Author Archive

Prescribing Exercise

Maybe it’s because at Wellpepper we’re quite active–a recent weekend saw us running, skiing and snowboarding, and rock climbing–but it’s a bit surprising to us that the merits of exercise as a prescription for health are still being proven.

Cross country skiing is a great workout!

Cross country skiing is a great workout!

For example, it’s not regular practice for doctors to tell people to get active. However, many doctors are not active themselves and if they don’t have the experience, then it’s hard for them to recommend the benefits. The US Center for Disease Control recently collated results from a number of studies that showed that doctors who exercise themselves are more likely to prescribe exercise.

The findings showed that active physicians were two to five times more likely to recommend fitness regimens than those doctors who led physically inactive lives. Link to full story.

The NHS in Scotland is piloting an intervention where doctors recommend and prescribe physical activity. Again, a very helpful intervention, but why is it a pilot and not a practice?

Increasing physical activity is a simple, cheap and highly effective way of both staying healthy if you are well, and reducing the health risks of many chronic conditions like diabetes and heart disease. It works at any age. RCGP Scotland is happy to support this initiative, which will give GPs vital information on how to help patients increase activity and improve their health. John Gillies, Chair of Royal College of General Practitioners Scotland. Link to full story

The problem seems to start earlier. The British Journal of Sports Medicine reports that doctors are not taught about the benefits of exercise.

This gap in knowledge means that future doctors will have insufficient knowledge to effectively promote physical activity to their patients, which results in a failure to help combating serious diseases that are linked to insufficient exercise according to the study authors. Link to full story

First Lady Michelle Obama’s “Let’s Move” initiative pinpoints that the problem actually starts a lot earlier.

Thirty years ago, most people led lives that kept them at a healthy weight. Kids walked to and from school every day, ran around at recess, participated in gym class, and played for hours after school before dinner. Meals were home-cooked with reasonable portion sizes and there was always a vegetable on the plate. Eating fast food was rare and snacking between meals was an occasional treat.

This is in contrast to the current situation where diets regularly include junk and where kids are driven to and from school and scheduled appointments. The Let’s Move campaign is looking to change this situation through education on healthy habits: eating well and exercising. Great campaign, just sad that we got to this state.

At Wellpepper we were fortunate to have had active parents, role models, and the encouragement “to get outside when the sun was shining” from a young age.  Added to that the wisdom of Hal and Joanne at Participaction to help instill good habits in our formative years. 😉

We’re building a healthcare technology business starting from exercise program prescription and adherence. It’s been surprising to us that the benefits still need to be proven, but we’re looking forward to helping in that area through the data we collect and resarchers we’re working with.

As Hal and Joanne say, until next time “Keep fit and have fun.”

Posted in: Exercise Physiology, Managing Chronic Disease

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Marketing Physical Therapy

At Wellpepper, we’ve been surprised about the amount of effort physical therapists need to do to promote their services and profession. We’ve had great personal experiences with physical therapy ranging from sports injury recovery, chronic illness recovery and management, and pediatric developmental support. To us, it was a bit of a no-brainer that physical therapy works. The more time we spend with the community though, we realize there’s a lot more work to do. On that note, we’d like to highlight some great marketing of the profession that we’ve seen.

One of the most impressive is the award-winning campaign “Moving for Life” from the British Columbia Association of Physical Therapists. Here’s the television spot that was launched in 2011.

The campaign works for two reasons, it connects the general public to the profession and to what physical therapists can do for them, and it introduces physical therapists as professionals and people. The Facebook portion of the campaign shows physical therapists out enjoying all the wondrous nature that British Columbia has to offer, while providing tips for staying safe and fit during physical activity.

Why I Became a Physio

Why I Became a Physio from Physical Therapy Association of BC

We know that physical therapist are happy in their profession, but this campaign takes it one step further by introducing reasons why people are inspired to be physical therapists.

One caveat, of course, is that people in BC have direct access to physical therapists, so the customer for therapy is the consumer, not a doctor who is providing referrals. The campaign would probably look very different if it were aimed at convincing doctors to send therapy referrals. Also, with the abundance of nature and the resource-based economy, BC has a very active population who tend to be more familiar with the benefits of physical therapy and want to get back to work and play faster.

What great examples have you seen? What do you wish your local association was doing for you?

Posted in: Healthcare Social Media, Rehabilitation Business, Uncategorized

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Tips for Managing Arthritis in the Hands

Muscular-skeleto diseases cost the Canadian Healthcare system $33B/year

Hands and Arthritis Workshop by the Arthritis Society

Hands and Arthritis Workshop from the Arthritis Society

Last night we attended a workshop in Vancouver, BC put on by the Arthritis Society about coping with hand arthritis, one of the most commonly affected areas . Although, Jacquie and I both suffer from arthritis we were surprised to learn how little we actually knew about the disease. The Arthritis Society did a great job of filling in the gaps and answering questions that aren’t possible in a brief doctor’s visit.

Some things we learned:

  • There are over 120 forms of arthritis
  • It affects 1/10 people in Canada, and 1/7 people British Columbia.
  • Most sufferers are in the workforce (combating the perception that it only affects the elderly).
  • By the time arthritis can be seen on an X-ray, it’s too late for preventative measures.

We also learned the differences between how osteoarthritis and rheumatoid arthritis cause joint breakdown. Rheumatoid arthritis, the most common form, is the inflammation of the joints and surrounding tissues. When the swelling declines, there is the painful bone-on-bone contact. In osteoarthritis, the fluid between the joints begins to decline, resulting in bone on bone contact and eventual fusing of the bones. Not much fun to look forward to.

