about your care plan. If you’re consider how to integrate voice into your patient experience, you may be interested in our new white paper on Designing Effective Voice Interfaces.

Get your copy today!

Register to get the full report

 

Verification

Posted in: alexa, Voice, voice interfaces

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The Healthcare of the Future: Equity and Access

If the sold-out “Healthcare of the Future” event presented by Puget Sound Business Journal, is any indication, Seattle is ready for healthcare transformation. Last week’s event at the Fairmont Olympic featured prominent local healthcare leaders discussing equity and access to care, and why Seattle is the right community to deliver.

Healthcare of the Future

Interesting, the panel discussion started with a definition of access, framed as not just being able to receive care, but also to navigate and understand care. Speakers mentioned that in the transition from uninsured to insured, people might now have access to care but not enough health literacy to receive care. This was exemplified when one of the panelists, a physician herself talked about a recent experience with getting care for her son where she navigated multiple providers and care settings, and all the while had a firm handle on who she was talking to, why her concerns were important, and the eventual diagnosis.

You can see examples of this everyday on #medtwitter when physicians or other healthcare professionals talk about how hard it was for them to navigate the system as caregivers for their families. Now, just imagine that you’ve never had healthcare coverage before. How do you know what your options are, how much you may have to pay, or when and where to see a doctor?

Panelists also felt that in addition to access, health equity needed to include helping patients make decisions based on their own values, not the values of the system. Again, a difficult situation to navigate for someone new to the system, or potentially being intimidated by the ‘white coat.’ Equity also looks at whether anyone is being left behind in the system, which could be from a myriad of reasons: language, cultural, or even geographical barriers. Given the problems of staffing rural clinics and hospitals, are people in remote areas able to receive the same level of care as those in the cities?

Unsurprisingly, panelists were bullish on Seattle’s ability to deliver, both from the collaborative nature of the healthcare organizations in the region, and from our stronghold of technology. Tech and healthcare partnerships were cited as the best opportunity to shorten the 17 year cycle from research to clinical practice, with technology disruption in the areas of big data, AI, and cloud infrastructure from local tech giants Microsoft and Amazon pushing the healthcare industry forward. (Let’s hope they can also solve the interoperability of data problems, as one speaker equated having the largest Epic installation at Providence as being a substitute for data portability and interoperability.)

All in all, this was a great event, and discussions at my table ranged from best practices for oncology care, especially with patient-facing tools outside the clinic, to how smart hospital room design includes sensors in the furniture to predict patient falls. That the room was buzzing before 7:30 on a Friday morning shows that we have a lot of great momentum for solving hard problems in healthcare in Seattle.

Posted in: Healthcare costs, Healthcare Disruption, Healthcare Technology, Healthcare transformation

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Boston University Study Demonstrates that mHealth-Supported Exercise Program Benefits People with Parkinson Disease

Boston University Study Demonstrates that mHealth-Supported Exercise Program Benefits People with Parkinson Disease

Boston, MA – February 7, 2019 – The randomized controlled pilot study used the Wellpepper patient engagement platform to examine the comparative effectiveness of mobile-health-supported exercise compared with exercise alone for people with Parkinson disease.

Key Points:

  • The comparative-effectiveness study, which took place over a 12-month period, was published in the February 2019 issue (Volume 99, Issue 2) of the journal Physical Therapy.
  • It is among the first randomized controlled studies to clinically validate the use of digital health tools in supporting improved patient outcomes.
  • The study positively demonstrated the impact of a digital intervention on people with Parkinson disease who were evaluated as sedentary during study enrollment. People with Parkinson disease who were less active when they entered the study, and who used the Wellpepper application during the 12-month period, showed a statistically and clinically significant improvement in their overall mobility scores compared to similar individuals in the control group without the digital intervention.
  • The study was led by Terry D. Ellis, PT, PhD, Department of Physical Therapy and Athletic Training and Sargent College of Health and Rehabilitation Sciences at Boston University with a research team from Boston University, the University of New England and Brigham and Women’s Hospital at Harvard Medical School (see full list of authors below).
  • Ellis is continuing research in this area at two sites with an NIH-funded clinical trial to further determine the effectiveness of a “connected behavioral approach” against a control group in increasing real-world walking activity in persons with Parkinson disease. The study is onboarding the first subjects this month (February 2019).

