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23andWho?

Jacquie Scarlett, Wellpepper Director of Customer Experience, and I were some of the last people to get full genomic testing using the $99 personal genomic testing kits from 23andMe before the FDA “cease and desist” letter on November 22, 2013. We had sent in our saliva samples and were waiting for results, when the following letter was published by the FDA.

WARNING LETTER
 
Dear Ms. Wojcicki,
The Food and Drug Administration (FDA) is sending you this letter because you are marketing the 23andMe Saliva Collection Kit and Personal Genome Service (PGS) without marketing clearance or approval in violation of the Federal Food, Drug and Cosmetic Act (the FD&C Act). Read the full letter here

What was fascinating to us about the letter is that it hinted pretty clearly to the strategy of 23andMe: try to ignore the FDA as long as possible. The letter references many prior letters and meetings during which 23andMe had apparently made some promises to get back to the FDA but didn’t. Many health and technology writers commented that the strategy was in keeping with both Silicon Valley arrogance and modeled after Google’s belief that data trumps all. They posited that 23 and Me was racing to get to the magic 1 million record number at which point their data alone would prove whether the tool provides valid genetic results so that they would not get bogged down in what are usually lengthy FDA approval processes. While it does make sense for a start-up to try to avoid the FDA route if possible based on their technology and business model, 23 and Me is definitely well-funded enough to survive an FDA approval process. And, they’ve been having these conversations with the FDA for 5 years, which is actually enough for some FDA approvals to get through.

[M]ore than 5 years after you began marketing, you still had not completed some of the studies and had not even started other studies necessary to support a marketing submission for the PGS. 

The letter calls for 23andMe to discontinue marketing the PGS until it receives FDA marketing authorization.

There’s a saying that if you’re not paying, you’re the product. It seems that this can be true even if you are paying, or if what you’re paying, for example $99 is such a nominal amount that it doesn’t cover the full value you are receiving, or when the value you are providing the organization, for example, your DNA or buying habits is the most valuable of all. After this FDA letter and related editorials were published, we waited to see what would happen. It took 6 days from the time of the FDA letter for 23andMe founder and CEO Anne Wojciki to send a letter to paying customers to explain what was going on, and that letter really did not say anything at all. This is the type of letter that PR and legal typically send within 24 hours of an incident: we know there’s an issue and we’re working on it. 6 days later, it felt like too little to late for us to believe they really cared about us as consumers. (Contrast that to last week when New Balance sent  a number of customers, including me, some erroneous emails and had corrected them within an hour and also had updated their call center line.)

Dear 23andMe Customers,

I wanted to reach out to you about the FDA letter that was sent to 23andMe last Friday.

It is absolutely critical that our consumers get high quality genetic data that they can trust. We have worked extensively with our lab partner to make sure that the results we return are accurate. We stand behind the data that we return to customers – but we recognize that the FDA needs to be convinced of the quality of our data as well.

23andMe has been working with the FDA to navigate the correct regulatory path for direct-to-consumer genetic tests. This is new territory, not just for 23andMe, but for the FDA as well. The FDA is an important partner for 23andMe and we will be working hard to move forward with them.

I apologize for the limited response to the questions many of you have raised regarding the letter and its implications for the service. We don’t have the answers to all of those questions yet, but as we learn more we will update you.

I am committed to providing each of you with a trusted consumer product rooted in high quality data that adheres to the best scientific standards. All of us at 23andMe believe that genetic information can lead to healthier lives.

Thank you for your loyalty to 23andMe. Please refer to our 23andMe blog for updates on this process.

Anne Wojcicki
Co-founder and CEO, 23andMe

A full 15 days later, we found out that since we’d purchased our kits before the November 22nd letter from the FDA, we would receive both genetic and ancestry results.

“If you are a customer whose kit was purchased before November 22, 2013, your 23andMe experience will not change. You will be able to access both ancestry and health-related information as you always have.

So first off, they didn’t have the most basic customer targeting capabilities to determine when I purchased to send a more personalized letter, and it doesn’t seem like any concessions were made to people who would only be receiving half of what they paid for as they received the same letter. When we signed up for 23andMe we did know what we were getting into: they are a start-up with some pretty lofty aspirations. However, this experience made it pretty clear that the consumer is not the customer for this company. That said, would we do it again? Yes. The process, whether 100% accurate or not has been extremely interesting. Our next blog post will talk about 1. the things we learned. 2. how 23andMe drives a highly sticky and engaging experience for end-users. We’ll also touch a bit on the ethical aspects and how this type of testing can help and also create potential risks for the empowered patient.

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Flipping the Clinic Visit

Doesn’t it seem like there’s never enough time? Nowhere is this more prevalent than with our healthcare system. We don’t have enough time to do things that keep us well, and increasingly doctors don’t have time to spend with us to thoroughly understand our issues. A spate of recent articles tries to blame the implementation of technology and the EMR as taking even more time away from the patient/doctor relationship.

Doctor and scribe, source New York Times

Doctor and scribe, source New York Times

Electronic health records have become a disease in need of a cure, as physicians do their best to diagnose and treat patients while continuously feeding the data-hungry computer. “A Busy Doctor’s Right Hand, Ever Ready to Type

This isn’t necessarily the fault of the EMR. It really stems back to money. One of the primary purposes of the EMR is to document for billing purposes and federal rebates. They weren’t designed to improve face-to-face care.

This New York Times article describes how scribes are helping to increase doctor face time with patients, but hiring another person to record what the patient is saying seems more like a band-aid solution.

Without much fanfare or planning, scribes have entered the scene in hundreds of clinics and emergency rooms. Physicians who use them say they feel liberated from the constant note-taking that modern electronic health records systems demand. Indeed, many of those doctors say that scribes have helped restore joy in the practice of medicine, which has been transformed — for good and for bad — by digital record-keeping.

