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Voice: The most natural user interface for healthcare

There’s so much promise, and such a natural fit for voice in healthcare that unlike electronic medical records, we should not have to mandate its use. If anything, right now we are being limited by the lack of HIPAA controls rather than end-user demand. If the sessions at the recent Voice Summit, which was focused broadly on voice tech, and the upcoming Voice of Healthcare and Voice Summit at Connected Health conferences are any indication, there are many natural use cases, and a lot of pent-up demand.

With so many concerns about documentation and screens getting between patients and physicians, and the ability to deliver empathy, and to rapidly learn from interactions using natural language processing, and artificial intelligence, voice seems a natural fit and unobtrusive interface that could leapfrog traditional interfaces.

The Healthcare track at Voice Summit showed some of this promise, but also pointed out that we are still early days. Many solutions are pilots or prototypes, and I had the distinct impression that some of today’s HIPAA workarounds would not stand up to a detailed audit. Despite Alexa’s sponsorship of the conference, Google’s strong presence, and both companies push into all things healthcare, both were mum on whether or when their consumer voice devices might be HIPAA compliant. Regardless, healthcare organizations and technology vendors alike are charging forward on new scenarios for healthcare, and you can see by the diversity that if even a few of these end up being the “killer app” it’s a big opportunity.

Patient Care

Rooming: Waiting for a physician to see you in an exam room is often a wasted opportunity. A voice interface in the clinic room, could help further pinpoint why a patient is having a visit or educate pre and post visit on medical issues. Or simply having a voice assistant capture the questions that a patient has during a visit might go a long way to improving the visit.

Inpatient stay: The combination of voice assistants, wifi, and tablets could completely replace expensive and proprietary systems for inpatient patient engagement. We’re already seeing use cases for anonymous interactions with voice devices to order food, check the time, or find out the time of the next physician visit.

Long-term care: Alzheimers and dementia care are cited as the poster child for the benefits of voice in long-term care facilities. Unlike human caregivers, voice assistants never get tired of answering the same questions repeatedly. There are so many times you don’t want Saturday Night Live to predict the future, but with this one they got it right.

Patient Engagement

If we define patient engagement as interactions outside the clinic, then the opportunities today fall into three main categories triage (or eventually diagnosis), education, and self-management.

Triage Skills: Today we see some basic triage skills from organizations like Mayo Clinic, and Boston Children’s Hospital where you can check some basic first aid, or ask common questions about children’s health. While there are approximately 1,000 healthcare skills, most likely there will be a few winners or “go-to” experiences here from leading healthcare organization or trusted publishers like WebMD. (Interestingly, the presenter from WebMD was one of the more skeptical on voice experiences for patients at the Voice Summit, possibly because of the complexity of the information they present through text, video, and images on the Web.)

Health Education: Chunking content into manageable bites is currently being touted as the best practice for education material through voice. However, this is an area where the interactivity that’s possible through voice will be necessary for stickiness. If you think about the best podcasts, they use different techniques to both engage you and also impart knowledge: interviewing, verbatim quotes, sound effects, interjections, and expository material. To get engaging and sticky health education content, publishers will have to think about how to test for knowledge, advance explanations, and interact with the end-users. Since we can only remember 5 things at a time, simply chunking content is not going to be enough to make the delivery of health education through voice stick.

Reminders and Interactive Health Tasks: As we’ve seen from our testing, where voice interfaces may have the most impact for patients is in helping them complete health tasks for example, in medication adherence, simple surveys, or check-ins and reminders of basic information. Given that the voice interface is a natural in the home, checking in with a voice assistance on when to take medication, or tracking meals is an easy way to engage with a care plan. As well, cloud-based interactive voice response systems could call patients with reminders and check-ins.

Clinical Notes

Conquering the pain of charting is possibly the closest term opportunity for voice in healthcare. With every increasing workloads, and the need to capture information digitally for both care and reimbursement, the EMR has been blamed for physician burnout and lack of job satisfaction. Microsoft recently partnered with UPMC to use their Cortana voice assistant to transcribe clinical notes during a patient/provider interaction. Others attacking this space include SayKara, Robin, and incumbent, Nuance Communications. With HIPAA compliance, it’s hard not to imagine Amazon and Google looking at it as well.

Hands-free lookup

Voice really shines as an interface when your hands are not free, like driving, dentistry, or when you need to keep your hands clean. Voice is a natural in settings where touching a screen or device can cause contamination or distraction. Simplifeye is tackling this in dentistry to improve charting, and lookup of x-rays, and we expect this to infiltrate all aspects of healthcare.

You may have seen a recent article on why Alexa is not ready for healthcare primetime. With all of these great examples it’s hard to believe it. It turns out that the criticisms in this article basically highlight the current limitations of voice overall (except for HIPAA compliance of course). However, some of the challenges of discovery, context, and navigation, are why we at Wellpepper believe in not just voice, but a “Voice And” future where voice is a key interface that is helped or helps others like screens or even augmented reality. Voice is powerful, “Voice And” will be even better.

Posted in: Behavior Change, chronic disease, HIPAA, patient engagement, Patient Satisfaction, patient-generated data, Voice

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Voice First or Voice And? Dispatches from Voice Summit

The inaugural Voice Summit was held last week in New Jersey, with the hashtag #voicefirst. At Wellpepper, we’re actually in the “Voice and” camp. We love voice interfaces for their convenience, promotion of empathy and connection, and their natural engagement. However, there are times when voice isn’t the best interface for the task or others when voice plus other interfaces are even better, which is reflected in some of our work with the Alexa Diabetes Challenge, which I spoke about at the conference.

People can only remember 5 things at a time, which is a challenge for delivery of complex instructions, education, or information through voice. Add this to the fact that voice is a “headless” navigation. That is, there are often no cues to figure out where you are going. Most of us are visual creatures, and visual cues together with voice or text often provide a richer experience. And believe it or not, the many of the sessions at this inaugural voice conference also seemed to reinforce this idea, in particular many of the consumer sessions, in addition to the healthcare sessions.

Talks by two very different consumer organizations, Comcast and Lego both showed how early we are in voice design, and how when voice is more seamless and ubiquitous we may see the promise of “voice first” but also how “voice and” is possibly the better path forward.

While when you think of giants of voice, you many immediately think of Amazon and Google, did you know that Comcast processed over 6B voice queries last year? My first thought on attending this session was that it was going to be about using interactive voice response trees before you get to a customer service agent, but Comcast has been quietly infusing voice into their entertainment experiences.

Did you know that your Comcast remote has a “voice” interface? You can talk to your TV to find programs, change the channel, or start a show. This is probably one of the best examples of “voice and.” First, voice search is actually found on a physical device. The Comcast design team had originally created a mobile app for the remote voice experience, but found that downloads were a small fraction of their entire subscriber base, so adding a “voice button” to the remote encouraged more searches. Also remember that when you use voice to search it shows you the results on your television screen. This is a “voice and” experience which wouldn’t make a lot of sense as voice standalone. Imagine searching for a movie to watch, say you’re looking for something starring Harrison Ford, and you’ve got to keep in your mind all the titles over his varied career and then choose one. First it’s a lot to remember, and second isn’t it easier to browse titles when you can see pictures and a description to jog your memory? I spoke briefly with the Comcast presenters about why they chose to put voice on the remote, versus directly in the cable box, and they said that it helped their users find the option, which was a big takeaway from the conference for me, although voice is a natural interface, the end-user still needs guidance. (A nice side benefit of the button on the remote is that it’s not always on and listening.)