“Behavioral change strategies provided through mHealth applications such as those delivered by Ellis and colleagues provide a promising theoretically based and practical approach for helping people with PD (and possibly other chronic disabling conditions) to successfully engage in sustained exercise behavior over the long term,” said Alan M. Jette, PT, PhD, FAPTA and editor in chief of Physical Therapy in an editorial. “As the rehabilitation field shifts from traditional approaches to digital platforms in delivering behavior change interventions, an mHealth application like the one examined in the Ellis et al study holds promise in increasing the reach and scalability of physical therapist services in the digital age.”

This VIDEO demonstrates how the technology was used.

Background:

Declining physical activity commonly occurs in people with Parkinson disease (PD) and contributes to significantly reduced functional capacity and overall quality of life. Previous studies have demonstrated the benefits of exercise and physical activity in reducing disability and enhancing quality of life in people with PD.

This study was designed to explore the effectiveness, safety and acceptability of a mobile-health-mediated exercise program in promoting sustained physical activity in people with PD. Essentially, the Wellpepper mobile patient engagement application became a tool for motivating and monitoring behavior change.

There were 51 participants in the study, all of whom had mild-to-moderately severe Parkinson disease. They were divided randomly into two groups – mHealth and active control – and each group was further subdivided into those who were more active when they came into the study and those who were more sedentary.

Over the course of one year, the mHealth group’s outcomes were compared with those of an active control group, looking at daily steps, moderate-intensity minutes and other measures of activity and mobility. Evaluations were made at the beginning and again at the end of 12 months and exercises were provided by physical therapists with expertise in PD.

  • mHealth: The mHealth group participated in a technology-mediated exercise program that included walking with a pedometer and engagement in exercises. The Wellpepper mobile patient engagement application was used to provide the take-home exercise instructions (along with videos of each person doing their own exercises in proper form), ongoing text-based communication and support (e.g. changing exercises over time to accommodate progress or health changes) and tracking of physical activity and adherence. Ttracking was visible to participants to monitor their own progress and to researchers.
  • Control: The active control group walked with a pedometer, received paper-based exercise instructions and tracked their activity in a paper calendar.

Outcomes:

At the end of one year, both groups had increased their daily steps, moderate-intensity minutes and 6-Minute Walk Test, however the Parkinson Disease Questionnaire 39 mobility scores among the subgroup who were less active prior to the study demonstrated a statistically and clinically meaningful improvement.

An abstract of the study is available HERE and the full study can be made available to media upon request. Editorial overview of the study is also available.

Study Authors:

Terry D. Ellis, PT, PhD, Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University; JamesT. Cavanaugh, PT, PhD, Department of Physical Therapy, University of New England, Portland, Maine; Tamara DeAngelis, PT, DPT, Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University; Kathryn Hendron, PT, DPT, Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University; Cathi A. Thomas, RN, MS, Department of Neurology, Parkinson’s Disease and Movement Disorders Center, Boston University; Marie Saint-Hilaire, MD, Department of Neurology, Parkinson’s Disease and Movement Disorders Center, Boston University; Karol Pencina, PhD, Research Program in Men’s Health, Aging and Metabolism, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and NancyK. Latham, PT, PhD, Research Program in Men’s Health, Aging and Metabolism, Brigham and Women’s Hospital, Harvard Medical School.

About Boston University Center for Neurorehabilitation

The vision of Boston University Center for Neurorehabilitation is to lead the development of evidence based, innovative, theory-based approaches to the rehabilitation of persons with Parkinson disease and other neurological conditions and to disseminate this information on a global level. Lead by Director and assistant professor Dr. Terry Ellis, PhD, PT, NCS, the center is part of the College of Health and Rehabilitation Sciences, Sargent College, Boston University.