Exercises for Arthritic Hands

Exercises for Arthritic Hands

However, there is help! Similar to refrains we’ve heard throughout our journey through the current state of healthcare, prevention is key. The presenter, Joanne Smith, Certified Hand and Occupational Therapist, stressed the need for hand exercises to stave off the progression of the disease. Participants were provided with a handout of hand exercises, which Joanne recommended doing 5 times per day. She stressed that keeping hands mobile is key, a warm up period is always necessary, and no exercises should be done to the point of pain. Even though we know that being proactive is the best way to manage a chronic disease, most people in the audience were already in advanced stages of arthritis. It would be great to see more outreach and awareness for people who might be at risk for future development.

Products for Arthritis Sufferers

Products for Arthritis Sufferers

Some key tips we learned for keeping your arthritis from progressing while getting on with the business of daily life:

  • Avoid repetitive motions
  • Avoid pinching
  • If you are gripping with your finger and thumb, use a “C” shape, which distributes pressure more evenly, rather than a “D” shape
  • Use bigger tools and grips
  • Pace yourself
  • If you can’t do something, trade work with someone who can, for example yard work for baking
Assisted Can Opener: why not make cans easier to open for everyone?

Assisted Can Opener: Why not make cans easier to open for everyone?

The session also highlighted a myriad of products and aids designed to help you open cans, jars, and pill bottles, and reach difficult places. It did make us wonder though, why are so many products to hard to open? We love what OXO Good Grips have done for better design of household items. Shouldn’t everyone have products that are easy and delightful to use?

Posted in: Managing Chronic Disease

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If you can’t measure it, you can’t manage it

If you can’t measure it, you can’t manage it.

For years we’ve heard this familiar business adage, attributed to either Peter Drucker or  W. Edward Deming. Reading today that 9 out of 10 Americans believe that they are in good health, made us think that perhaps not everyone is measuring and managing your health. Then we wondered whether measuring your health, in the kinds of  ‘quantified-self’ ways that guest-blogger Jacquie recently talked about, enables you to better manage your health?

9 out of 10 Americans say they are healthy

9 out of 10 Americans say they are healthy

First off, let’s start with the study. Americans were asked whether they thought they were healthy: 90% said yes. And yet, we know that people are moving less, eating more fat and sugar, and chronic diseases like diabetes are at an all time high. Perhaps the next question in the study should have been “how do you know you are healthy?” Let’s go back to the business analogy. Let’s say a CEO asked her CFO, are we profitable? If the CFO said yes, wouldn’t he be asked to provide some proof of that? In the same way, how can an individual actually know if they are healthy? What is their proof? And what are they measuring against?

To answer those questions, it does seem that you need to track something. As we’ve seen recently there are a myriad of new consumer devices measuring all kinds of things. One I’ve been using is Moves. If you’d asked me before I started using it whether I walked more than the average person, I would have said “yes, absolutely.” Now that Moves is tracking my every step (although it does get a bit confused when I’m snowboarding), I would have to say no, not really. So much for my subjective view of my habits.

Not enough steps

Not enough steps

Next, you have to compare your measurements to some sort of standard. FitBit and other activity trackers have popularized the idea that a healthy individual takes 10,000 steps. Taking that as a benchmark, I could feel good about all the days I took more than 10,000 steps. However, at the American Physical Therapy Conference in San Diego in January, we learned that 10,000 steps would put a person in the ‘active’ but not ‘highly active’ category. So, now you have a whole lot of people patting themselves on the back, but maybe they are not as active as they think.

We recently discovered a new startup called WellnessFX that would appeal to the quantified self people, and also make sure they are measuring the right things. WellnessFX enables you to have your blood tested for a number of different criteria, see your results online, discuss the results with a healthcare professional, and then determine whether you need to make any adjustments to your health. Kind of brings it all together doesn’t it?

At Wellpepper, we’re not going to draw your blood, but we are going to try to connect you, your healthcare professional, and your positive health outcomes by tracking and measuring. We’ll remind you to do your exercise and ask you what you did. We’ll also let your physical therapist know if you reviewed your exercises. Yes, some of it is based on self-reporting like the study, but you wouldn’t lie to us or your healthcare professional would you?

Posted in: Healthcare motivation, Healthcare Technology, Uncategorized

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A Short Burst of Inconsequential Information?

…we came across the word ‘twitter’, and it was just perfect. The definition was ‘a short burst of inconsequential information,’ and ‘chirps from birds’. And that’s exactly what the product was.
– Jack Dorsey[18]

Twitter may have been conceived as being inconsequential, but hard to say that now. Major news now breaks on Twitter, often significantly before other news outlets. For brands, Twitter is a great way to connect with customers, often to deal with customer service issues. Modern businesses should ignore Twitter at their own peril.

Healthcare Tweetchat Statistics, source Symplur

Healthcare Tweetchat Statistics, source Symplur

At Wellpepper, we’ve found great value in Twitter, especially in the many weekly chats about healthcare. We’ve been able to ask questions of potential customers that help define our product direction. We’ve learned more about the priorities of our customers and how we might be able to support them. We’ve learned best practices from others in the m-health space, and been able to stay on top of new developments. We’ve been able to validate assumptions about our direction. All this from participating  in real-time chat.

For healthcare practitioners, tweet chats are an opportunity to talk to like-minded peers, learn about new techniques or research, or sometimes vent. Many chats have regulars and a community forms around the topic.

For those wondering how it works: a topic is posted in advance, and a moderator asks a series of questions about that topic. Usually not more than 5 questions for an hour-long chat. People then answer the questions using the chat hashtag, and sometimes the question number. At this point, the comments, questions, and follow-on threads often start flying fast and furious. You can use a browser sorted on the hashtag to follow the chat, however, using a Twitter client,  can sometimes make it easier to follow the conversation.