Lego was another unlikely consumer company playing in the voice arena. Lego “Duplo Stories” is an Alexa skill that tells stories that children can then build using Duplo blocks. While the video was heartwarming, this session in particular highlighted both opportunities for “Voice And” using augmented reality, and also the current discovery limitations of voice.

In the video, a child playing with Duplo blocks asks his mother to start a story. The mother asks Alexa to play a Duplo story. Think about this: the skill had to be discovered and activated before any of this could take place. How would you learn about the skill without something printed on the box that the Duplo blocks came in? While it’s clever, imagine a new scenario where voice and augmented reality are built right into the blocks: a virtual Duplo minecraft. The child builds something with Duplo, and then a voice and visual interface projects the story on the child’s creation.

It’s still early days, and the potential for “Voice And” is still huge. In fact, a lot of the content at this conference reminded me of the early days of web interfaces. There was lots of talk about taxonomy of information, and “chunking” information into manageable pieces. (I used to teach a course on writing for the web, where we practiced this, which is funny as we now are so accustomed to screens that long-form journalism is making a real comeback.)

Similar to the early days of the web, there seemed to be slightly more focus on publishing than on end-user goals: what does the end-user actually want to accomplish, not what is the end-goal of the content publisher. What’s different though is that while during Web 1.0, the answer to question of whether every business needed a website, was a resounding yes, it’s not clear that everyone needs a voice skill. With 30,000 skills already available for Alexa, and new features coming online weekly, the irony is that the Alexa team sends a weekly newsletter to keep us up to date. So, even Alexa knows it’s a “Voice And” world.

Posted in: Behavior Change, Voice

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Voice Tech In Healthcare

Voice tech is a hot topic in healthcare, and for good reason. Healthcare is built on personal interactions, and voice technology can replicate and even replace the human interviewing experience. Voice has other valuable benefits in healthcare like being hands-free—for someone who is recovering from surgery and mobility challenged this might mean being able to get information without getting up. In the hospital setting, the hands-free interface has obvious benefits for hygiene.

At Wellpepper we first started experimenting with voice-enabling our interactive care plans in early 2017, and dug deeper into the topic, prototyping voice powered devices and testing with real people as part of our winning entry in the Alexa Diabetes Challenge. I’ll be talking more about this at the Voice Summit July 24-26, 2018 in Newark.

However, voice experiences in healthcare are not new. This week the Seattle Design for Healthcare meetup Ilana Shalowitz, Voice Design UI Manager, from EMMI Systems (part of Wolters-Kluwer) talking about best practices for voice design based her work on their interactive voice response system. This system effectively does outreach through “robocalls” to help influence people’s behavior, like getting them to schedule general health primary care visits, or get a flu shot. The pathways are designed to guide the patient through specific material, ensuring a basic understanding of the topic, and moving to take action (although not actually taking action), since that was not possible in the interface.

While they have been effective at changing patient behavior, the talk got me thinking about the differences between the interaction model for more traditional, non-AI based interactive voice response and the voice assistants like Alexa and Okay Google popping up in the home, the challenges of each, and the opportunities in healthcare.

Interactive voice response (IVR) can provide a structured pathway, which could be akin to an intake form or an interview. However, it doesn’t allow for an end-user driven experience. In her session, Shalowitz talked about designing a path to give the end user the illusion of control, where a yes or no answer to a knowledge question actually ended up in the same place. Compare that to the home voice experiences where the end user can drive any experience. The upside of this experience is that the end-user is in control, which is often not the case in healthcare, and can drive the direction of the conversation.

Here’s a common experience interacting with a Wellpepper care plan.”

Person: “Alexa, tell Wellpepper I have pain.”
Alexa: “Okay, what is your pain on scale of 0-10 where 0 is no pain, and 10 is the worst pain imaginable.”
Person: “Four”
Alexa: “Okay, I’ve recorded your pain as 4 out of ten. Is that correct?”
Person: “Yes.”
Alexa: “Anything else?”

The difference between this and a typical IVR communication is that the end-user is the initiator. However, the drawback with this type of scenario is that the end-user needs to know what they want to do. This is a notorious problem with headless interfaces like voice. In fact, each week, I get an email from the Alexa team that tells me what new thing I can do with Alexa, essentially a print-guide for the voice interface. Discoverability, context, and capabilities remain problems with these interactions even while they put the end-user at the center.

However, the benefits of these new consumer tools is that, they are designed to not anticipate each pathway in advance, and rather than the pre-recorded prompts of traditional IVR, they are learning systems where continual improvement can be made by examining successful and failed intents. We saw this is in our testing when a patient told Alexa he was “ready when you are.”

I’m excited to be heading to the Voice Summit this coming week, where we’ll talk about what we learned in the Alexa Diabetes challenge, and how we’re applying voice to all our patient experiences at Wellpepper. It’s still early days, but we see a lot of promise, and patients love it.

“Voice gives the feeling someone cares. Nudges you in the right direction.”
Test patient with Type 2 diabetes

Posted in: Healthcare Disruption, patient engagement, Voice

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Digital Transformation in Pharma: Digital Pharma West

Like the rest of the healthcare industry, the pharma industry is also grappling with lots of data, disconnects from end-users, and shifting to a digital-first experience while grappling with ongoing regulatory and privacy challenges. Actually it’s pretty much what every industry is grappling with, so the good news is that no one is getting left behind in this digital revolution.

In pharma though, the division between commercial and R&D creates both delays and lags in implementing new technology and the regulatory challenges cause specific issues in communication with both providers and patients.

Last week, I was invited to speak at Digital Pharma West about our work in voice-enabling care plans for people with Type 2 diabetes, and also how our participation in the Alexa Diabetes Challenge enabled us to engage with pharma. It was my first ‘pharma-only’ conference, so it was interesting to contrast with the provider and healthcare IT world.

If you think that there are a lot of constituents who care about digital health in provider organizations, pharma rivals that. For example, there was a discussion about the value of patient-facing digital tools in clinical trials. While everyone agreed there could be real value in both efficiencies of collecting data, and engaging patients and keeping them enrolled in trials, a couple of real barriers came up.

First the question of the impact of the digital tools on the trial. Would they create an intended impact on the outcomes, for example a placebo effect? Depending on how the “usual care condition” is delivered in a control group, it might not even be possible to use digital tools in both cohorts, which could definitely impact outcomes.

Another challenge with digital technology in randomized control trials is that technology and interfaces can change much faster than drug clinical trials. Considering that elapsed time between Phase 1 and Phase 3 trials can be years, also consider that the technology that accompanies the drug could change dramatically during that period. Even technology companies that are not “moving fast and breaking things” may do hundreds of updates in that period.

Another challenge is that technology may advance or come on the market after the initial IRB is approved, and while the technology may be a perfect fit for the study, principle investigators are hesitant to mess with study design after IRB approval.