What we really need is something like the “flipped doctor’s visit” being explored by the Robert Wood Johnson Foundation and inspired by Sal Khan, of the Khan Academy, an organization that has already made headway into education innovation by suggesting that classrooms are for homework and viewing lectures can be done at home. The idea of the flipped classroom is to maximize the interaction between teacher and pupil. The RWJF project suggests we need to do the same thing for the doctor’s visit.

The project is looking at ways that can turn the doctor’s visit on its head to get better results for patients and healthcare providers. While the example of EMR scribes seems like it might fit, to us it seems like a bit of a placebo. From personal experience, I had a doctor’s visit where an intern recorded my information and then read it back to the doctor and me. She had gotten some major facts wrong, for example, somehow she understood I worked in construction, not software. Open Notes and Blue Button, where patients see their own notes are two examples of trying to take this a step further. Who better than the patient to review what was written about them? We also need to return to documentation to improve patient care, not documentation for billing. The point of good documentation should be to accurately describe the situation and for continuity of care. Sadly, again technology is being blamed for an underlying issue of time, in this example the ability to copy and paste is being used for false records and billing. Again, it’s not the technology, it’s that people are pressed for time and again that time is money.

I recently had a few doctor visits that gave me time to pause and consider the flipped visit. The main thing that struck me is how different the doctor’s visit is from any other type of business interaction. As I was thinking about preparing for the visits with my list of things to make sure we cover, I thought about comparing this to a business meeting. The doctor had no agenda in advance, no idea why I was coming in, or even who she was meeting with until I walked in the room, and spent the first few minutes of a 10 minute visit looking at notes to try to remember who I was and what had happened before. Imagine you’d hired a consultant for a project (ie manage your health) who approached the project in this manner. You’d want your money back. You’d expect them to come to a meeting prepared. As the client you’d send them any pertinent information or updates for the project before the meeting. I was also trying to imagine the day of a doctor: every 10-15 minutes changing context with a new patient and no prep time while trying to care for patients and sometimes facing life-threatening decisions. Hairdressers have more insight into how their day is going to go: cut, color, cut, blow-out. We talk about moving to a preventative model for healthcare. First step would be to enable doctors to prepare to see patients and decrease the documentation burden after they see them.

We need better and more cost effective ways of communicating in healthcare. Ones that focus on patient care and are seamless for both patients and healthcare providers. We have applied technology for better communication and collaboration in business and in our personal lives, how can we extend this to healthcare? How can we flip the doctor’s visit and how can technology help?

If you’re interested, the Robert Wood Johnson Foundation is hosting a Google Hangout on the flipped clinic January 16 at 11:00 am PST.

Posted in: Healthcare Disruption, Healthcare motivation, Healthcare Technology

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Resolve to Create Better Resolutions!

Tis the season to regret all the cookies, chocolate, and rich foods you ate over the last few weeks and start the New Year off right! Resolution time is here. Do you make them? Do you think they work? Do you incorporate behavioral change methods in your resolutions? Simply deciding to do something new or stop doing something old without making corresponding changes in your ability to do so will not have the impact you’re looking for.

There are three key factors that facilitate behavior change:

  1. You have to have the capability to change.
  2. You have to have the motivation or desire to change.
  3. You have to have the opportunity to change.

If these three conditions exist, you can change. So let’s say your goal for 2014 is to sit less. However, you have a job where you sit at a computer all day, and while you know that sitting is not good for you, you like your job and quite frankly your family and mortgage like your job too. You might be motivated to sit less but unless your employer supports you in this desire for example by helping you install a standing or treadmill desk, or removing all the chairs from the conference rooms, you might not have the capability to change. Or let’s say you want to walk to work but your office is 20 miles from your home in an industrial park off a freeway. Again you might have the motivation, but not the opportunity unless you are able to change jobs.

Picture of cocktail

Cocktail source: Steamykitchen.com

One year I decided that I had become old before my time (in my pajamas by 9 on a Friday, if you must know), and I made three resolutions:

  1. Drink more cocktails
  2. See more films
  3. Go to more art galleries.

Now, you’re thinking, these don’t sound like good New Year’s resolutions, but according to the factors that facilitate behavior change, I was on the right track. I had disposable income, single friends, and lived in a large metropolitan area with plenty of theatres and art galleries. Friends were more than happy to help me keep these resolutions, and I got out of my hermit-like funk and was inspired by connecting with people, the vibrancy of the city, and by art.

If you need some help designing your resolutions, first off use the simple framework. Are you capable? Are you motivated? Do you have the opportunity to make the change? If any of these is no, consider whether these factors can change. This video by behavior change expert, BJ Fogg can also help you break it down to something that is manageable.

Finally, get help! Studies show that even if friends of your friends are obese, you have a greater chance of being overweight. The same is true with positive behavior. As a long time “left-coast” dweller, I can attest to the positive transformation that happens when people move here and are surrounded by those with an active lifestyle. Get some friends together who are working towards the same goal. Start a walking group at work. Employee wellness was one of the hot topics of 2013, and while some of the promise of employer-organized wellness programs have not come to fruition, there are simple things that employees and employers can do to facilitate change. We loved these examples from the BUPA HQ in London. If any employee has the motivation, the company facilitates the opportunity.

Eat more fruit!

Eat more fruit!

Take the stairs!

Take the stairs!

Psst. Over here!

Psst. Over here!

Best in 2014 from all of us at Wellpepper for a healthy and happy year!