Runkeeper Tweet Chat #rkchat

Runkeeper Tweet Chat #rkchat

Chats to check out:

  • Runkeeper holds a weekly customer feedback chat. It provides interesting insight into people who are using self-tracking tools. Hashtag: #RKChat. It’s also a great example of a company engaging with their fan/customer base. 
  • #SolvePT discusses issues related to the business of physical therapy and improving the profession overall. The next chat is a topic dear to our hearts: technology and physical therapy.
  • Harvard Business Review runs chats on specific topics of interest to leadership and business development. These are particularly well moderated chats that are easy to follow. If you’re thinking of starting your own Tweetchat, we recommend attending a few for best practices. Hashtag: #HBRchat
  • #HCSM is a slightly self-referential chat: social media discussion about social media. It’s a good one to talk about the adoption and issues of social media in healthcare, a topic we’ve blogged about a few times.

Our biggest issue with Healthcare Tweetchats is that there are too many of them. A person could easily spend all of his or her time chatting and never get anything done. Add to that the fact that chats originate in every timezone and you could be chatting 24 hours a day. The sheer number of discussions going on every day can also contribute to a feeling of FOMO (fear of missing out) that Twitter seems to thrive on.

Symplur has a complete list of all healthcare tweet chats listed by time and with an overview of the topic. Enjoy and chat with you soon!

Posted in: Healthcare Social Media

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Carrots and Sticks

We’ve been thinking a lot about carrots and sticks lately. Wellpepper is an application designed to motivate you to do your exercises. It does so by making it easier to see what you’re supposed to do, reminding you it’s time, and providing words of encouragement. It also sends your results to your physical therapist. When we surveyed some of our early adopters, we found out that the reminders and the knowledge that your therapist was watching were two of the biggest motivators. You might consider these both to be sticks: nagging and watching over you.

Carrot and stick calling names

Carrots and Sticks from

Some studies have shown that people are more motivated by fear of loss than by positive reinforcement. The website has over $12M dollars at stake based on this very principle. Stickk users set a goal, and if they don’t keep in line with that goal, their money is donated to an organization they don’t believe in. NPR recently profiled a user who is donating money to the NRA if he does not meet his weight loss goals. Contrast this with three nurses in the same story who stand to win $10,000 if they meet their target. Would their motivation be stronger if they were given the $10,000 up front and had it taken away if they didn’t lose weight? You can read or listen to the full story on NPR’s website.

Employee health and wellness plans are using both carrot and stick motivation. Carrots are in the form of points and rewards for achieving certain fitness milestones. Sticks are in the form of increased premiums for engaging in dangerous behavior.

According to behavioral economist Dan Ariely, emotions are a powerful motivator, especially negative emotions. One of his readers found that she was unable to change her behavior until negative emotions overwhelmed her. For years she had been trying to bring her lunch to work. She knew that bringing her lunch was more nutritious and would save money. It wasn’t until she moved to a job that had no lunch options but the cafeteria which she found disgusting that she was able to make a positive behavior change and start brown bagging.

At Wellpepper we think both carrots, sticks, and other forms of motivation are important, and it’s circumstantial. For example, someone who is in rehab due to a car accident might not want to be reminded of what they will lose if they don’t do their exercises. Someone who is in rehab for a sports injury that happened because they didn’t warm up properly might be more motivated by being reminded that if they don’t go their exercises they might not play pick-up basketball again. Motivational psychologist Dr. Heidi Grant Halvorson does a great job of outlining how different people are motivated in this article on stress management.

How are you motivated? Does it change depending on what goal you are trying to achieve?


Posted in: Healthcare motivation

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Social Media Tips for Healthcare Professionals

In 2009, Google launched its Flu Tracker application to map the spread of infectious disease by monitoring search keywords by geography. More recently, researchers at Johns Hopkins claimed that they could track the spread of the flu using Twitter significantly faster than the CDC could predict. Its like the town crier amplified by a million. Individually, there have been examples of doctors learning more about their patients on social media that has lead to either diagnosis, or follow-up visits. In previous posts we explored how social media can play a role in recovery for patients. Now, we’ll take a look at social media for healthcare professionals.

Ways in which healthcare practitioners can benefit from social media:


icanhazpdf hashtag for finding research documents

  • Research. There is a ton of information being shared through social media, including studies that might be otherwise hard to find. Did you know there’s a Twitter hashtag where you can ask for a publication? If someone in your network has a copy that is allowed to be shared, you can usually find it. #icanhazpdf
  • Connect with your peers. There are people from all over the world participating in conversations about treatments and best practices.
  • Connect with your clients and potential clients. Social media is an easy, and inexpensive marketing and patient engagement tool.

A few simple Do’s and Don’ts for healthcare practitioners for engaging on social media:


  • Do: Use social media to build your reputation and practice. Can patients and potential patients find you on Twitter, Facebook, LinkedIn? Can patients who love you easily recommend your services? The Mayo clinic offers a course in social media for healthcare practitioners. They also monitor which social media sites are used by healthcare organizations
  • Do: Use social media to research, connect with your peers, and spread best practices. Did you know that there’s a weekly Twitter chat where physical therapists discuss business issues related to their profession? Tune in to #solvePT at 9PM EST to see what it’s about.
  • Do: Take advantage of the immediacy of social media. Jointworks Chiropractics, for example, uses Twitter to fill last-minute cancellations.
  • Do: Start slowly. Managing social media can take a lot of time. Make sure you know how you want to participate. Start by watching what similar practices or people are doing.
  • Do: Keep learning. The methods of communication are changing constantly and are going to keep evolving.