Interestingly, while in the patient-provider world the number of channels of communication are increasing significantly with mobile, texting, web, and voice options, the number of touch points in pharma is decreasing. Pharma’s touchpoints with providers are decreasing 10% per year. While some may say that this is good due to past overreach, it does make it difficult to reach one of their constituents.

At the same time, regulations on approved content for both providers and patients means that when content has had regulatory approval, like what you might find in brochures, on websites, and in commercials, the easiest thing to do is reuse this content. However, new delivery channels like chatbots and voice don’t lend themselves well to static marketing or information content. The costs of developing new experiences may be high but the costs of delivering content that is not context or end-user aware can be even higher.

At the same time, these real-time interactive experiences create new risks and responsibilities for adverse event reporting for organizations. Interestingly, as we talk with pharma companies about delivering interactive content through the new Wellpepper Marketplace, these concerns surface, and yet at the same time, when we ask the difference between a patient calling a 1-800 line with a problem and texting with a problem there doesn’t seem to be a difference. The only possible difference is a potential increase in adverse event reporting due to ease of reporting, which could cause problems in the short term, but in the long term seems both inevitable and like a win. Many of the discussions and sessions at the conference were about social media listening programs for both patient and provider feedback, so there is definitely a desire to get and make sense of more information.

Like everyone in healthcare, digital pharma also seems to be at an inflection point, and creativity thinking about audiences, channels, and how to meet people where they are and when you need them is key.

Posted in: Adherence, Clinical Research, Data Protection, Health Regulations, Healthcare Disruption, Healthcare Policy, Healthcare Research, Healthcare Social Media, Healthcare Technology, HIPAA, M-health, Outcomes, pharma, Voice

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The Challenge of Challenges: Determining When To Participate

There’s an explosion of innovation in healthcare and with that comes a plethora of incubators, accelerators, pitches, challenges, prizes, awards, and competitions. Trying to sort through which ones are worth paying attention to can be a full-time job. At Wellpepper we’ve tried to be selective about which ones we enter. A recent post by Sara Holoubeck, CEO and founder of Luminary Labs about the outcomes of challenges got me thinking about the cost/benefit analysis of entering challenges. Both costs and benefits come in hard and soft varieties.

If you want to be scientific, you can assign a score to each of the costs and the benefits, and use it to decide whether to throw your hat in the ring. (For the purposes of this blog post, we’ll use the term “challenge” to refer broadly to all of these opportunities.)

Costs

  • Time: How many hours will your team need to put into this challenge? How much of your team needs to be involved?
  • Focus: Does the focus on this challenge distract your team from core customer or revenue priorities?
  • Financial: Is there an entry fee to participate? What other costs, like travel, may you need to incur to deliver on the challenge?
  • Strategy: Is this challenge aligned with your
  • IP: Do you have to give up intellectual property rights as part of this challenge? Do you have to give away any confidential information that you are not yet ready to share publically?

Benefits

  • Financial: Is there prize money? Does it cover your expected costs? Could you actually profit from entering? If winner receives funding who decides the terms? Is this an organization that would be beneficial to have on your cap table?
  • Focus: Does this challenge provide the team with a forcing function to deliver innovation in an area that is aligned with your overall strategy?
  • Innovation: Does this challenge take your team in stretch direction or enable you to demonstrate a direction on your roadmap that you may otherwise not immediately approach due to market issues?
  • Publicity: Where will the winner be announced? Is there a PR strategy for the entire process or just the winner? Does it help your organization to be aligned with the content or sponsors of this challenge?
  • Introductions: Who will this challenge help you meet that can further your business goals?

It’s up to you to consider the cost/benefit analysis. Both may not have to be high, but when they are the opportunity can be high if you have the ability to put in the effort. You may also consider your chances of winning if it’s defined as a competition, and whether there is any drawback to losing, or if just participating provides enough benefit.

Here are a few examples from our own history that may help illustrate the tradeoffs.

Low cost/medium benefit

We entered a local pitch event for a national organization. The effort to pitch was minimal: we had case studies and examples that fit the thesis directly. The event was nearby and there was no cost to enter. The pitch was short. We won this pitch and got some local awareness and leads. However, when we were offered to go to the national conference and pitch for an even shorter period in a showcase heHIMSS Venture+ Winnersld simultaneously with other conference activities and with no actual competition, we declined as the cost/benefit was not there.

Medium cost/medium benefit

Each year HIMSS has a venture competition at the annual conference. We won this event in 2015, and received PR as well as in-kind benefits at HIMSS conferences including booth space. The effort to prepare was medium: any startup should be prepared for an onstage venture pitch, and the audience was exactly right. As a follow on from this event we’ve been involved in panels showcasing our progress.

High cost/migh benefit

Both the Mayo Clinic ThinkBIG challenge, and the Alexa Diabetes Challenge had a relatively high effort and opportunity cost to participate and high rewards, but both were aligned with directions our company had already embarked on, and both resulted in deeper connections for us with the sponsoring organizations, positive press, validation of our company and solution, and financial support.

In the case of the Mayo Clinic ThinkBIG challenge, we received investment on our convertible note for winning, and the challenge afforded us introductions to important clinical and IT contacts at Mayo Clinic. We were also able to showcase our solution to other potential customers live at the annual Transform event.

Our team put in a tremendous effort on our winning entry for the Alexa Diabetes Challenge but the pay-off was worth it in a number of ways. Certainly the prize money and publicity was welcome, but more importantly, we have created new IP and also come to a whole new understanding of how people can move through their daily lives with technology to support them in managing chronic conditions.

Both of these challenges have afforded us ongoing opportunities for engagement and awareness as a result our participation, and our positive outcomes.

One thing to note, none of these challenges I mention had an entry fee. Sometimes nominal entry fees are used to deter casual entries, but for the most part if a challenge is seeking to fund itself by charging the startups to participate, it’s the wrong model.

While you don’t have to be this explicit when making your decisions about entering a challenge, consideration of the costs and opportunity cost of either participating or not, can help you sort through the ever increasing number of grand challenges.

Posted in: Healthcare Disruption, Healthcare Technology, Healthcare transformation, Uncategorized, Voice

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Dispatches from the Canadian E-Health Conference: The same but different

Bear statue in VancouverThe annual Canadian E-Health Conference was held in Vancouver, BC last week. I had the opportunity to speak about the work we’re doing at Wellpepper in applying machine learning to patient-generated data, and in particular the insights we’ve found from analyzing patient messages, and then applying a machine-learned classifier to alert clinicians when a patient message might indicate an adverse event. Our goal with the application of machine-learning to patient generated data is to help to scale care. Clinicians don’t need to be alerted every time a patient sends a message; however, we don’t want them to miss out if something is really important. If you’d like to learn more about our approach, get in touch.

My session was part of a broader session focused on ‘newer’ technologies like machine-learning and blockchain, and some of the other presenters and topics definitely highlighted key differences between the US and Canadian systems.

Aside from the obvious difference of Canada having universal healthcare, there were subtle differences at this conference as well. While the same words were used, for the most part: interoperability, usability, big data, and of course blockchain and AI, the applications were different and often the approach.