Posted in: Behavior Change, Healthcare motivation

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Wellpepper’s Top Health Tech Stories of 2013

It’s the time of year to reflect and make lists! It’s been a great year for Wellpepper: our first full year in business. We’ve enjoyed bringing new features to our users and learning more about the needs of both patients and healthcare providers. We’re committed to building useful tools that patients and providers love to use. We’ve been inspired at conferences meeting with end-users, hospital administrators, and other startups who share the same mission of changing how patients and providers engage around their health. We’ve experienced the power of social media, met new friends through Twitter, and learned so much from Tweetchats. As a young company, it’s been a year of firsts for us that, while monumental for us, pale in comparison with the changes going on in health IT, so rather than telling you more about us, let’s talk about the year in Health Tech.

There is no scientific basis to this list, just what we think stands out from the year in Health Tech.

Healthcare.gov

The beleaguered website was definitely the top Health IT story of the year. At Wellpepper we were unable to make it through the registration process ourselves, and ended up going to a broker to find out our healthcare options. As the news came out on why the site was so bad, it was pretty obvious there was a lack of accountability and no project management. It’s really unfortunate that the Affordable Care Act was mired in this mess of an implementation, but we’re very excited that former Microsoft exec Kurt DelBene is taking the reins. Ship It!

Quantified-Self Hits the Mainstream

tec-gift-guide-fitness-trackers.jpeg-1280x960Or, “everyone is tracking.” The mainstream press started writing about fitness gadgets and our Facebook feeds were full of friends who got new FitBits for Christmas. Not sure what this means about the trend though. We have found the FitBit to be really interesting to calibrate activities, for example, a game of Ultimate Frisbee but after you know how inactive or active you are do you really need to track? And do you become okay with your activity or lack thereof?

Meaningful Use Phase Delayed

The Centers for Medicare and Medicaid have delayed the deadlines for implementing Meaningful Use Stage 2. Stage 2 will be extended through 2016 and Stage 3 won’t begin until at least fiscal year 2017 for hospitals. Meaningful Use Stage 2 focuses on patient engagement, which is very minimally defined as patients interacting with healthcare information electronically. We’ve always said that electronic medical records vendors are not the best equipped to deliver tools that patients (ie consumers) want to use, so it’s not surprising that healthcare providers are struggling with this phase. That said, m-health is poised to deliver on these requirements.Wellpepper2-1195a

M-Health Comes of Age

While we can definitely debate where we are in the m-health hype cycle, there is no question that M-Health is a formidable category. The FDA is now monitoring and releasing guidelines, albeit with little clarification. Eric Topol made headlines by using an iPhone EKG on a plane to diagnose a heart attack and and advise the captain to make an emergency landing. Most positively, we’re hearing less talk of ‘apps’, and more talk of integrating mobile health into the overall patient experience and the official hospital records.

23andMe Ignores FDA

Source: Wikipedia commons

You might consider this one to be a bit specific, but it’s representative of a number of key stories in 2013: big data, the explosion of healthcare investing, and the dramatic gulf between current Health IT and other technologies, and between Silicon Valley and the FDA. 23andMe, which does cheap DNA testing, direct to consumer, was forced to stop providing genetic results and only include ancestry after effectively ignoring FDA warnings for over a year. Speculation is that they were trying to get to a million tests (they are at about 500K) so that they could prove their tests were valid and thereby circumvent long FDA approval processes. Those on the side of the FDA saw this as Silicon Valley thumbing their nose at patient safety and regulations. Those on the side of 23andMe saw this as tech disruption at its purest. As recipients of some of the last full genetic and ancestry tests before the shut-down, expect more from us on this topic. 😉

This one is not healthtech, but we’d be remiss if we didn’t mention the focus on costs of care. Time Magazine, and the New York Times both published rather scathing interactive features on the costs of healthcare in the US. One of Reddit’s top threads right now is about a $50,000 appendectomy. It’s great to see these issues called to light. Let’s hope we see progress in solving them in 2014.


NewYearWP

We’re pretty excited to see what 2014 brings Wellpepper and what new innovations, disruptions, and improvements are brought to the healthcare industry as a whole. Best to you and yours from all of us at Wellpepper!

Posted in: Health Regulations, Healthcare Disruption, Healthcare Technology, M-health

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Call the (NHS) Midwife!

I’ve been watching the BBC Series “Call the Midwife” on Netflix. It’s set in the late 1950’s and focuses on a group of young nurses working in London’s east end, riding their bicycles through the streets to deliver babies and running health clinics out of a gymnasium. If a situation becomes more than a nurse can handle, she’ll call in a doctor and sometimes expectant mothers are sent to the hospital but for most it’s home births. The series is sweet and fun to watch although doctors often spout slogans like “without the National Health Service this baby would have died” in the middle of a delivery. It’s a rosy commercial to reinforce a matter of national identity and pride in the UK.

Call the Midwife. Source PBS.org

Call the Midwife. Source PBS.org

The NHS is the largest health system in the world, serving over 65M patients. Every person in the UK has basic health services covered, and some, like pregnant women also receive dental services. It’s based on a model of Trusts that run their own organizations supported by some centralized services. I learned more about this system on my recent trip to attend Health 2.0 Europe, which was in London and had a large focus on how to engage with the NHS.

As the CEO of a m-Health and Health IT startup, my interest was largely in how information is managed across this vast system. Interestingly some areas are highly advanced while others are still paper-based.  For example, BT (British Telecom) implemented “The Spine” almost 10 years ago to deliver one system that has basic patient demographics that can be accessed from any health institution. The Spine authenticates patients using their health card and provides their health ID number, age, and basic demographics to any healthcare organization. This means, that say you are from London but are vacationing in Cornwall, over 250 miles away, you can walk into any clinic and get care. Alternatively, 80% of patient records are on paper, and while there are 65M patients there are 85M records suggesting that there is some potential error in the system. Some hospitals in Central London are moving to electronic records and saving millions of pounds annually just by not having to store the records in extremely expensive London real estate. This is quite impressive considering that many EMRs cost hundreds of millions of dollars to implement. 😉

While so many records are still paper-based in many areas,  digital technologies are being implemented for innovative uses. I learned about hospitals deploying hundreds of iPads to staff, as well as tele-health in use for cognitive behavioral therapy. Patients were able to record their therapy sessions and replay them later when they needed a refresher on the advice or what was said. Patient centered care was the reason for adopting these new technologies, however the 18-month waiting list for cognitive behavior therapy may also be driving new models of care.