  • Don’t: Ever share patient identifiable information on social media. If you learn something helpful about a patient on social media, follow up privately. An individual can share whatever they like about their health, but you cannot, so even if they post something on your Facebook page, you still need to answer privately. Even email may not be private enough for HIPAA standards. All communication needs to be encrypted. 
  • Don’t: Share information about yourself on public networks that you wouldn’t want patients or colleagues to know
  • Don’t: Criticize patients on social media. Yes, they can rate you and criticize you, but it doesn’t go both ways.
  • Don’t: Be afraid to show some of your personality. It will help patients connect with you and you might have more effective visits.
  • Don’t:  Underestimate the impact that social media has and will have on health.

If you’re interested in this topic, here are a few additional articles you might want to take a look at.

Should Doctors and Patients Be Friends? from the Wall Street Journal

A survey of physicians last May by Epocrates inc., which develops medical reference apps for physicians, found that 82% were using social networks to engage with other physicians, while just 8% were doing so with patients.

Teenagers, Social Media, and Health Information Privacy from

Teens “do not seem to associate their personal identity with their diagnosis. They identify who they are by their friends, school, interests, etc. It is in this context that some of them mentioned that they don’t talk about their diagnosis or treatment on Facebook because they don’t want to be perceived as ‘attention-seekers,

How Facebook is Transforming Science and Public Health from Wired

The logic is a simple one: Everyone on Facebook, all 1 billion-plus people, will have an illness at some point in their lives. And, as Facebook’s social creatures are in the habit of doing, that mass of people will share their experience battling disease, ask questions of their friends, and field advice from outsiders


Posted in: Healthcare Social Media

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Can social media be good for your health?

Is posting or tweeting about your health a good idea? We think so, if you do it right.

Social support has been shown to be a key factor in encouraging exercise and healthy behavior. With geographically dispersed families and friends and extremely busy lifestyles, sometimes social networks like Facebook or Twitter provide that social engagement that would have previously been in person. As a result, people are sharing more and more about their health on social networks, as shown by a recent PricewaterhouseCoopers study that asked which health-related activities people had done on social media.

Have you done any of these heath related activities on social media?

Have you done any of these heath related activities on social media?

The study also found that younger people were more likely to share health information through social sites. 80% of 18-24 year olds compared to 45% of 45-64 year olds.

When we were first planning Wellpepper, we thought that sharing physical therapy progress on Facebook and Twitter could have positive benefits for patients like receiving encouragement from friends and keeping people up to date. We wondered whether anyone would actually do it though, until we saw a friend who is a concert photographer with 1,300 friends posting on Facebook about his recovery from a dislocated shoulder. He wanted to let people know what happened, how he was doing, and why they might not see him around for a bit. In return, he received well wishes and support from many people.

In our user testing, we’ve found that being able to share on Facebook and Twitter is a motivating factor. For some, it helps keep them honest about doing their exercises. Also, it enables them to provide kudos to their therapist for the treatment and recommend that therapist or clinic to others. We’ve noticed that some therapists become popular within social groups like amateur teams, and Facebook is another way to share a good recommendation.

Considerations for sharing

Sharing a status update on Facebook is more like whispering to a group of your friends in the back of the auditorium. You’re talking specifically to people who know you, who (hopefully) like you. A few of them will hear what you say, some will respond, some will offer their own stories in relation to what you have shared. You like them too and you probably care what they think about you.

Great advice assuming you’ve set your Facebook privacy options right. Facebook privacy isn’t the easiest thing to set, and it’s changing all the time but you can limit your posts to groups and to your friends only. This means your posts aren’t in the public domain. However, also remember that Facebook does tend to change their privacy options frequently.

Facebook Privacy

Facebook Privacy set to “Friends Only”

So before you go off and share all kinds of information consider this:

  • Who do I want to see it?
  • What do I want to share?
  • Is there some reason not to share this information?

IMG_0248 We think that sharing can signify to your friends that you want their help and support in your recovery and it’s generally a good thing. (Most examples of sharing gone wrong are due to someone trying to do something they shouldn’t, like vacationing in Mexico while on disability leave. We don’t condone this at all at Wellpepper but we are also not going to publish the location you’re doing your exercises.)

The important thing is that you’re in control of whether, where, and what you post. Even if you’re not using Wellpepper, consider posting something about your health to your friends, you might be surprised at the result.

We believe this trend is going to continue, hopefully, with wise decisions about what is shared and not shared. In a future blog post, we’ll tackle the larger issue of healthcare and social media: patient/provider communication.

Posted in: Healthcare Social Media

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Functional Screening as a lead generation tool

UBC BodyWorks Centre

UBC BodyWorks Centre

This past week the Bodyworks Fitness Center at the University of British Columbia School of Kinesology had an open house. They offered free functional movement screenings (FMS) and Titlest Performance Institute (TPI) screenings for golfers.

A few of us signed up for the 20 minute screens and walked away with a scoring sheet of results. The TPI was probably more useful as it specicially targeted golf and was pretty clear where the individual would need to improve to positively affect golf swing. The FMS was interesting in that it highlighted core stability issues that a person might not be aware of, however, the session could have been improved if the screener had engaged us in a few questions about our sports and exercise goals. Otherwise, it was hard to make the leap from the screening results to potential areas for improvement. It was nice to find out that an old shoulder issue has healed and is back to a full range of motion.