Interoperability: Universal doesn’t mean one

Each province has their own system, and they are not able to share data across provinces. Unlike the UK which has a universal patient identifier, your health records in Canada are specific to the province you live in. As well, apparently data location for health records is sometimes not just required to be in Canada, but in the actual province where you reside and receive care. As for interoperability, last we heard, British Columbia was doing a broad roll out of Cerner while large systems in Alberta were heading towards EPIC, so Canada may see the same interoperability challenges we see here if people move between provinces.

Privacy: The government is okay, the US is not

What’s interesting is as a US company, is that whenever we talk to health systems in Canada they bring up this requirement, but as soon as you mention that the PIPEDA requirements enable patients and consumers to give an okay for out of Canada data location they agree that it’s possible. Regardless, everyone would rather see the data in Canada.

What was possibly the most striking example of a difference in privacy was from one of my co-presenters in the future technologies session, who presented on a study of homeless people’s acceptance of iris scanning for identification. 190 out of 200 people asked were willing to have their irises scanned as a means of identification. This identification would help them access social services, and healthcare in particular. The presenter, Cheryl Forchuk from the Lawson Health Research Institute said that the people who participated didn’t like to carry wallets as it was a theft target, that they associated fingerprinting with the criminal justice system, and that facial identification was often inaccurate due to changes that diet and other street conditions can make. When I tweeted the 95% acceptance rate stat there were a few incredulous responses, but at the same time, when you understand some of the justifications, it makes sense. Plus, in general Canadians have a favorable view of the government. The presenter did note that a few people thought the iris scan would also be a free eye exam, so there may have been some confusion about the purpose. Regardless, I’m not sure this type of identification would play out the same way in the US.

Reimbursement: It happens, just don’t talk about it

The word you didn’t hear very much was reimbursement or when you did, from a US speaker the audience looked a bit uncomfortable. The funny thing is though, that physicians have billing codes in Canada as well. It’s just that they are less concerned about maximizing billing versus being paid for the treatment provided and sometimes even dissuading people from over-using the system. Budgets were discussed though, and the sad truth that money is not always smartly applied in the system, and in a budget-based system, saving money may decrease someone’s future budget.

Blockchain: It’s not about currency

Probably the biggest difference with respect to Blockchain was the application, and that it was being touted by an academic researcher not a vendor. Edward Brown, PhD from Memorial University suggested that Blockchain (but not ethereum based as it’s too expensive) would be a good way to determine consent to a patient’s record. In many US conferences this is also a topic, but the most common application is on sharing payer coverage information. Not surprisingly this example didn’t come up at all. If you consider that even though it is a distributed ledger, a wide scale rollout of Blockchain capabilities for either identification or access might be more likely to come from a system with a single payer. (That said, remember that Canada does not have a single payer, each province has its own system, even if there is federal funding for healthcare.)

“E” HR

Physician use of portalFor many of the session the “E” in e-health stood for EHR, which while also true in the US, the rollout of wide scale EHRs is still not as advanced. Cerner and EPIC in particular have only just started to make inroads in Canada, where the a telecommunications company is actually the largest EHR vendor. In one session I attended, the presenter had done analysis of physician usage of a portal that provided access to patient labs and records, but they had not rolled out, what he was calling a “transactional” EHR system. Physicians mostly accessed patient history and labs, and felt that if the portal had prescribing information it would be perfect. Interesting to see this level of access and usage, but the claim that they didn’t have an EHR. What was also interesting about this study is that it was conducted by a physician within a health system rather than an academic researcher. It seemed like there was more appetite and funding for this type of work within systems themselves.

Other Voices: Patients!

Patients on the mainstageDuring the interlude between the presentations and judging for the well-attended Hacking Health finals, and on the main stage, presenters interviewed two advocate patients. While they said this was the first time they’d done it, both patients had been at the conference for years. So while the mainstage was new, patient presence was not, and patient advocate and blogger Annette McKinnon pushed attendees to go further when seeking out engaged patients. Noting that retirees are more likely to have the time to participate in events she asked that they make sure to seek out opinions for more than 60 year old white women.

There was also an entire track dedicated to First Nations Healthcare. Think of the First Nations Health authority as a VA for the indigenous people of Canada, which incorporates cultural differences and traditional practices of the First Nations people. The track started and concluded with an Elder song and prayer.

Manels

Speaking of diversity, I didn’t witness any manels.

Best Quote

 

Posted in: big data, Clinical Research, Health Regulations, Healthcare Disruption, Healthcare Research, Healthcare Technology, Healthcare transformation, Interoperability, M-health, patient-generated data

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Healthcare Transformation: Emulating Disney Is Not A Bad Idea

Last week, I had the privilege of speaking to a group of CMIOs about disruption and consumerism in healthcare. We had a lively discussion, with the two main takeaways being that having a broad digital strategy is key, and also that healthcare really needs to find its own way to delivering the things consumers want. While looking to other industries for inspiration is a good way to think about change, blindly implementing strategies without thinking about how to adapt them for your own industry is not a good path.

We started off the discussion with this quiz from Elizabeth Rosenthal, former physician and health editor of the New York Times, and author of An American Sickness. Try it for yourself: it’s fun to try to figure out which is the hospital and which is the luxury hotel. (The CMIOs got 8/12 correct. Can you beat them?)

This prompted a debate about how much environment matters to healing, and why hospitals have no “back office.” Having a calming environment can definitely promote healing, however, it wasn’t clear from some of the images presented in the quiz whether healing or luxury was the goal.

Adopting ideas from other industries without fully understanding their priorities and understand how they might differ from your goals. For example, people may complain about the Disneyfication of healthcare, and point to managing to the HCHAPS survey as driving this and other evils. However, did you know that Disney’s #1 corporate value is safety? Adopting safety as a number one organizational value in healthcare would be completely relevant and appropriate. What has happened with these hotel-like experiences is adopting the surface of what Disney stands for without understanding the core goals and objectives of the experience or of the patient, or even of what Disney is trying to achieve.

Recently I received this in the mail from UnitedHealthcare.

Much has been written about the power of hand-written notes, however, usually within business situations and often from a senior manager to a junior manager. This, however, is not a good use of a handwritten note. It’s so many kinds of wrong, and bordering on creepy, especially since I had just gone for my annual physical.

The pressure to deliver better service, and better outcomes is not going to decrease in healthcare. However, it’s easy to avoid these types of pitfalls by considering what people are really looking for. This might not be the same for all patients, but we think this sets up a good framework to approach consumerization.

In addition to thinking about how your offerings, outreach, and engagement with patients fulfills these needs, going a step further, you could try to think about which one of these is most important to each individual patient, and that’s really the crux of delivering a great patient or consumer experience.

Posted in: Healthcare Technology, Healthcare transformation, Meaningful Use, Outcomes, patient engagement, Patient Satisfaction

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HIMSS 2018: We’re having a party in your house!

From the opening keynote of HIMSS 2018, you could tell things were going to be different. Unlike last year, where actors touted the marvels of flash drives and backup storage, this year kicked off with singers from The Voice. Not sure how to interpret their music choices, though, I’m sure Leonard Cohen never envisioned his anthem Hallelujah pumping up 45,000 healthcare IT experts.