Private hospitals have cropped up catering to the “worried wealthy” who want to access more frequent care or avoid waiting lists for surgery, MRI, or other popular treatments. I heard mixed feedback about whether these waiting lists were real. Some people said that they were exaggerated while others pointed to the popularity of private care as proof.

Another areas of contrasts was around portability and protection of health information. On the one hand, an NHS representative said that a major issue was consent: sharing of patient records across trusts or hospitals or even with someone not directly involved in the patient’s care. On the other hand personal health information regulations while important did not seem to be as big an emphasis as in the US. As for the portability of health data, patients often are given their paper file to carry directly to a specialist. While it would be great if they were able to do this on their mobile device, it’s great to see this level of access to information for patients.

As I’ve written before, there does not seem to be a magic bullet between private and public systems. Private can deliver a much higher level of service however, the right to healthcare seems like it should be universal. The trip provided an interesting peek into another model that has its share of advancements and opportunities to get even better.

Now, back to seeing what the girls are up to on Call The Midwife.

Posted in: Data Protection, Health Regulations

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Health 2.0 Europe “Tools for the Elderly”

Filming a patientPrior to the Health 2.0 Europe Conference there was a deep-dive 3 hour session called “Tools for the Elderly.” I was particularly interested in this session for two reasons, first we are doing some work with Boston University on a study using Wellpepper to manage the health of Parkinson’s patients the eldest of whom is 75 and second, a common criticism we hear from healthcare providers and investors is “old people can’t use technology.” We disagree wholeheartedly, but acknowledge that those who may have less than 20/20 vision or arthritic hands may require different types of interfaces and engagement than the stereotypical 20 year old developer is building for. Based on this, I was very interested to see what types of innovations and challenges this session presented.

Two of the most interesting were Many Happy Returns and Intelesant. Many Happy Returns is a memory, engagement, and conversation aid for people with dementia. It was developed originally as a not-for-profit by Sarah Reed who was introduced to the world of dementia when her mother was diagnosed over 10 years ago. Originally a card game, and now being developed into a mobile application, Many Happy Returns presents pictures from different decades to jog the memory of dementia sufferers and encourage inter-generational communication. People who have dementia have increasingly clear long-term memory with deteriorating short term memory and the cards provide the ability to have meaningful conversations with those with dementia and also learn family stories before they are lost. The app interface was simple and highly usable, and the benefit of using an iPad app over printed cards is huge: sound can be added, and sounds have proven to be very evocative for memory jogging, new card sets can be created by scanning and adding the person’s own photos, and finally, tracking can be done related to which photos, or sounds are most interesting to people.

Tools for the Elderly

Intelesant could have also been in the “unmentionables” session in the full conference. They provided an advance “end-of-life” care plan that was accessible by patients, their care givers, and could be shared with healthcare providers, especially in a care home setting. Too often this information is lost or not communicated clearly until it’s too late, and Intellesant aims to change this. What was compelling about the Intellesant presentation is that the interface, while capable of reporting clinical results, was designed for the patient and the caregiver who are really the most important constituents in this scenario.

There were also three startups that were focusing on building interfaces for the elderly, one to make it extremely simple to use a phone,  one to make it extremely simple to use a tablet, and one to make it extremely simple to have a conference call or telehealth chat through your TV. The first two were solving the problem that Android interfaces are generally a lot less usable than other interfaces, which really seems like 1. A short term problem and 2 something that should be addressed by Android OS developers. (Are you listening Samsung?). The third, SpeakSet was solving a problem that of course affects the elderly, but also everyone else. According to some former colleagues of mine at Microsoft (Skype), it takes 10 minutes on average for any conference call to get started. While there are definitely tools that can help the elderly manage their health and wellbeing, good usable design should be available to everyone. I’d love to use a big button that says “start conference call” and have it work immediately.

The AARP has gone on record asking Silicon Valley to start building tools for the aging population. Based on this session at Health 2.0 Europe, they may want to look further afield.

Posted in: Aging, Healthcare Disruption, Healthcare Technology, M-health

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Health 2.0 Europe “Improving and Enriching the Patient-Provider Relationship”

Last week, I had the opportunity to demonstrate Wellpepper and participate on a panel on “Improving and Enriching the Patient-Provider Relationship” at the Health 2.0 Europe Conference in London.  I’m grateful to the Washington Trade Association who funded a trade delegation to the conference and helped facilitate other meetings in London as well.

Health 2.0 Europe Panel

Health 2.0 Europe Panel

The panel format was that the moderator, in this case Health 2.0 CEO Indu Subaiya, and invited guests framed the conversation, and then invited companies to demonstrate their products related to the topic. After the demo, the panelists asked questions and discussed the implications and relevance of the product to the topic. The “Provider” view was represented by Dr Simon Brownlee, a primary care physician and Chief Medical Officer of Healthloop UK. The “Patient” view was represented by Susan Jones, a person living with ME also known as “chronic fatigue syndrome.” I spoke with Susan a bit backstage and learned that she was frustrated by the lack of knowledge about her condition, she took it upon herself to look for specialists and treatments outside of the UK, the epitome of an engaged patient.

Other startups on the panel were:

Mark Friess from WelVU, focused on patient education and engagement.

Nishant Bagadia from Nuehealth, helping patients find and connect to surgeons.

Tim Williams from myClinicalOutcomes, helping patients track and get information about long term conditions.