Titlest Functional Movement Screen

Titlest Functional Movement Screen

The real value to the center in providing these free screenings in getting the person to sign up for a program based on improving their weak areas. The open house also featured free access to the fitness center, talks on wellness, and tours. All of these activities were designed to raise awareness and hopefully gain new clients, especially before they become injured.

Our curiosity and love of the word “free” got us in the door, which is definitely a good first step. Did we join? No, and that’s because the location isn’t convenient, which is something for single clinic practitioners to consider. Unless you’re the local expert in a particular type of treatment or injury, your market is largely your local community.

Titlest Functional Movement Screen

Titlest Functional Movement Screen

We weren’t really the target market:  the Kinesiology student who showed us around mentioned that the target was mostly professors, students, and seniors who lived in the area. Apparently people won’t walk more than a block to a coffee shop, which is why in Seattle and Vancouver there’s one on every corner. We wonder if anyone’s figured out how far they would walk or drive to a clinic or a fitness center.




Posted in: Rehabilitation Business

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A Disruptive Solution for Healthcare

In order to deliver healthcare for all, we need to reevaluate the ‘gold standard’ of healthcare delivery and look to new models of care.

This was the message of a talk a few of us from Wellpepper attended last week given by Dr Jason Hwang. Dr Hwang is an MD and also an MBA who collaborated with Harvard professor Clayton Christensen on the book “The Innovator’s Prescription: A Disruptive Solution for Health Care.

IBM 704 Mainframe Circa 1964. Source Wikipedia.

Dr. Hwang used the familiar story of disruption in technology from the mainframe to the PC and now smart phone to draw analogies between the current state of healthcare, and where it needs to go. He calls hospitals the “mainframes” of the healthcare system. Highly powerful, capable of delivering great output, but not necessarily convenient or accessible, just like mainframes used to be. Consumer clinics, for example a nurse practitioner working out of a storefront in Walmart can be seen to be more similar to the convenience of a smart phone.  However, the industry hasn’t changed processes and regulations to accommodate these new models causing unnecessary overhead and barriers. Does a storefront clinic with no doctors need the same levels of documentation and EMR as a hospital?

Disruption makes what was once inaccessible more accessible, and eventually delivers it into the hands of consumers. The ridiculously powerful computer that 50% of us have in our pocket or purse is the perfect example of that. This computer is also democratizing healthcare. There are approximately 17,000 medical applications that enable consumers to track and sometimes even diagnose health issues that previously required visits to specialists.

Any doctor that can be replaced by a computer deserves to be. The idea is not to replace doctors but to free them up to do the work they were trained to do.

The same could be said of specialist and generalist roles in healthcare. Nurse practitioners can take on a lot of responsibilities that were previously tasks of doctors. Medical aides can take responsibilities from nurses. Advances in technology are helping to make expensive diagnostic tools cheaper and more ubiquitous.

What does all this mean for physical therapists? Dr. Hwang stressed that it’s very difficult for those within the system to disrupt it. For example, once a hospital exists there become all types of reasons for it to continue to exist: shareholders, board of directors, senior management, employees. It’s very hard for a company to cannibalize itself. He believes that those in the wellness, prevention, health and fitness industries have a greater opportunity to cause this disruption. Physical therapists have the unique position of being within the industry but not at the center of “how things have been done.” As they move into looking at the whole health of the patient, and more important in preventing injuries, they can be part of this change in medicine.

An interesting example of this is physical therapy combined with other health and wellness; for example, a clinic that has an MD, naturopath, nutritionist, and physical therapy practice, or a “medical gym” which combines a physical therapy practice with a traditional fitness center. This would be the perfect place to practice preventative medicine.

We’ve seen a lot of chat on Twitter about how physical therapy can be part of the positive disruption that’s happening in healthcare. At Wellpepper hoping we can help you move forward new models for patient engagement and involvement.

Posted in: Healthcare Disruption

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Best practices for Telemedicine

Telemedicine has great potential to deliver just-in-time physical therapy. While it’s not appropriate for all situations, where it is, it can be a cost effective way to stay connected to patients and deliver service.

Our previous recap from the American Physical Therapy Conference session featured Just-In-Time Management principles including telemedicine. There was so much good advice in the session we’d expand on some of the best practices for telemedicine outlined by Carol Jo Tichenor, Director Physical Therapy, at Kaiser Permanente.

Where to Implement Telemedicine

First consider where telemedicine can augment, improve, or streamline your practice. For Kaiser Permanente, telemedicine was very effective treating students who were part of Kaiser’s system in California but attending out-of-state colleges. A British study found that using telephone calls as an intial screening for back pain resulted in shorter wait times for patients, and fewer missed appointments.

As you consider where you might include telemedicine, ask yourself whether you have patients who:

  • Are remote or need to travel long distances for treatment.
  • Are ‘road warriors’ and travel frequently for their profession.
  • Have work schedules that make it difficult to schedule appointments.
  • Have physical difficulty getting to the clinic but are not candidates for home care.
  • Might need a short-check in rather than a full-scheduled visit.

How to Implement Telemedicine

Successfully implementing telemedicine, or any technology into your practice for that matter, requires not just a technical implementation plan but also a people and process plan. Technology projects fail if they are not integrated into the way people work.

Some things to consider.