Keynote speaker Eric Schmidt executive chairman of Alphabet, admonished the crowd to get to the cloud, any cloud, even Google Cloud’s competitors. He also described a scenario with an assistant named Liz, listening in on a doctor/patient visit and transcribing notes. Ironically, this exact scenario was announced by Microsoft the week before. I’ve witnessed shifts to digital and cloud before in other industries, and it does take a village, so Eric calling on the power of the technology and being rather vendor agnostic is a good sign. That said, there were a few things in his talk that might have ruffled his audience. First, where were the partners? In the utopia of voice and cloud for healthcare that Schmidt described the only partner referenced was Augmedix, poster child for Google Glass, and absolutely no healthcare system examples. Which makes sense, as when asked by HIMSS president emeritus, Steven Lieber for his parting words to the crowd, Schmidt said:

“You’re late to the party.”

Which is an interesting comment at as he was a guest keynote speaker at a healthcare IT event and representing big tech, so you could interpret this to mean:

“You’re late to the party (that we’re throwing in your house).”

As the keynote emptied in a mass stream to the tradeshow floor, I eavesdropped on a number of conversations, and many people weren’t too happy about the message: “they (aka tech) don’t understand how complicated our lives are.” It’s an interesting conundrum, because Google et al have solved some pretty complicated problems making sense of what we’re all looking for online, a problem of completely unstructured data, and yet, as recent Facebook incidents show, there can be a lack of respect for people’s data and privacy that is crucial for any type of healthcare deployment in big tech.

The tradeshow floor itself showed a lot of new entrants, including booths from Lyft and Uber, who previously had only partnered with companies like Circulation for medical transportation, and a much larger Google Cloud and Amazon Web Services presence than the previous year. Microsoft and IBM have been at the healthcare party for a long time, and have settled in.

Big tech is indeed at the party. Who else is at the party? Purveyors of security and in particular block-chain crypto were definitely there. We saw APIs hanging around the punch bowl, this time invited by the new Blue Button 2.0 initiative, unlike previous years as the date of big tech.

Who wasn’t at the party? Patients. On the one hand, we’ve found that the digital patient experience and patient engagement is now mainstream, and our research partner Tamara Deangelis from Boston University Center for Neurorehabilitation was awesome talking about patient/provider messaging at the patient engagement summit. At the broader HIMSS conference, it seemed only vendors were representing patients. Most of the patient invitations must have gotten lost in the mail.

One CIO I talked to suggested that there was a different feeling at HIMSS this year and that this is the year we’ll look back and see that things really changed for healthcare IT. We’ve seen an acceleration of the shift to the cloud for new patient-facing applications, and a rapid realization of a need for an overall patient digital strategy. All heartening, especially since it will take everyone at the party to accomplish this transformation, debutantes and charming hosts alike.

Until next year’s party, cheers!

(Footnote: The actual Google Cloud party had a long line immediately, so some people heeded Schmidt’s words about not being late for the fantastic view of the Bellagio fountains, poke bowls, and open bar. The party was predominantly male, which hopefully isn’t part of the vision. Of course, it was at the same time as the Women in Healthcare IT event, which I heard was awesome. Perhaps a poor party choice on my part.)

Posted in: Healthcare Technology, Healthcare transformation, HIMSS, Interoperability

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Mayo Clinic Care Plans to be available on the Wellpepper patient engagement platform

PR Newswire release

Las Vegas, Nevada, March 5, 2018 – Mayo Clinic Global Business Solutions and Wellpepper, Inc. announced today that Mayo Clinic will be providing best practices for interactive care plans on the Wellpepper platform. Wellpepper is a clinically-validated patient engagement platform used by major health systems to improve outcomes and lower costs of care.

Wellpepper customers who use any electronic health record will be able to use Mayo Clinic care plan protocols to help patients follow their physicians’ instructions outside the clinic to self-manage and improve their outcomes.

Mayo Clinic Care Plans will be available through Wellpepper Marketplace, which launches later in the second quarter of 2018. Mayo Clinic Care Plans initially will be available to cardiac rehabilitation, headache and sports medicine patients. The care plans eventually will encompass hundreds of patient interventions showcasing the breadth of Mayo Clinic expertise.

“Wellpepper and Mayo Clinic share a continuous commitment to providing care that ultimately benefits patients,” says Steve Ommen, M.D., interim medical director of  Mayo Clinic Global Business Solutions. “We look forward to the opportunity to share our best practices with other health systems through the Wellpepper platform.”

Wellpepper’s interactive care plans are based on a framework of building blocks that support creating any type of patient instructions. Wellpepper patients are more than 70 percent engaged in their care plans, and control trials conducted by researchers at Boston University and Harvard University show clinically meaningful patient outcomes for patients using the Wellpepper platform.

“We are thrilled to launch the Wellpepper Marketplace starting with one of the leading academic medical centers in the world,” said Wellpepper CEO Anne Weiler. “Our customers and their patients will benefit immensely from access to Mayo Clinic best practices. Analysis of patient experience and outcomes from these care plans will enable continual improvement and new insights to deliver better care.”

The Wellpepper Marketplace will offer health systems the choice of best practice care plan templates from leading health systems and Wellpepper’s out-of-the-box care plan templates. These turnkey solutions will enable quick deployment of evidence-based and clinically-validated care plans to improve patient outcomes.

About Wellpepper 
Wellpepper is a health care 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.

Media contacts:

Jennifer Allen Newton, Wellpepper, (503)-805-7540, jennifer@bluehousecg.com

Rhoda Madson, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

Posted in: Press Release

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Alexa, Get Well Soon

The unofficial winner of the Super Bowl ad race this year was “Alexa Loses Her Voice”, an ad that shows celebrities subbing for Alexa when she (anthropomorphic being that she is, comes down with a cold). Both USA Today and YouTube are calling it the most watched ad.

Alexa, who won USA TODAY’s 30th Ad Meter?

“Well, um – me.”

Jeff Bezos looks skeptical that his team can replace Alexa as he should be, since their solution of Gordon Ramsay, CardiB, Rebel Wilson, and Anthony Hopkins is both extremely expensive, (Wellppper CTO Mike Van Snellenberg did the math), and breaks the key trust relationship that people have with Alexa.

Voice is a natural interface, and empathy can be quickly established by the types of utterances and engagement. By default, Alexa apologizes when she doesn’t understand something and it feels genuine. Compare that to Gordon Ramsay insulting his poor hapless user—all the guy wants is a bit of help making some comfort food. What he gets is abuse.

Or, the woman who wants Alexa’s help while she’s in her boudoir presumably getting ready for a date with her love. Instead, Anthony Hopkins insinuates that something horrific has happened to her beau possibly involving a pet peacock.

Cardi B insults a young man’s interest in Mars. Let’s hope she has not squashed his spirit of discovery and his desire to ask questions.

Since this is an all-ages blog, we won’t even mention the response Rebel Wilson gives from her bubble bath to the poor gentleman who asked Alexa to set the mood for a party. He and everyone at his party were fully traumatized.

We get it, Alexa is just better at delivering what people are asking for than real people. Especially real people with attitude like these celebrities.

As we found in our research with people with type 2 diabetes, Alexa has a natural ability that these celebrity Alexa impersonators do not. You can see it in this feedback we received from real people trying to manage Type 2 diabetes.