Interestingly, while we all focused on the patient-provider relationship, each took a different approach and the technologies ended up being complementary rather than competitive.

We discussed how patients are often confused by treatment plans and how care outside the clinic was becoming increasingly necessary as patient volumes increased. A recent study by Deloitte showed that elderly patients will increase the demand for in-person consultations by 33%. Given the expected shortage of healthcare providers, this isn’t going to be possible so we need new ways to engage. We also discussed the need to align outcomes between patients and providers. Oftentimes the patient has a very different view of a successful outcome as the provider, as outlined in this Harvard Business Review Infographic.

The conference was inspiring as healthcare providers, industry professionals, and startups acknowledged that we need to start doing things differently if we want to see better health outcomes. While there were similarities between the solutions presented across all the panels, there was actually very little duplication, which points to the vast challenges in healthcare today. Solutions came from all over the US, UK, and Europe and were tackling both local and international markets. The best solutions were on par with what you see coming out of Silicon Valley, and in particular we liked UMotif for it’s extremely usable approach to patient tracking and engagement and the as yet unreleased  “You app” from Health Puzzle of Finland, that enables collaborative health challenges with friends.

My favorite session was the “Unmentionables” where startups tackled problems that often weren’t discussed like sexually transmitted diseases and alcohol abuse. My panel featured 3 US based startup and one UK, this session was a representation of European innovation, and organizers were pleased so showcase so many more local talents than in previous years. Presenters represented their countries well, and moderator Matthew Holt, pointed out that true to form and stereotypes, a Norwegian presented a light-based solution for depression, an Italian for sex information, and a Brit for drinking.

Posted in: Healthcare Disruption, Healthcare Technology, M-health

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FutureMed 2013

The FutureMed format included keynotes, several short presentations on one theme, breakout workshops, and evening collaborative activities. Days were long, starting at 8:30 with sessions sometimes until 8pm. The span of topics was vast from genomics, to devices, to patient engagement, to health IT. What was great about this was some topics pushed the imagination while some were actionable today. Similar to HealthTech, attendees were health industry folks, investors, and startups, although we definitely noticed more health industry than the other two groups. The collective experience and wisdom at the conference was intimidating and inspiring at the same time.

FutureMed Main Hall from the cheap seats

FutureMed Main Hall from the cheap seats

It’s hard to summarize this conference since the topics were so diverse and so much was covered over the three days. Some of the highlights for us were of course Eric Topol talking about the creative destruction of medicine, and demonstrating an iPhone ottoscope on conference chair Daniel Kraft, and the focus on building tools that are engaging and highly usable for providers and patients alike. Topol’s session was a tweet a minute, saying things like “DNA is the ultimate in preventative medicine” and “average is over” to decry the end of population health.
One-size fits all population health was seen as being replaced by personalized health. Treatments and instructions that are specific to a patient; drugs designed for your own genome. Big data is key for truly personalized medicine as well as the ability to find individuals that are similar to your patient. Natural language search for EMRs was seen as a way to unlock the data that’s in them. (For example, ask the EMR to find you a patient that’s like the one you are seeing right now to compare treatments and outcomes.)
One point of contention we heard at the conference was whether the doctor of the future needed to be a data scientist. According to Marty Kohn of IBM’s Watson project 1 Trillion connected devices generate 2.5 quintillion bytes/day and 90% of the world’s data was generated in the last two years but 80% of it is unstructured! Proponents of doctor as data scientists took these facts to their logical conclusion that everyone would need to understand big data yet opponents pointed to computers (like Watson for example) far superior ability to parse this data as an indication that the role for doctors was in providing empathy and care, not in number crunching. A few sessions talked about the need to screen medical school candidates not just on intellectual horsepower but on empathy.

This theme also came up in the Future of Health IT session led by Kaiser’s Mattison. We felt very fortunate to join this workshop of 30 people talking casually about the problems and opportunities in health IT. Kaiser has been doing “big data” since before they implemented electronic records keeping so when they say things like “you are 26% less likely to die in a Kaiser institution than another one” you believe they can prove this. Mattison’s solution for how to manage the increasing amounts of data is to move to an agnostic data model and then do intelligent queries rather than starting with a structured model. One reason for this is that 50% of the data that is being created now is images and machines are much better at evaluating images than machines are.
What was inspiring about FutureMed was that the solutions ranged from exponential changes in genomics and neurology to common sense solutions, like those presented by Dean Ornish who has proven through long term studies that the simplest interventions around diet and exercise can have a profound impact, or Esther Dyson’s HICCup project to apply these types of interventions to an entire community to improve their health. There were dreamers and pragmatists but everyone at the conference was united in one goal: improve our health and quality of life.

Who to follow:
@EricTopol
@daniel_kraft
@MSKohn
@kpshare
@futuremedtech
@DeanOrnishMD
@edyson

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HealthTech Conference

healthtechconference

Topics at this conference covered the gamut from unmet needs of providers through changes in insurance and payment, and how startups should partner in healthcare. Mobile health and aging in place was the one clinically focused topic of the day.

Consumerization of healthcare was a frequent discussion at this conference, with skeptics and proponents of how much change will come from consumers. One point of agreement, is that high deductibles on insurance plans turn patients into consumers who expect value for their money. Debate came from how much consumers could actually influence healthcare organizations as well as some questioning of how much consumer-generated data is valuable. One speaker made the bold statement that 99% of quantified self-data is irrelevant, and encouraged providers and startups to figure out how to find the meaning in that data. Another said that Telehealth held great promise in delivering distributed care but that Telehealth direct to consumer was a pipe dream (interesting as we’ve seen a few startups trying this). We believe it’s not so black and white. Patients are behaving like consumers in many aspects of healthcare: just look at online reviews of doctors. However, it was thought that it would not be an easy transition for the healthcare system to make the transition from volume to value. Panelist Amir Dan Rubin, president and CEO of Stanford Hospitals and Clinics, predicted that 50-80% of these transitions would fail but those that succeed would focus on coordination with the patient and work within the health system.