  • Will you offer virtual appointments to all patients or just some who meet a certain criteria?
  • Will you use virtual appointments for pre-screening or will you require a face-to-face visit first? There are pros and cons to either approach. Pre-screening might help get patients to treatment faster. Face-to-face allows a hands on assessment and the ability to establish a rapport with the customer.
  • Do you have space in your clinic to run the telemedicine sessions? You will need a quiet location with good lighting.
  • What technology will you use? Does it work on existing computers? This could be an entire blog post in itself. A few key points for you to consider:
    • Is it secure? Skype and FaceTime do not provide the security required for HIPAA or other personal data protection laws. These are consumer technologies that will not guarantee that data is passed securely.
    • Is it easy for the provider and the patient to use? Does the patient need to install plug-ins?
    • How many people will need to use it?
      Teleconferencing with Microsoft Lync

      Teleconferencing with Microsoft Lync

Thinking about the way people work, do you have some providers who are better than others at patient communication? Telemedicine removes some forms of communication, so only your best communicators should probably participate. When will you schedule appointments? During the day or before or after office hours? If the equipment is shared, how do you make sure it’s available for an appointment.

Also think about how you will make technology adoption as easy as possible for practitioners. What types of training programs will you offer for them to learn the technology? How will you make sure it’s available?

How to Run the Session

With the adoption of telehealth there are starting to be best practices on how to conduct a session. Here are a few things for you and your practitioners to consider.

  • If possible, start with an in-person visit to establish rapport.Consider how you can make the technology adoption as easy as possible for practitioners.
  • Plan what is possible for the visit. Telehealth is better for check-ins than to establish a new program with a patient.
  • Practice using the technology before the session, and if you don’t have a lot of personal experience with video calls with consumer technology like Skype or FaceTime, make sure to do some practice calls first.
  • Start the session with some small talk to make communication easier.
  • Look at the camera. Make eye contact.
  • White coats add too much glare and it’s hard for the other person to see you.
  • Try not to move around too much.
  • Keep the background clear of distracting clutter.
  • Keep the patient aware of what you’re doing. If you’re looking something up or thinking about a response, tell them. Video calls often miss these queues.

Telemedicine might not be for every practice, however, increasing costs coupled with increasing expectations of consumers and patients, it will most likely become a key service in healthcare delivery.

Posted in: Healthcare Technology

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Just-In-Time Management Principles for Physical Therapy

Disruptive technologies and business models, paired with changing consumer expectations, will change healthcare.

In keeping with our theme of lean healthcare, today’s topic is a recap of the American Physical Therapy Conference CSM 2013 is a session called “Doing Today’s Work Today: How To Reduce Inefficiencies in Physical Therapy Service Delivery Through the Application of ‘Just In Time’ Management Principles.” Yes, the title was quite a mouthful, but the session was well organized, clear, and straightforward. Presenters Todd E. Davenport, Nicholas J. Ferlatte, Ivan Matsui, Carol Jo Tichenor, were all from Kaiser Permanente. Since Kaiser Permanente is a managed care consortium, they are able to experiment with programs and collaboration between disciplines all within the umbrella of their organization.

Starting with a recap of lean management principles applied to healthcare, presenters focused on case studies and learning from three programs at Kaiser, all designed to increase client satisfaction and decrease waste.

Roving physical therapists program

This program had physical therapists ‘on-call’ to be brought in if a consulting MD needed support. The therapist could quickly access the situation, make a prescription, and then decide whether the patient needed a referral. If the patient needed a referral to a physical therapist, they might have to wait 30 minutes to see that physical therapist rather than a few weeks. The results of the program were significantly happier patients, and a dramatic reduction in the wrong physical therapy prescription. Given that patients were seen sooner, there could also be assumed to be better recovery times as well.

While this program turned out to be the best for patients, some considerations needed to be taken on how to manage the physical therapist’s productivity. Kaiser’s structure of being a full-service managed care organization enabled this scenario, but it’s definitely worth considering how to bridge this gap with integrated care.


Telehealth is expected to grow 55% in 2013 and reach 1.8M patients. This is partially driven by Medicare’s penalties on readmission, but also as Kaiser Permante learned, by consumer preference. Patients liked the video check-in because it meant they didn’t have to leave work or battle traffic for their appointments. There was also a strong personal connection having the appointment at their convenience and location rather than a clinic. However, one extremely important reason they liked the Kaiser program was that it was free. This is a consideration that’s not possible for many clinics. However, we have seen changes in billing codes in most states that allow for telemedicine.

Patients Preferred Communication Modes

Patients Preferred Communication Modes

The presenters also shared some best practices if you’re thinking of implementing video visits into your practice which we’ll dedicate a separate post to in the coming days.

To judge whether telehealth is effective, you need to consider two factors: clinical outcomes and patient satisfaction. If you’re going to try a telehealth pilot, think about how you will measure in advance.

Workplace occupational injury prevention

Workplace injuries are decreasing, while workplace injury costs are actually increasing. That is, fewer people are being injured but it’s costing more to treat those injuries. The main users are younger men who work as laborers, and women 50-60 who work as tradespeople. Similar to other sessions, this session promoted physical therapists as ambassadors of total health and wellness, and in this case occupational wellness.

Kaiser Permanente implemented an occupational wellness program in their own workplace in two high-injury departments: radiology and materials management. Starting with an ergonomic assessment, they then created programs that include pre-shift and at-home exercise programs, and stress and weight management. The result has been a steady decline in workplace injuries over the last 15 years, and a general increase in the importance of health and safety.

While this program was internal to Kaiser Permanente, corporate wellness programs are quite common with their focus on preventative healthcare. This could be an interesting area of focus for physical therapy organizations.

Finally, the panelists encouraged the audience to start thinking about and embracing new business models by saying “It’s okay to ask for money for services provided.”