  • “Voice gives the feeling someone cares. Nudges you in the right direction”
  • “Instructions and voice were very calm, and clear, and easy to understand”

Voice is a natural fit to deliver empathy and care. However, since each one of these people is expecting Alexa, and has no visual indicator that anything has changed, the negative experiences will reflect on Alexa and she’ll have to win back their trust.

While the implied message of the ad spot is that Alexa does a better job of delivering on your needs than any of these celebrity experts we’re still feeling a bit traumatized by the abuse they hurled. For the sequel to this commercial, we’d expect to see Jeff firing the team that replaced Alexa with celebrities, and Alexa as a therapist working through the trust issues that her replacements created. She can do it. We believe in her.

Posted in: Behavior Change, Healthcare Disruption, Healthcare Technology, Voice

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The Secrets of Strong CIO and CMIO Relationships

What’s the secret of a strong CIO and CMIO relationship? Many things including the ability to be adaptable, understand organizational priorities, and deadlines, but most importantly to align on shared goals and purpose.

These were some of the takeaways from the insights shared by CIOs and CMIOs of Confluence Health, and EvergreenHealth at the annual Washington State HIMSS Executive dinner. While the conversation was split between how to foster innovation, and how to manage the demands of an EMR rollout (including the resulting backlog of other IT requests), where the relationship really shone was in the implementation of tools for a shared purpose, in this case tracking and control of opioids to help curb the epidemic we’re seeing in this country.

In particular a project at EvergreenHealth to implement e-prescribing of controlled substances, showed the need for strong CMIO and CIO collaboration. The program is designed to decrease fraud and misuse of controlled substances, but it can also improve patient care. Since it involves both technology implementation and clinical guidelines it’s a perfect example of medical and technology collaboration. In Washington State, where we’re based, the Bree Collaborative also has recommended guidelines for prescribing opioids, that while optional are widely adopted across the state.

We’ve written about this problem before in pain management for total joint replacement. Sadly, an unintended consequence of the pain management question on the HCAHPS survey, is sometimes an overprescribing of prescription pain medication. According to one speaker at the event, 30mg of oxycontin over 7 days is enough to trigger an addiction, and yet often post-surgery up to 30 days of pills are prescribed. We talked to one patient (not a Wellpepper user) who reported taking all of her prescribed pain medication, not because she needed it but because it was prescribed. The first step to solving this problem is with the prescription, and EvergreenHealth’s e-prescription program, combined with locked cabinets in the operating room (the idea is that if you don’t need it immediately, you don’t actually need it), alerts on over prescribing, and programs to substitute suboxone, coupled with behavior health management can all help. As well behavior change happens with the physicians, and a powerful image was the story of a pharmacist who put a bag of unused opioid prescriptions on the table to show that even if they didn’t think so, some physicians may have been over-prescribing.

However there are ways to take it a step further: tracking what the patient actually took outside the clinic, which is why we include a pain medication usage task in many care plans. This activity asks patients some simple questions about their over-the-counter and prescribed pain medication usage, and alerts if the numbers or the length of time is over certain thresholds. It’s in use in care plans that include general pain management, surgical, and neurology (headache management), and provides a view into usage, and the opportunity to reach out and help patients outside the clinic before usage becomes a problem.

We’re strong believers in the ability for patients to record their own outcomes and experiences, and the value of combining this with prescribing and clinical data to close the loop on delivering better care. If you’re interested in learning more, get in touch.

Posted in: Adherence, Behavior Change, Healthcare Legislation, HIPAA, Opioids, Outcomes, patient engagement

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Your Cupcakes Are Not My Goals

This year Google Maps tried out a short-lived motivational technique of showing how many cupcakes you would burn off or ostensibly could eat if you chose to walk to your destination. Not surprisingly this backfired, and they quickly retracted the feature. The reasons ranged from users expressing feelings of shame for not walking, to those with eating disorders saying it would encourage more obsessive behavior. Beyond that, many questioned how Google was even calculating both caloric expenditure and the actual calories in the cupcakes.

Regardless of the myriad of criticisms the experiment illustrated a key point: motivation and goal setting is best left to the individual, and understanding someone’s personal context is extremely important if you want to help them set goals.

One of our most read blog posts of 2017 was a 2015 post on whether setting SMART or MEANINGFUL goals was most effective for patients. I’m not sure why this bubbled to the top this year but the post provides an overview of two thoughtful frameworks for helping patients set goals.

At Wellpepper, we’d like to propose a third methodology: let people figure out what’s important to them. This year we expanded a capability we’ve had since V.1 that enables patients to set their own goals. This is a free-form, 140 character text box where patients write about what’s important to them. Over the years, we’ve had some clinicians express concern about whether patients could set their own goals. Functional goals are best left to the experts, but these are life goals, things that are important to people and why they are even bothering to use this app which helps them through healthcare activities to manage chronic diseases or recover from acute events.

Since we already knew that setting patient-generated goals is motivating, we also got to wondering whether you could track progress in a generic way based on patient-generated goals. After analyzing thousands of patient-generated goals, we figured out that asking a question about the patient’s perception progress on a Likert scale would work, and so this year we expanded the patient goal task type to include tracking.

It looks like this.

In case you’re skeptical that this works, here are a few examples of patient-generated goals.

Spend more time with family.

Get outside more frequently.

Walk more.

Be ready for vacation.

Now ask the question. See, it’s entirely possible for patients to set their own goals, unaided, and track progress against those goals. We’re pretty excited about the possibilities of this for improving motivation, and also for further analysis of patient adherence and outcomes. If you’d like to know more, or see a demo, we’d love to hear from you.

Posted in: Behavior Change, Healthcare motivation, Healthcare Technology, Healthcare transformation, patient engagement, patient-generated data

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May You Live In Interesting Times: Wellpepper’s Most Interesting Blog Posts of 2017

Who would have predicted 2017? As soon as the election results were in, we knew there would be trouble for the Affordable Care Act no one could have predicted the path through repeal with no replacement to claw backs in a tax bill that no one has read. It’s been a crazy ride in healthcare and otherwise. As we look ahead to 2018, we’ve found that a good place to start is by looking back at what was popular in 2017.

Looking back over the past year’s top blog posts, we also believe trends that started in 2017, but will even stronger in 2018. These four themes bubbled up to the top in our most-read blog posts of 2017:

Shift to the cloud

We’ve noticed a much wider spread acceptance of cloud technologies in healthcare, and the big cloud platform vendors have definitely taken an interest in the space. Wellpepper CTO Mike Van Snellenberg’s comprehensive primer on using AWS with HIPAA protected data was one of our most read posts. Since he wrote it, even more AWS services have become HIPAA-eligible.

Using AWS with HIPAA-Protected Data – A Practical Primer

Consumerization of healthcare

Consumer expectations for efficient online interactions have been driven by high-deductible plans and an expectation from consumer technology and industries like retail and banking that customer service should be personalized, interactive, and real-time. These two posts about the consumerization of healthcare were among the most popular.

The Disneyfication or Consumerization of Healthcare

Consumerization Is Not A Bad Word

Value of patient-generated data

In 2017 we saw a real acceptance of patient-generated data. Our customers started asking about putting certain data in the EMR, and our analysis of the data we collect showed interesting trends in patient adherence and predictors of readmission. This was reflected in the large readership of these two blog posts focused on the clinical and business value of collecting and analyzing patient-generated data.