Mike multi-tasks at the HealthTech Conference.

Mike multi-tasks at the HealthTech Conference.

John Mattison, CMIO of Kaiser Permanente, and also one of our favorite speakers at FutureMed, was optimistic and felt that collaboration between patients and providers and understanding behavioral economics were some of the keys to this massive disruptive change that he saw as inevitable.

On the topic of how startups should look for partnerships, the venture capitalists and healthcare organizations were opposed. Perhaps this was related to conference chair Anne DeGheet’s comment that it was the easiest time to start a healthtech company and the hardest time to sell to healthcare organizations. ( Mattison also observed that the Federal government was creating disincentives to healthcare innovation through regulations). VCs gave the startups in attendance the advice to “do something audacious, reinvent healthcare” while the hospital representatives said “do something we can implement.” If you follow Clayton Christenson, you’ll know that those who don’t disrupt themselves are disrupted, and yet hospitals can hardly stop everything and create entirely new models. However rising costs, aging populations, and a looming shortage of healthcare professionals will definitely require new approaches. How do you think the change will come?

People to follow:

@stanfordhospital
@kpshare
@ADeGheest
@healthtechcap
@claychristensen

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3 Health Conferences in 4 Weeks on Two Continents

healthtechconferenceHealth 2.0 Conference Europe 2013

Whew, three health conferences in 4 weeks is a lot. I’m just back from FutureMed 2013 and starting to pack for Health 2.0 Europe. Before I forget, here are a few impressions on HealthTech which Wellpepper CTO Mike and I attended in Mountainview, CA and FutureMed 2013 which Wellpepper Director of Customer Experience Jacquie and I attended in San Diego, both were a sunny respite from rainy Seattle autumn but as with most conferences, we spent a lot of time inside.

Both conferences were a collection of health professionals, investors, and technology companies (both health IT and biotech). HealthTech was a 1-day conference that featured panels debating a number of topics, while FutureMed was 4 days of panels, keynotes, sessions, and demos. Both were thought provoking, although HealthTech seemed to have quite a few more conflicting opinions (especially between investors and industry folks) while speakers and attendees at FutureMed2013 seemed more uniformly convinced that healthcare was headed towards a major disruption.

Both conferences had great food—it seems you can’t serve unhealthy food at a healthcare event. HealthTech had a “happy hour” while FutureMed had evening activities that sometimes took place in the bar but were presented as brainstorming, fun, and collaboration.

One heartening theme we heard at both conferences was that it’s time to put the caring back in health care. We concur!

HealthTech Conference Recap

FutureMed 2013 Conference Recap

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You Too Can Be An Orthopedic Surgeon

This past weekend I performed arthroscopic surgery on a knee and extracted a sponge that was clogging up the joint. Sounds scary doesn’t it? It was great fun, part of the open house at UW Medicine’s new Sports Medicine Center at Husky Stadium in Seattle. The newly opened clinic has been operating for about a month, but this was an opportunity for the general public to see what it was all about.

The open house was framed around a “Passport to Health” and participants visited various stations staffed by doctors, physical therapists, and radiologists. At each stop, experts explained procedures and benefits, and answered questions from attendees. Volunteers from some of the UW sports teams acted as guinea pigs for some of the treatments.

Specialties in the clinic and stops along the tour included:

 

    • Anti-gravity treadmill

      Anti-gravity treadmill

      Dr. Ashwin Rao explaining platelet-rich plasma therapy

      Dr. Ashwin Rao explaining platelet-rich plasma therapy

      Running Medicine: Here we saw how the anti-gravity treadmill can help both running performance and rehabilitation.

    • Sports Performance and Rehabilitation: In the “gym” area of the center, physical therapists discussed how they help improve performance and restore function using exercise and equipment including a full Pilates set up.
    • Soft-tissue Injuries: The focus was on preventative measures and bringing people back to full performance.
    • MSK Ultrasound: Ultrasound technology has come a long way from fuzzy gray images. In this session we saw how ultrasound can be used to access and diagnose nerve damage using Doppler technology to show nerves and blood vessels.
Dr Elena Jelsing demonstrating MSK Ultrasound

Dr Elena Jelsing demonstrating MSK Ultrasound

  • Platelet Rich Plasma: This technique involves injecting a patient’s plasma back into a troubled area to help repair and regenerate cells. It’s particularly helpful for nagging tendon injuries, although physical therapy is recommended first if it’s an acute injury.
  • Minimally Invasive Surgery (Knee and Shoulder demonstrations): I don’t want to say this was the most fun, but it was, as participants were guided in performing arthroscopy surgery on a dummy knee or shoulder joint.
  • Sudden Cardiac Arrest: The focus of this stop was prevention. Young athletes are at the highest risk for sudden cardiac arrest and UW is leading the way by offering screenings to high school teams around Puget Sound.
Shoulder Surgery Dummy

Shoulder Surgery Dummy

Visitor performing shoulder surgery

Visitor performing shoulder surgery

In some cases, tour participants received minor consultations, like one woman who had an MSK ultrasound. In addition to providing education and showcasing the clinic’s staff and new technologies, the event generated new patients for the clinic. The tour conveniently ended at reception where many people were seen booking appointments.

The opening of a new clinic like UW Sports Medicine at Husky Stadium provides the perfect time to engage patients. However, maybe adding a new service or technology could provide you with the opportunity to invite the public in for a tour of your facilities. Or maybe it’s a patient appreciation thank-you event. Any opportunity to engage with patients is an opportunity to help educate them to take charge of their own health, and let them know that you’re there when they need help.