Posted in: Lean Healthcare, Rehabilitation Business

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Mobile health and the gap between professional and consumer tools

FitBit One Wireless Activity Tracker

FitBit One Wireless Activity Tracker

M-health, quantified-self, daily tracking, FitbitBodyMediaRunkeeperMyFitnessPalStrava, even Nike has gotten in the game. The ways in which consumers can keep track of their health seems to multiply each day. The average consumer device is about $200, often with a monthly subscription fee to track results. Some only charge a subscription if you want more detailed access to your results. At the same time, complex sensors and accelerometers used in medical research can cost thousands of dollars. Sure they are more accurate, but are they more effective in motivating behavior change?

These were some of the questions raised in the American Physical Therapy Conference Session “Mobile Health Technologies” presented by George D. Fulk, Edward Sazonov, and James Cavanaugh.

BodyMedia Tracker

BodyMedia Tracker announced at CES 2013

They reviewed popular consumer devices from a clinical research perspective and weighed them against professional healthcare devices, looking at accuracy, convenience, user preference, and price. While the professional devices are still more accurate, for all other factors it did seem like the consumer devices were winning. For example, many of the new devices, like FitBit can be easily hidden beneath your clothes, while ActivePal‘s anklet makes the wearer look like they are under house arrest. Female participants in one study using ActivePal removed the anklet when they wore skirts. At the Consumer Electronics Show this year, BodyMedia showed trackers that look like jewelry which would solve this problem, and provide some nice word of mouth marketing for them.  While professional devices may record more accurate results, is the overall study more accurate if the subject isn’t being consistently monitored?

Another criticism of the consumer devices was the inability to get raw data, and that if the data were shared, it wasn’t encrypted for HIPAA compliance. Given the price difference, market potential, and popularity of consumer devices, we can imagine these differences will fade in the long run. 

The New York Times reported this past week that more and more people are turning to electronic health monitoring. There are over 13,000 personal health tracking apps available. While some track automatically, self-tracking has shown promise in chronic disease management.

Nike+ Activity Tracker

Nike+ Activity Tracker

A study by Pew research referred to in the NY Times article found “most people with several chronic conditions said that tracking had led them to ask a doctor new questions, led them to seek a second opinion or influenced their treatment decisions.” As well, at Wellpepper we’ve noticed that FitBit has driven a new level of awareness around the number of steps a person should be taking each day, 10K according to Locke et al, with technology venture capitalists challenging each other on a virtual leaderboard.

What does all of this mean for physical therapists? The panelists in the session admitted that the profession is often behind the game in technology adoption, and as a result the technology isn’t developed in a way to be most useful to physical therapists. They encouraged researchers to collaborate with engineering to see better results. Here at Wellpepper, we are technologists building our products in close collaboration with professionals in rehab and research. We are hoping to help bridge this gap between consumer and professional healthcare technology. If you’re passionate about how mobile technology could improve your practice, we’d love to hear from you!


Posted in: M-health

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Whole Health and Wellness in Physical Therapy

Physical therapists are uniquely positioned to look at the whole health of the patient, however,  many are still just treating the injury. Health promotion needs to be a key evolution of the profession.

These were themes  in a few sessions at APTA CSM 2013 last week in San Diego, particularly in “How Can We Integrate Wellness Into Orthopedic Physical Therapy?” and “Challenging PTs to Thrive in a Changing Healthcare Environment.”

Both sessions challenged physical therapists to think about how to expand their impact by focusing on whole wellness of the person, whether that is trying to understand other lifestyle factors that may affect their health, or how to keep people active after their treatment.  When they only focus on the injury, physical therapists get the patient to a certain point of recovery and then discharge. The patients then don’t continue their exercises and are likely to re-injure. The idea of “patients for life” was introduced, not that we want patients to be injured for life, but that patients can continue to look to their physical therapist for prevention of injuries and support for their general well being.

Behavior change was cited as a key tool in helping patients manage their entire health. It’s not enough to get them to do their exercises, they may also have to change their behaviors if these are also impacting their recovery. For example, diet might need to change. Physical therapists are urged to look at one unhealthy behavior and figure out how to change it.

7 Forms of Wellness from University of California Riverside

7 Forms of Wellness from University of California Riverside

Understanding the full picture of wellness, will help understand the full patient. The  University of California Riverside defines these 7 forms of wellness as:

  • Social
  • Physical
  • Emotional
  • Spiritual
  • Environmental
  • Occupational
  • Intellectual

Identifying whether any of these, besides physical, are inhibiting the patient from recovery is key. For example, a patient might be missing social support, like a friend who could go for walks with them, which could slow or impair overall recovery.

Although both talks were similar in their recommendation that physical therapists become more involved in helping the patient modify their behavior to get better, neither offered practical tips on how to do this in a clinical setting. As well, they both admitted that although physical therapists were uniquely suited to do this they didn’t have the right training or tools.

At Wellpepper, we’d say this is consistent with our experience during our research on patient exercise compliance. Some of the physical therapists we talked to had well-defined strategies for getting patients to do their exercises, for example, don’t assign too many exercises or get the patient to choose the time, while others just prescribed and hoped. Helping patients modify their behavior for positive outcomes is a key tenant of what we’re trying to do at Wellpepper, so we’d love help physical therapists take a more active role in this.

Both sessions also encouraged the profession to have a voice in public health on health promotion and wellness. Doing this could make health promotion a more systematic part of physical therapy practice, and give physical therapists a seat at the table in the larger health reform conversation. We’re all in favor of this, and hope we can help.


Posted in: Healthcare Disruption, Rehabilitation Business

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Learning about Lean Healthcare at APTA CSM 2013

We’re just back from the American Physical Therapy society Combined Sessions meeting in San Diego. How lovely, you say, San Diego in January. We think it was lovely but we spent most of the time in the convention center meeting people, and soaking up all kinds of information. Over the next few blog posts, we’ll go into detail about a few of the sessions.