In Defense of Patient-Generated Data

Realizing Value In Patient Engagement

Power of voice technology

Voice technology definitely had a moment this year. Okay Google, and Alexa were asked to play music, turn on lights, and more importantly questions about healthcare. As winners of the Alexa Diabetes Challenge, we saw the power of voice firsthand when testing voice with people newly diagnosed with Type 2 diabetes. The emotional connection to voice is stronger than mobile, and it’s such a natural interaction in people-powered healthcare. Our blog posts on the Alexa Diabetes Challenge, and developing a voice solution were definitely in the top 10 most read.

Introducing Sugarpod by Wellpepper, a comprehensive diabetes care plan

Building a Voice Experience for People with Type 2 Diabetes

Ready When You Are: Voice Interfaces for Patient Engagement

Since these themes are still evolving we think 2018 will present a shift from investigation to action, from consideration to deployment and possibly insights. Machine-learning and AI will probably remain high in the hype cycle, and certainly the trends of horizontal and vertical healthcare mergers will continue. We also expect a big move from one of the large technology companies who have all been increasing their focus in healthcare, which in turn will accelerate the shift to a consumer-focus in healthcare.

There’s a saying “may you live in interesting times.” We expect 2018 to be at least as interesting as 2017. Onwards!

Note: There was one additional post that hit the most popular list. Interestingly, it was a post from 2014 on whether SMART or MEANINGFUL goals are better for patients. We’re not sure why it resurfaced, but based on analysis we’ve done of patient-directed goals, we think there’s a third approach.

Posted in: Behavior Change, Healthcare Disruption, Healthcare motivation, Healthcare Research, Healthcare Technology, Healthcare transformation, HIPAA, patient engagement, patient-generated data, Voice

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HealthLoop, Wellpepper, and Livongo Collaborate to Advance Digital Health

Three companies engaged with CMS toward inclusion of patient engagement and outcomes tracking in the MIPS Improvement Activity for provider reimbursement.

MOUNTAIN VIEW, CA, UNITED STATES, December 13, 2017 /EINPresswire.com/ — Approved digital health tools will soon be eligible for Medicare reimbursement. Beginning in 2018, physicians and other healthcare providers participating in the Merit Based Incentive Program (MIPS) track of the Medicare Access and CHIP Reauthorization Act (MACRA), can qualify for reimbursement for using clinically endorsed digital health tools to remotely guide and monitor patients outside of the clinical encounter. The new Improvement Activity recognizes the important value that digital patient engagement tools play in driving healthcare quality and lowering costs.

The new CMS MIPS Improvement Activity, entitled “Engage Patients and Families to Guide Improvement in the System of Care,” enables healthcare providers to be reimbursed for the remote monitoring, review, and interpretation of patient generated health data (PGHD) gathered through clinically endorsed mobile patient engagement applications. This provides an incentive for physicians to use digital health tools to track patient progress and improve the quality of ongoing care outside of the hospital or clinical setting while empowering patients to take more active roles in managing their own health.

Three digital health companies, HealthLoopWellpepper, and Livongo – leaders in this fast-growing market – collaborated in working with CMS to raise awareness of how PGHD and digital patient engagement tools can play critical roles in improving the quality of care and outcomes for patients. Top executives from the three companies also participated in the CMS PGHD Round Table in Washington, D.C. on December 6 to further the importance and understanding of the value of PGHD in patient care.

HealthLoop, Wellpepper, and Livongo can improve the level of personalized care for patients by providing ongoing guidance and assessments outside the physician-patient encounter. Physicians and care teams can use these tools to provide and adjust care plans, assist with ongoing disease management, and support return-to-work and patient quality of life improvement. Data collected from these digital health platforms can be used to track patient outcomes in support of continuous improvement initiatives and for participation in alternative payment models.

“Patient generated health data is a valuable tool in patient care,” said Anne Weiler, co-founder and CEO of Wellpepper, a clinically-validated platform for patient engagement that provides personalized, digital patient treatment plans delivered via mobile devices, SMS, email, Web and interactive voice interfaces. “We’re pleased that CMS has recognized this, and is enabling the collection and analysis to be used in demonstrating quality patient care.”

While many consumer digital devices like smart watches and activity trackers are in use by patients, the new MIPS Improvement Activity requires that physicians and other providers use clinically endorsed patient engagement and outcomes tracking tools that provide an active feedback loop – meaning they provide timely (real or near-real time) PGHD to the care team or generate timely automated feedback to the patient, such as automated patient-facing instructions based on care plan adherence or glucometer readings. These patient engagement tools may inform the patient and the clinical team of important parameters regarding a patient’s status, adherence to care plans, comprehension and indicators of clinical concern.

“This new rule is an important step forward for physicians and patients using digital engagement tools,” said Dr. Ben Rosner, CMIO of HealthLoop, a software solution that enables care teams to engage all patients before and after clinical encounters through automated daily check-ins. “For clinicians already using a patient engagement platform, these efforts will help satisfy the Improvement Activities category and earn 10 Advancing Care Information bonus points. Eligible clinicians must simply attest to completing the activity for at least 90 days to meet 2018 reporting requirements. Financial incentives aside, engaging with patients is the right thing to do. Practices using automated patient engagement solutions see reduced readmission and complication rates, lower call center volume, better online ratings for physicians, and, most important, happier, healthier patients.”

“It’s not enough to want providers to expand care beyond the four walls of the office, it’s about empowering consumers and updating all parts of the system,” said Michael Sturmer, Livongo Senior Vice President of Health Services. “The new CMS MIPS Improvement Activity further connects digital health with providers and care practices and is a significant advancement in making digital health part of the fabric of the health care experience. It is better for patients and providers, and that’s better for all of us.”

Posted in: Press Release

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Pointing Fingers at Healthcare Problems

I’m only halfway through Elizabeth Rosenthal’s “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back” which means that I haven’t gotten to the “what you can do about the problem” part. It’s a slow read, not because it’s not compelling but because it’s too compelling, and if like the current President, you were surprised at how complicated healthcare is, this book will do nothing to dissuade you. It’s really really complicated.

So far, I have two main takeaways from the book, that are easily illustrated through my recent experience of breaking and dislocating my finger: a simple, non-life-threatening problem, that unearthed a couple of key dysfunctions and unintended consequences.

My first takeaway is that everyone is complicit, and yet seem to manage to finger point at everyone else. Rosenthal spares no punches in unearthing decisions that are not made with the best interest in of the patient at heart. Providers, healthcare organizations, payers, pharma, and employers all are complicit in the mess that is our current healthcare system.

This past fall, I broke and dislocated my finger. It wasn’t a big deal, but because it happened on a Saturday night, my only option for care was at the ER. Last week I received a letter in the mail from my insurance company, that according to the envelope required my urgent reply. In the letter, the insurance company suggested that perhaps someone other than them may be on the hook for my ER bill. While I understand they wanted to make sure this wasn’t a worker’s compensation claim, the form was basically for me to tell them whose fault my injury was so that they could go after another insurance company to pay. This was a sports injury in a game of Ultimate Frisbee, a game so granola-like that there are no referees: players call fouls on themselves. . No one was at fault, and even if they were, I would never have considered suing. However, the form didn’t give me that option: only gave me the option of saying whether I had settled my claim. I created a new box that said “NA” and checked it.