Posted in: Exercise Physiology, Rehabilitation Business, Sports Medicine

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Ensuring Secure Patient Information with Wellpepper

Every country has regulations on how to protect and secure personal health information. In the US it’s HIPAA or the Health Insurance Portability and Accountability Act. In Canada PIPEDA, or the Personal Information Protection and Electronic Documents Act. In the UK it’s the Data Protection Act. Each act is designed to help citizens keep personal information private and yet also account for the fact that information does need to be shared between individuals and organizations, and across organizations.

Technology vendors, like Wellpepper need to ensure that they are following certain guidelines around data access and encryption to protect this information. The types of things we need to do include encrypting information when it’s in transit or stored, making sure each person has a secure login ID, limiting access to who can see information. Basically, most of these regulations are just best practices for protecting any type of digital information, and we’d expect to see them in any well-designed software that needs to protect information.

1626.strip

 

Wellpepper does not store any information on the device. It is all stored securely on Amazon Web Services. Video, which includes patient identifiable information, is uploaded and encrypted when you record it. It’s transferred to our servers, and it’s streamed back to the client in an encrypted manner. (Also remember that the patient can do whatever they want with their health information. However, we still don’t store any of their information on their devices, and we send information encrypted to them.)

We can only fulfill part of the equation on protecting information. How you use Wellpepper and protect the hardware that it’s installed on is the other part.  In fact, if you look at some of the top health-related data breaches in the US in 2012, you can see that a number of them were human error. Examples include not cleaning the hard drive of a photocopier before selling it, having records stored on a laptop computer that was stolen from an employee’s car, and disabling a firewall that protected records. All of these situations were preventable with good data management practices.

We’ll take care of securing the information, you take care of the devices and your passwords. So, with that a few things to remember when using Wellpepper.

  • If you are recording video in an open space, make sure you don’t accidentally have other patients in the background. Otherwise, you may inadvertently include recognizable information about one patient in another patient’s record.
  • Put a password on the iPad. We know that you will want to stay logged into Wellpepper during clinic hours. Use the password protect feature on the device to lock it when it’s not immediately being used.
  • Use remote management features. Apple provides the capability to wipe all devices if they are lost or stolen. Note that since we do not store information on the device, if it’s stolen you don’t need to worry unless you were logged into Wellpepper. Then, you can use remote management features to delete Wellpepper so no one can log in.
  • Secure the iPad when it’s not in use. Make sure you have a secure place for it, either in a locking docking station or locked location when it’s not at use or when the clinic is closed.

You do your part, and we’ll do ours to secure patient information.

 

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Taking Preventative Medicine to the Store

Storefront health clinics, patient engagement, and community outreach are all touted as great new innovations in healthcare. Well, today we found a great example that includes all three and was established over 3 decades ago yet continues to engage patients today. And it takes place somewhere you might not expect: a shoe store.

Over 30 years ago Dr. William Warnekros, a podiatrist from Seattle, approached running store Super Jock N Jill founder Laurel James with the idea that he have “office hours” in the store every Thursday night where he would answer questions and do screenings. Dr. Warnekros believed that by doing this he could provide a community service, practice preventative medicine, and also create referrals to his clinic. At the time, running had not gained the popularity it has now, so there was limited information for runners on how to prevent injury.

Events at Super Jock N Jill

Events at Super Jock N Jill

The relationship between the podatrist and the store proved to be symbiotic, where staff became more educated in biomechanics from Dr. Warnekros and he learned about the different types of running shoes on the market. Together, they were practicing preventative medicine by making sure runners received the best advice and the right shoe for their style. Dr. Warnekros recalls that at the time the most common injuries he saw through the store  were plantar facitis, achilles issues, tendonitis, ingrown toenails, stress fractures.

In addition to these  “Medical Nights” at the store, Dr. Warnekros also visited community centers every Saturday to lecture on preventing running and athletic injuries. When I asked Dr. Warnekros why he did all this, he said that “outreach and community service helped me generate the type of patients I wanted to see, rather than relying only on referrals.” Sometimes we forget how simple community engagement can be, and while social media enables us to reach the world, often the best way to reach the community is face-to-face.

The Injury Wall at Super Jock N Jill

The Injury Wall at Super Jock N Jill

Since its inception, the Medical Nights program has proven so popular it’s been expanded to two nights per week, and features podiatrists, sports medicine doctors, physical therapists, and massage practionners from over 25 local clinics on a rotating schedule.

Rim Veitas from University of Washington Medicine at Super Jock N Jill

Rim Veitas from University of Washington Medicine at Super Jock N Jill

On the night I attended, Rim Veitas, a physical therapist from the University of Washington’s Roosevelt Exercise Training Center Clinic was the attending healthcare professional. He had a treatment table set up, conveniently near Super Jock n Jill’s selection of injury aids.

I was surprised to see that Rim spent between 15 and 20 minutes with each client. When I asked him about it, he said that he did it because he loved treating people. (Sadly, he said he especially loved treating people when he didn’t have to fill out all the insurance or Medicare paperwork after.) Rim wasn’t sure that the University of Washington received a lot of new clients from participating in the Medical Night program, so for him it really was a labor of love and community outreach. I suspect that other clinics that might not be as well-known as the University of Washington see a lot of referrals from this program, and that for them it’s both goodwill and good business, just like Dr. Warnekros’ original intention.

In addition to interviewing Dr. Warnekros, Rim, and the Super Jock N Jill staff about the Medical Nights program, I decided to participate. I have tight hamstrings. I come by them naturally as a short person, and running tightens them further. I thought that might be the reason that after longer runs I had a clicking in my achilles. Rim did a few assessments, and pointed out that I had unusually tight ankle joints. He gave me some exercises and said if I did them, I could become a faster runner. (I assume they will also improve my Downward Dog.) I’ll try it!