About Wellpepper

Wellpepper is a healthcare technology company with an award-winning and clinically-validated patient engagement platform used by major health systems to improve outcomes and lower costs of care. Wellpepper treatment plans can be customized for each health system’s own protocols and best practices and personalized for each patient. Wellpepper’s patented adaptive notification system helps drive over 70 percent patient engagement with treatment plans. Wellpepper was founded in 2012 to help healthcare organizations lower costs, improve outcomes and improve patient satisfaction. The company is headquartered in Seattle, Washington. Visit http://www.wellpepper.com/ for more information.

Media Contact:

Jennifer Allen Newton
Bluehouse Consulting Group, Inc. for Wellpepper
jennifer@bluehousecg.com
503-805-7540

 

Posted in: Press Release, Uncategorized

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The HIMSS Flu

As usual HIMSS was an overwhelming whirlwind of meetings, opportunities, and information. We had a great show at Wellpepper, and were impressed by a few things. First we heard a lot less about wanting the EMR to do everything. People have realized that especially for all of the patient-facing digital experience, that there need to be interoperable solutions, that are designed with the needs of the end-user in mind. Another thing we noticed was less hype that any one technology (AI, blockchain) was going to be the savior of healthcare. It seems like the market is maturing and there’s an understanding that technology is a key underpinning but only when it’s solving real problems for patients and clinicians. John Moore from Chilmark, who was attending his 11th HIMSS has a great take on this.

Each year, we come away from HIMSS with something we didn’t expect. While it’s usually new leads, partnerships, or competitive intelligence, this year for me, it was the HIMSS flu. Being in a conference center full of technology to diagnose, manage, connect with, and treat sick people, made it seem like a solution should be close by. Ironically, I had meetings with a number of physicians who said that it looked like I had the flu, but couldn’t treat me because they weren’t licensed in Florida. Also, my primary care physician couldn’t help me for this reason as well.

After seeing CirrusMD tweet at my friend and fellow patient-centered care advocate Jan Oldenburg with an offer of a consult, I thought that telemedicine might be the answer.

MDLive came through with a visit code, and I signed up. The sign-up process was pretty painless although an option to clarify where I was physically versus where I lived might have been helpful.

Once I signed up, the app told me it would notify me when it found a physician. This was the slightly confusing part, as when I exited the app and opened it again there was no record that I was in a queue for an appointment, so I started trying to sign up again. Eventually, a video visit came through while I was trying to re-register.

My doctor looked like she was taking calls from home, from the video. Unfortunately, video didn’t work very well from the HIMSS floor—not surprising given the status of the network, so we switched to phone. After a 10 minute conversation, she concluded I had the flu (she was right), and prescribed Tamiflu.

As Jan also found out when she had her asthma attack, the pharmacies near the convention center weren’t actually pharmacies, that is they didn’t offer prescription medication. For Jan it was an expensive Uber to pick up her prescription. For me it was finding a pharmacy that would be open between Orlando and Tampa where were were headed for customer meetings on Friday. By the time I got the prescription, it was 7 hours later, and with Tamiflu the timing matters.

While I was thankful to get care, here are a number of points of friction that made it more difficult than it needed to be, and also show how healthcare really hasn’t adapted to the needs of people:

  • State-based licensure makes telemedicine prohibitive. It also means that you can’t get care from your primary care or other specialists if you’re traveling. Kind of ridiculous that because the patient is physically in Florida suddenly the physician is not licensed to practice.
  • Pharmacies need more delivery options. Even locally, I’ve ended up at pharmacies that don’t take my insurance. Driving around when you’re sick is annoying, and showing up in person when you’ve got the flu is unhelpful for everyone else there.

On the licensure, it’s slow going, but states are starting to have agreements to solve this. On the delivery options, Amazon-drone delivery can’t come fast enough. Overall, the experience wasn’t terrible, and the technology worked but it certainly wasn’t seamless or convenient, and I probably infected a bunch of people while trying to get care. I’d like to apologize to anyone I may have passed the flu along to. I’m not the type to work when sick, but when you’re on the road it’s hard not to.

Also, we’d like HIMSS and all conferences to consider pop-up urgent care. The bandaids in the first-aid room weren’t enough.