When I received the letter, I couldn’t help but think back to Rosenthal’s book, and also consider the amount of effort and cost that was going into finding someone else to blame and pay. Just imagine what this effort and cost would have been if there were legal action….

The second takeaway is that the original intention of a decision always has much farther reaching implications than anyone who agreed on what seemed like a reasonable decision though. Again with the finger, I was asked a number of times if I wanted a prescription for OxyContin. I did not. As has been well publicized we have an opioid addiction problem in North America. While my finger hurt, aside from morphine during inpatient for an appendectomy, I hadn’t had opioids, and really didn’t think that it was necessary, which I explained to the physician. It wasn’t. Tylenol worked fine—however, it seemed that it was very important that I be the one to make this call, not the physician.

One of the unintended consequences of patient satisfaction scores may be the over prescription of pain medication, as many of the questions on the HCAHPS are about whether the patient’s pain was well managed. In Rosenthal’s book, I was also surprised to learn that a finger fracture where an opioid is prescribed has a different billing code than if it is not prescribed, and that with the fracture plus opioid billing code, hospitals get paid more. Now, if you are wondering how this may be the case, if you think about it, a fracture that requires an opioid must be more severe than one that doesn’t and therefore the billing code reflects the severity. This is exactly where the unintended consequences of billing codes can result in exactly the wrong behavior for patient care and safety.

It’s quite possible that the physicians on duty were not aware of either of these two drivers for prescribing, especially the billing code one. They may have just been told “this is our standard of care” and were following guidelines.

If a simple finger fracture and dislocation can shine a light on two key problems in our healthcare system, just imagine what else is out there. Actually, you don’t have to, just get a copy of Elizabeth’s book yourself, and let’s compare notes when I get to the part about what the fix is. It’s going to take all of us.

Posted in: Health Regulations, Healthcare costs, Healthcare Disruption, Healthcare Legislation, Healthcare Policy, Healthcare transformation, Opioids

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Are Women Better Surgeons? Patient-Generated Data Knows The Answer

As empowerers of patients and collectors of patient-generated data, we’re pretty bullish on the ability for this data to show insights. We fully admit to being biased, and view things through a lens of the patient experience and outcomes, which is why we had some ideas about a recent study that showed female surgeons had better outcomes than male surgeons.

The study, conducted on data from Ontario, Canada, was a retrospective population analysis of patients of male and female surgeons looking at rates of complications, readmissions, and death. The results of the study showed that patients of female surgeons had a small but statistically significant decrease in 30-day mortality and similar surgical outcomes.

Does this mean that women are technically better surgeons? Probably not. However, there is one sentence that stands out to a possible reason that patients of female surgeons had better outcomes.

A retrospective analysis showed no difference in outcomes by surgeon sex in patients who had emergency surgery, where patients do not usually choose their surgeon.

This would lead us to believe that there is something about the relationship between the patient and the provider that is resulting in better outcomes. We have seen this at Wellpepper, while we haven’t broken our aggregate data down by gender lines, we have seen that within the same clinic, intervention, and patient population, we see significant differences in patient engagement and outcomes between patients being seen by different providers.

Some healthcare professionals are better than others at motivating patients, and the relationship between provider and patient is key for adherence to care plans which improve outcomes. By tracking patient outcomes and adherence by provider, using patient-generated data, we are able to see insights that go beyond what a retroactive study from EMR data can show.

While our treatment plans, and continued analysis of patient outcomes against those treatment plans go much further than simply amplifying the patient-provider relationship, for example with adaptive reminders, manageable and actionable building blocks, and instant feedback, never underestimate the power of the human connection in healthcare.

Posted in: Adherence, Behavior Change, big data, Clinical Research, patient-generated data

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Boston University Center for Neurorehabilitation: A Novel Mobile Intervention For People With Parkinson’s Disease

In 2013, when we were a brand new m-health company, we had the good fortune to meet Terry Ellis, PhD, Director of the Center for Neurorehabilitation at Boston University. Dr. Ellis was an early investigator in the value of digital interventions, and saw an opportunity to partner with Wellpepper so that her team could focus on the new care models, and Wellpepper could focus on the technology. The first building blocks in the Wellpepper platform aligned closely with outpatient rehabilitation, and Dr Ellis and team wanted to prove that people who had Parkinson disease could improve strength and mobility without costly in-person visits. At Wellpepper, we also had an interest in proving that mobile health can improve outcomes, and also that those 50 plus could use mobile technology.

Persons with Parkinson Disease (PD) have been described as 29% less active than older adults without PD, and see a 12% decline in mobility for each year after their first diagnosis with the disease. In-person interventions with physical therapists can help, but in the usual care condition, a person has one in-person assessment at The Center for Neurorehabilitation, and may not be seen again for 6 months to a year, during which time there was a decline in mobility. Dr Ellis and team were looking for a way to prove out a novel intervention that could improve outcomes for these patients.

Patient Experience

This video does a great job of showing the patient experience, both with the clinician and while using the application at home.

User Journey from Wellpepper on Vimeo.

Outcomes

While Dr. Ellis and team are still analyzing additional data, and will be submitting to a peer-reviewed journal, and are exploring expanded studies on the topic, we can share some very promising results.

  • This study revealed that using mobile health technology to remotely monitor and adapt exercise programs between bouts of care in persons with Parkinson disease was feasible and acceptable.
  • On average, subjects engaged with the app every week for 85% (+/- 20%) of the weeks with an 87% satisfaction rating.
  • Significant improvements in physical activity, walking and balance measures were observed over 12 months.
  • People who showed lower exercise self-efficacy at the beginning of the study saw the greatest gains.

Technology

  • This technology used the Wellpepper platform, clinic application for iPad, and patient application for iOS. Requirements were for ease of use for both clinicans and patients. Features include the ability to record custom video of patients doing their exercises, for patients to record results, and for patients and providers to message securely with each other.
  • Fitbit was used for patients to track non-exercise activity, and this was the first integration of a consumer exercise tracker with the Wellpepper platform.
  • The entire Wellpepper platform is built on Amazon Web Services, in a HIPAA secure manner, which was a requirement for the study. No data was stored on mobile devices and all personal health information was encrypted in transit and at rest.
  • The Boston University team required a monthly data extract of all patient-generated data for their analysis purposes.
  • Post study, we were able to analyze anonymized patient-provider messages using a machine learned message classifier, and have presented this data at digital health conferences.

The positive preliminary results of this study, lead to a larger study with seniors at risk of falls, lead by principal investigator Jonathan Bean, MD from Harvard Medical School. Details of this intervention are available here. While Dr Bean is also in the process of submitting to a peer-reviewed journal, his assessment is that outcomes exceeded clinically significant measures.

We are looking forward to sharing more about the results of both of these studies when they are publicly available in peer-reviewed journals. If you are a researcher who would like to know more, contact us and we may be able to put you in touch with the study leads.

Posted in: Clinical Research, Exercise Physiology, Healthcare Technology, Healthcare transformation, M-health

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