If you’re in Seattle and want to know more about your running style or if you’ve been struggling with an injury, definitely stop by Super Jock N Jill Medical Nights. You might get some tips or establish a long-term relationship with a new healthcare provider. If you’re not in Seattle, take a look for events in your area or maybe start one yourself!

Posted in: Exercise Physiology, Rehabilitation Business

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The Outcomes That Matter to Patients

As an industry, healthcare spends a lot of time measuring and reporting outcomes. Taking a consumer based approach would also consider the outcomes that matter to patients. This table from Harvard Business Review’s “The Strategy to Fix Healthcare” offers a patient-centered approach with the example of the patient’s view of a successful hip replacement.
The Outcomes That Matter To Patients

Posted in: Healthcare Disruption, Healthcare motivation, Rehabilitation Business

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The 1/2 Marathon Fun Run

Registration

Race registration

This past weekend we participated in the ANCPT 1/2 Marathon “Fun Run” and BBQ in Seattle. This is an annual race put on by Sarah Anderson and Noal Cattone for their physical therapy clients. Sarah and Noal were our earliest early adopters at Wellpepper and we were happy when they invited us to the event. (We did try to explain that “fun run” usually means 5K but Noal and Sarah are also ultra-marathoners so I guess 13.1 miles is fun compared to 50 miles.)

The Urban Trail 1/2 Marathon Fun Run Route

The Urban Trail 1/2 Marathon Fun Run Route

The event was billed as an “urban trail run” and the course wound its way from park to forest to ravine throughout Seattle. It was well marked and had volunteer aid stations. We did get lost a couple of times but that was part of the fun. With the exception of the Wellpepper representation, all the participants were former or current clients of Noal and Sarah. One runner asked us what our injuries were. Luckily we don’t really have any yet.

After the run there was a rooftop barbecue with fun prizes, like for the oldest participant and the best cadence. The race awards were handed out onsite and the winning time was something like 1 hour 35 minutes by a very tall and lean guy. At the barbecue, many of the participants knew each other from previous races or events that Noal and Sarah have put on, and everyone was extremely friendly. (We even received an offer of startup advice from a veteran entrepreneur who is one of their clients.) We were also really happy to talk with end-users who loved how Wellpepper helped them remember to do their exercises. How many physical therapy clinics can say they’ve built this type of community around their practices?

Rocking some swag at the BBQ

Rocking some swag at the BBQ

We write a lot on this blog about physical therapy marketing. Sarah and Noal are naturals. Yes, they fully admit their website could use some love. However, they are experts in client engagement. Their business is 100% based on referrals from clients and they are always booked for months. Their clients will run 13.1 miles for them, and want to hang out with them on a sunny Saturday afternoon. They had been looking for a solution like Wellpepper to engage their clients between visits long before we met them (from a referral from another client who loves them). They have provided us with amazing feedback to help us build out the product.

Oh, and it turns out that a 1/2 marathon can be fun. We had an amazing time on route and after, and weren’t even sore after. That’s how good Sarah and Noal are.

Sarah Anderson and Noal Cattone

Noal Cattone and Sarah Anderson

 

Posted in: Rehabilitation Business

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Data-Driven Exercise for the Disabled

Machines can be used by able-bodied and disabled athletes

Machines can be used by able-bodied and disabled athletes

A few weeks ago, I had the opportunity to visit the PARC facility at the ICORD Spinal Cord Research Centre in Vancouver, BC with our guest blogger Lynda Bennett. Lynda is participating in an exercise study for people with spinal cord injuries and she wanted to show me around. The study is in pilot stage right now and has less than 50 participants all of whom have spinal cord injuries. Lynda doesn’t actually have an injury, she was born with Spina Bifida. However, she has recently started using an electric chair and is concerned about keeping up her core and upper body strength, especially for transfers from the chair. The pilot study is looking for positive outcomes associated with regular and increasing levels of exercise in people with spinal cord injury.

All machines track workouts using a SmartCard system

All machines track workouts using a SmartCard system

The equipment at the facility looks like that at any gym, however there are two key differences. Each machine is adapted so that a person can access it from a wheelchair. Actually the machines are designed both for able-bodied and disabled users and ICORD employees are allowed to use the gym if the study isn’t actively using it. If a machine has a seat, which an able-bodied person might use, it swings away to enable someone to wheel up to it. The other difference is that each machine is fitted with a smart card reader. Study participants enter their cards to start the weight program. The machines use air-pressure to provide resistance, and the resistance is increased automatically based on previous day’s activities. All the data is collected and can be reviewed by researchers. You can think of it as ‘quantified-self’ but with extremely expensive quantification.

Super Mario on Weight Machine

Playing Super Mario provides motivation

While Lynda enjoyed her workouts and meeting with others at the facility, she would have liked to have seen active rather than passive goal setting. She wanted the goals to be translated into something that she needed to do in everyday life.  “to be able to transfer from your chair to a truck, you’ll need X amount of core body strength.” As the study is designed, she is increasing the amount of weight but doesn’t know what outcomes this will provide in her daily life.

“I’d like to see how I am progressing towards a goal rather than try to correlate the increased weights to some improvement myself.”

Since this is just a pilot, and they are trying to keep the research relatively open to start, this might be able to be designed into future research.

Unfortunately, the pilot study isn’t guaranteed to go to a large scale study. The initial funding was used to set up the facility, and additional funding will be required to expand beyond the pilot. However, pilot organizers are hoping once they get enough data and can start to form hypotheses, they will attract the interest of the many researchers in the labs upstairs at ICORD, who are working with cells and microscopes but not as often with real human subjects like the people who volunteered for this study. Facilities like PARC and the data they collect can go a long way to bridge the gap between research and human outcomes.

Posted in: Exercise Physiology, Healthcare motivation, Healthcare Technology

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