One of the most interesting, was Lean Physical Therapy presented by Proaxis Therapy, a 20 location organization serving South Carolina and Colorado. Team members from Proaxis had completed the Belmont University Lean Healthcare certificate, and were sharing how they used these practices in improving their organization. Lean Healthcare comes from Toyota’s famous Lean Manufacturing philosophy. Wellpepper is following Lean Startup techniques so we were extremely interested to see how this could be applied to healthcare. Lean philosophy looks at eliminating wasteful efforts and continual improvement.

Lean Healthcare Observation sheet

Lean Healthcare Observation sheet

The session started with a video of a physical therapist at a Proaxis clinic running around trying to start a session with a patient, looking for equipment, trying to find gloves that fit, and muttering under her breath. The patient, meanwhile, was waiting on the table. A great thing about this session is that it was interactive, and we used this video to start our own lean training, first by practicing the art of observation. We broke into groups and watched the video again, focusing on observing waste. We tracked how many steps she took (120-150), how long it took before she got back to the patient (almost 5 minutes), what activities she did (see image), and how many times she retraced her steps (a lot).

Proaxis had done the same observational activity, and talked about how they used it to cut waste: organize supplies better, make each PT accountable for all the supplies, and completely reorganized the clinic layout based on user tasks.

From a software perspective, it was pretty fun to experience this type of usability study in the physical world.


Lean Healthcare Value Map for hand washing

Next we learned about value stream mapping: breaking down an activity into it’s component tasks, and looking for tasks that are waste, versus tasks that add value for the customer. (All of lean is focused on adding value to the customer.) Here’s a value chain for hand washing. You might not think of this as a valuable task, but it keeps everyone healthy.

In this value chain, not being able to turn the water on is waste. There are other potential areas for waste, for example, maybe the soap or paper towels are empty. All of these take value away from the patient, and frustrate the caregiver.

Again, we practiced this by trying to map out the value stream for what seemed like a simple task: patient cancelling an appointment. Our small group very quickly realized that there are no simple tasks as we got into a complex decision tree about whether this was a chronic canceler or an isolated incident.

Our value map became quite messy.

Lean Healthcare Value Map Exercise

Lean Healthcare Value Map Exercise

Next step was to ask the 5 Whys, a series of 5 questions designed to get to the root cause of an issue. We figured out that the root cause on this problem was wanting to make sure that physical therapists were being as productive as possible, and scheduling was a key part of this. Although, at this stage you’re not supposed to problem solve, our little group discussed briefly how airlines solve this type of problem by overbooking.

When we came back together as a full group, Proaxis Therapy shared a few case studies on how they had implemented these techniques in their clinics in two key areas: reception/registration, and documentation.

Lean Healthcare Case Study Results

Lean Healthcare Case Study Results

The results were pretty amazing, especially in the area of documentation, saving physical therapists 2 weeks a year, and they had feedback that could really improve their EMR system. For lean software companies, having a user do this type of analysis would be invaluable.

This blog post only scratches the surface of the session, and presenters Sean Mc Enroe, Robbie Leonard, Nicole Kluckhohn, and Shannon Irish reminded us that they were distilling a 5-day course and months of work into 2 hours. They did a great job of it!

Posted in: Lean Healthcare

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Wellpepper is attending the American Physical Therapy Association 2013 Combined Sessions Meeting. We’re having a great time, although are quite exhausted with all of the amazing sessions and people to talk to. When we catch our breath, we’ll blog a bit more about what we found, but for now here are some brief impressions.

  • People are very friendly. We know that PTs are the 3rd happiest profession in the US (behind clergy and firefighters), but we’ve been really impressed with how friendly and helpful everyone is here.
  • Healthcare is at a crossroads. There are a number of sessions on Lean PT and using Toyota’s lean imagemanufacturing principles to improve clinic performance. One we attended was an interactive session that had us mapping out all the steps when someone cancels an appointment and looking for ways to improve. Kaiser Permanente led a session where they talked about the coming disruption in healthcare, stressing that it doesn’t matter what the billing codes say, patient expectations of service have increased and while budgets have decreased so figuring out better ways to deliver care is paramount.
  • Technology can change lives. We’ve seen some pretty amazing exoskeletal ‘machines’ that are enabling spinal cord injury patients to walk around the show floor. How’s that for a demo?
  • There’s a lot of talk about holistic health, health promotion, and seeing the whole patient. Physical therapists are uniquely suited to look at the broader picture and participate in prevention, because that’s what they already do.
  • Behavior change is key to improving outcomes, but it’s not necessarily something that PTs are trained in or good at. How can we help change this?

Those are just some high-level impressions, we’ll have more detail over the next few days. One day left to learn more!

Posted in: Rehabilitation Business

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What can you expect from the Wellpepper blog?

We’re not physical therapists. We’re working with some great ones, and with some university researchers, but we are software people.

With that in mind, here are some of the topics we’re planning to blog about

  • Mobile healthcare and healthcare technology
  • Behavior change and motivation
  • Games for health
  • Gesture and gaming technology
  • Wellpepper product development
  • Wellpepper news
  • Best practices for using Wellpepper and any findings from our research
  • General exercise and physical therapy news
  • Strategies for improving client exercise compliance
  • Customer profiles

We will occasionally have guest blogger posts from our physical therapy, chiropractic, and researcher clients and partners which will be more technical in nature on the practice of rehabilitation, but this won’t be a blog for in-depth study of the field. There are lots of people who can do a much better job of that!

We hope you’ll find something of interest and start a dialog with us here on this blog.

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