Posted in: Healthcare costs, Healthcare Disruption, Healthcare Technology, HIMSS, M-health, patient engagement, Telemedicine

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Calculating Return On Investment For Interactive Care Plans

Patient engagement and education is perhaps one of the most under-utilized resources in the care continuum. Patients who are engaged in their care cost healthcare systems [cost] 8% less than non-engaged patients in their base year, and 21% less in future years.[1]

Interactive treatment plans deliver return on investment in three key ways:

Improving patient satisfaction and outcomes

  • Patients look for quality and convenience when they choose a provider organization. They want to be able to interact with their healthcare organization on the same terms as everything else in their lives. Improving outcomes also increases patient satisfaction.

Increasing access to care

  • By monitoring what patients are doing outside the clinic and enabling patients to self-manage, you can increase access to care by seeing the right patients, seeing more patients, and improving recall. Making sure patients are prepared for surgery decreases no-shows and increases utilization and access to care.

Reducing costs

  • Cost reductions are the most dependent on model of care since a readmission or ED visit could be a source of revenue. However, you can look for reducing hard costs of seminars and handouts as well as costs of readmissions, extra visits in capitated models, and of complications. For patients poor outcomes increase costs both out of pocket and in quality of life. Manual labor costs of administering surveys and follow up questionaries can also be avoided with automated systems.

Long-term impact

Patient engagement can have a much stronger long-term impact, including reducing:

  • Hidden costs of variability in care delivery
  • Hidden costs of lack of standardization and manual processes
  • Costs of poor patient outcomes that result in worsening patient problems

As well, as an industry have only begun to scratch the surface of the types of clinical and behavioral insights that will be derived from patient-reported data, that will enable more efficient and effective treatment based on predictive models, and stronger patient participation in their own care.

For our full whitepaper, and ROI economic models contact sales@wellpepper.com or call (844) 899-7377 and press 1 for Sales.

[1] Health Affairs, 32, no.2 (2013):207-214 What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs

Posted in: Adherence, Healthcare Legislation, Healthcare transformation, patient-generated data, Return on Investment

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Machine Learning In Healthcare: How To Avoid GIGO

There’s a commonly used phrase in technology called “garbage in, garbage out” which means that if you start with flawed data or faulty code, you’re going to get lousy output. It results in high-levels of rigor whether that’s in doing user or market research or designing algorithms. Garbage in/Garbage out (or GIGO) is why, although, we are using machine-learning to improve patient engagement and outcomes, at Wellpepper, we’re also slightly skeptical of efforts by big tech (Google, Microsoft, and Amazon) to partner with healthcare organizations to mine their EMR data using machine learning to drive medical breakthroughs. I’ve talked to a number of physicians who are equally skeptical. The reason is that we and especially many physicians are skeptical is that the data in the EMR is frequently poor quality, much of it highly unstructured, and that a major piece of data is missing: the actual patient outcomes. It has what the doctor prescribed but not what the patient did and often what the result was. As well, the data collected in the EMR is designed for billing not diagnosis so it’s more likely the insights will be about billing codes not diagnosis. Why is the data poor quality?

  • A JAMA study found that only 18 percent of EMR notes are original. 46 percent were imported (without attribution) and 36 percent were copied and pasted. Let’s assume that the 18 percent of original notes have no errors, you’re still dealing with 80% of the notes that have a questionable source. This copying and pasting has also contributed to “note bloat” if the data is bad, having more of it will actually hinder the process of finding insights, even for a machine.
  • The data is not standardized. Since so much of the data in the EMR is in these notes, physicians are using different words for the same issue.
  • The dataset from an EMR is biased in several important ways. First, it was entered by physicians and other practitioners, rather than by a broad set of users. The language in healthcare is very different than how patients talk about their health, so these algorithms are unlikely to generalize well outside of the setting where their training data was acquired. Second, data in the EMR has a built-in selection bias towards sick people. Healthy people are probably missing, or at least substantially underrepresented in the dataset. So don’t be surprised if a classifier trained in this setting decides that everyone is sick.
  • Even without copy and paste errors, the data is often just wrong. I once had an intern read back a note to me where she’d recorded my profession as “construction worker”. Yes, I make things, but it’s not nearly as physically taxing and if a physician treating me thought I regularly did heavy labor with my small frame, you can see where over-treatment might be the result.

CNBC’s Christina Farr wrote more about this data problem, the potential for medical errors, and a strange unwillingness to correct the data. A patient quoted in the story understands all too well the problem of GIGO:

“I hope that companies in tech don’t start looking at the text in physician notes and making determinations without a human or someone who knows my medical history very well,” she said. “I’m worried about more errors.”

  • In addition to incorrect data, there are incorrect semantics or examples of physicians using different words for the same issue. In addition to learning medical synonyms which is no small feat, these EMR ML algorithms are going to have to learn grammar too to be truly effective.

Of course, there are solutions to all of these problems and the data quality can be improved with approaches like more standardized input, proof-reading, and possibly using virtual scribes (ironically using machine-learning to speed up input and improve the quality of the data). However the current issues with it make me question whether this is a garbage in/garbage out effort where everyone would be better off starting from cleaner data. The challenge today is that the experts in ML (big tech), don’t have the data, and the experts in the data (healthcare) don’t have the experts in machine learning, so they are partnering and trying to gain some insights from what they have which is arguably very messy data. Another, and possibly more interesting approach is to get a new data set. In 2014, HealthMap showed that you could glean social media data like Twitter, Facebook, and Yelp for health data, and even predict food poisoning faster than the CDC, and now government health organizations have adopted the approach. This is a great example of finding a new data set and seeing what comes of it. At Wellpepper, our growing body of patient-generated data is starting to show insights. In particular we’ve been able to analyze data to find the following, and use this to automate and improve care:

  • Indicators of adverse events in patient-generated messages
  • Patients at 3-times greater risk of readmission from their own reported side-effects
  • The optimal number of care plan tasks for adherence
  • The most adherent cohort of patients
  • The correlation between provider messages and patient adherence to care plan

We also use machine-learning in our patented adaptive notification system that learns from patient behavior and changes notifications and messages based on their behavior. This is a key drive in our high-levels of patient engagement, and can be applied to other patient interactions. While it’s still hard work to find these insights, and then train algorithms on the data sets, we have an advantage because we are also responsible for creating the structure (the patient engagement platform) in which we collect this data :

  • We know exactly what the patient has been asked to do as part of the care plan
  • We have structured and unstructured data
  • Through EMR integration we also have the diagnosis code and other demographic insights on the patient

If you’re interested in gaining new insights about the effectiveness of your own patient-facing care plans delivered to patients outside the clinic, get in touch. You can create a new and clean data stream based on patient-generated data that can start delivering new insights immediately.

Posted in: Clinical Research, Healthcare Technology, patient engagement

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Voice, Podcasts, Partnerships, and Amazon: Wellpepper’s most popular blog posts of 2018

Looking back over the past year, at our most popular blog posts, we suspect that these topics will remain popular in 2019 as well. New technologies and approaches to consumer and digital health have still not reached their full potential, and there’s still lots to learn.

Not surprisingly, a few of our most popular blog posts related to Amazon. In talking with regular people, healthcare organizations, and digital health folks, we find that they are split on whether they want the retail and cloud services giant to get into healthcare, but whatever side of the fence you’re on, there’s no denying they could have a big impact. Right Alexa?

Wellpepper 2018 Blog, Most Viewed Posts

Voice.Health Shows The Promise of Conversational Interfaces

Voice First or Voice And? Dispatches from Voice Summit

This post was actually from 2017, but our CTO’s take on why AWS Lambda serverless architecture is going to be really important for healthcare IT remains a popular topic.

4 Reasons Why the Future of Health IT is Serverless (AWS re:Invent 2017 wrap-up)

We’re also seeing more and more interest in a continuum of care approach: technologies and experiences that span the patient experience, and really help patients and care-givers self-manage, so our announcement of our partnership with Ensocare was also a very popular post.

Ensocare and Wellpepper Streamline Patient Discharge and Engagement

Continual learning is something both technology folks and healthcare folks share, so it comes as no surprise that our round-up of great podcasts for healthcare transformation enthusiasts, was also a popular post.

Podcasts for Healthcare Transformation Enthusiasts

 

 

Posted in: Healthcare Disruption, Healthcare Social Media, Healthcare Technology, Healthcare transformation, M-health, Voice

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Ensocare and Wellpepper Streamline Patient Discharge and Engagement

Ensocare and Wellpepper Streamline Patient Discharge and Engagement

The innovative healthcare companies have partnered to offer care management solutions that enable hospitals to improve the post-acute patient experience.

OMAHA, Neb. – December 6, 2018 – Ensocare, a leading provider of technology-enabled care management solutions, has announced a new partnership with Wellpepper, an award-winning and clinically-validated patient engagement platform used by major health systems to improve outcomes and lower costs of care.

Under the terms of the agreement, Wellpepper’s highly actionable and engaging mobile treatment plans sourced from leading providers such as Mayo Clinic and others will be offered as a supplement to Ensocare’s existing discharge management tool. With Wellpepper, healthcare providers who use the Ensocare Transition application will have the opportunity to customize post-acute treatment plans based on established care protocols enmeshed within the Wellpepper system, creating an unprecedented patient experience.

“Wellpepper was the perfect fit for our organization,” said Luis Castillo, CEO of Ensocare. “One of the biggest challenges we keep hearing about from our hospital and skilled nursing clients is the difficulty of getting patients to adhere to their care plans after leaving the facilities. They’re seeing costly readmissions and care regression that could have been prevented.

“With Wellpepper, we’re able to offer a solution. Their expansive yet endlessly customizable care plans let providers distill complex care into essential components any patient could follow, and I can’t wait to see the positive patient outcomes that occur when our transition software combines with their ingenious treatment plan solution.”

Anne Weiler, CEO and co-founder of Wellpepper, also emphasized the value of the partnership for both patients and providers.

“Partnering with Ensocare was a natural progression of our goals,” said Weiler. “We’re dedicated to helping healthcare providers mitigate the danger of readmission for their most high-risk patients. Ensocare’s transition solutions can be seen as the first step in setting up that treatment plan. If a patient is left to languish in a hospital bed while a case manager struggles to find them a post-acute care setting, that patient is going to immediately be at a disadvantage, regardless of the quality of the care plan. By combining these healthcare IT solutions, a facility can reduce any and all friction that would otherwise occur during the patient’s recovery process.”

Persons interested in learning more about either solution are encouraged to contact Ensocare or Wellpepper to discuss their current situation and explore opportunities to streamline their discharge and patient engagement protocols. Learn more at Ensocare.com and Wellpepper.com.

About Ensocare

Ensocare, a CQuence Health Group company, is a cloud-based solution suite that began as a single care coordination SaaS solution. Today, we are an end-to-end, service-enabled technology platform designed to help hospitals, health systems, physician groups and payers navigate the value-based environment and beyond. Transition, Ensocare’s care placement and referral software, automates the discharge process, effectively transitions patients between care settings and enables coordinated care across the continuum. A growing portfolio of services designed to identify and fill gaps in patient care complement Ensocare’s overall mission to coordinate care, engage patients and positively influence outcomes. For more information, visit www.ensocare.com.


About Wellpepper

Wellpepper is a healthcare technology company with an award-winning and clinically-validated patient engagement platform used by major health systems to improve outcomes and lower costs of care. Wellpepper treatment plans can be customized for each health system’s own protocols and best practices, and personalized for each patient. Wellpepper’s patented adaptive notification system helps drive over 70 percent patient engagement with treatment plans. Wellpepper was founded in 2012 to help healthcare organizations lower costs, improve outcomes and improve patient satisfaction. The company is headquartered in Seattle, Washington. Visit http://www.wellpepper.com/ for more information.

Contact:

Jill Reeves
Ensocare
jreeves@cquencehealthgroup.com
402-758-2617

Jennifer Allen Newton
Bluehouse Consulting Group, Inc. for Wellpepper
jennifer@bluehousecg.com
503-805-7540

Posted in: patient engagement, patient-generated data, Press Release

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