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Alexa, Get Well Soon

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

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

“Well, um – me.”

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

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

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

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

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

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

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

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

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

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

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

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The Secrets of Strong CIO and CMIO Relationships

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

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

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

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

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

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

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

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Your Cupcakes Are Not My Goals

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

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

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

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

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

It looks like this.

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

Spend more time with family.

Get outside more frequently.

Walk more.

Be ready for vacation.

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

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

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

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

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

Shift to the cloud

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

Using AWS with HIPAA-Protected Data – A Practical Primer

Consumerization of healthcare

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

The Disneyfication or Consumerization of Healthcare

Consumerization Is Not A Bad Word

Value of patient-generated data

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

In Defense of Patient-Generated Data

Realizing Value In Patient Engagement

Power of voice technology

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

Introducing Sugarpod by Wellpepper, a comprehensive diabetes care plan

Building a Voice Experience for People with Type 2 Diabetes

Ready When You Are: Voice Interfaces for Patient Engagement

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

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

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

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

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HealthLoop, Wellpepper, and Livongo Collaborate to Advance Digital Health

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

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

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

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

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

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

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

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

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

Posted in: Press Release

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Pointing Fingers at Healthcare Problems

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Patient Experience

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

User Journey from Wellpepper on Vimeo.

Outcomes

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

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

Technology

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

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

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

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

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Meet Wellpepper At Connected Health

We’re gearing up for a great week at Connected Health. See Wellpepper, and our Alexa Diabetes Challenge Grand Prize winning entry Sugarpod in Boston next week. Contact sales@wellpepper.com to schedule a demo, drop by Booth 84 in the Innovation Zone.

 

Wednesday October 25
Natural Language Pre-Conference, we’ll be talking about the Alexa Diabetes Challenge, Sugarpod, and voice

Thursday October 26

Voice Technologies In Healthcare Applications

  • Room: Harborview 2/3
  • Session Number:R0240D
  • 2:40 PM – 3:30 PM

U.S. Department of Health and Human Services Town Hall with Bruce Greenstein, Entrepreneur Panel and Q&A (Invite-only)

Friday October 27

The Power of Patient-Generated Data

Exhibition Showcase 11:00 AM – 11:10 AM

 

 

Posted in: patient engagement, Voice

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Wellpepper Wins $125K Grand Prize in Alexa Diabetes Challenge

NEW YORK: Today, the Challenge judges awarded Wellpepper the $125,000 grand prize in the Alexa Diabetes Challenge. Wellpepper is the team behind Sugarpod, a concept for a multimodal diabetes care plan solution using voice interactions.

The multi-stage Challenge is sponsored by Merck & Co., Inc., Kenilworth, New Jersey, U.S.A., supported by Amazon Web Services (AWS), and powered by Luminary Labs. In April, the competition launched with an open call for concepts that demonstrate the future potential of voice technologies and supporting Amazon Web Services to improve the experience of those who have been newly diagnosed with type 2 diabetes.

“Technology advances are creating digital health opportunities to improve support for people managing life with a chronic disease,” said Tony Alvarez, president, Primary Care Business Line and Customer Strategy at Merck & Co., Inc. “One purpose of the Alexa Diabetes Challenge was to identify new ways to use the technology already present in a patient’s daily routine. The winner of the Challenge did just that.”

Sugarpod is a concept for an interactive diabetes care plan solution that provides tailored tasks based on patient preferences. It delivers patient experiences via SMS, email, web, and a native mobile application – and one day, through voice interfaces as well. Since much of diabetes management occurs in the home, the Wellpepper team recognized that integrating voice was the natural next step to make the platform more convenient where patients are using it most. During the Challenge, Wellpepper also prototyped an Alexa-enabled scale and foot scanner that alerts patients about potential foot problems, a common diabetes complication.

“Sugarpod helps newly diagnosed people with type 2 diabetes integrate new information and routines into the fabric of their daily lives to self-manage, connect to care, and avoid complications. The Challenge showed us the appeal of voice solutions for patients and clinical value of early detection with home-based solutions,” said Anne Weiler, co-founder and CEO of Wellpepper.

The Challenge received 96 submissions from a variety of innovators, including research institutions, software companies, startups, and healthcare providers. The panel of judges, independent from Merck, narrowed the field down to Wellpepper and four other finalists, who each received $25,000 and $10,000 in AWS promotional credits and advanced to the Virtual Accelerator. During this phase of the competition, the finalists received expert mentorship as they iterated their solutions in preparation for Demo Day. At Demo Day on September 25, 2017, the five finalists presented their solutions to the judges and a live audience of industry leaders at the AWS Pop-up Loft in New York to compete for the grand prize.

“The Alexa Diabetes Challenge has been a great experiment to re-think what a consumer, patient, and caregiver experience could be like and how voice can become a frictionless interface for these interactions. We can imagine a future where technological innovations, like those provided by Amazon and AWS, are supporting those who need them most,” said Oxana Pickeral, Global Segment Leader in Healthcare and Life Sciences at Amazon Web Services.

Learn more at alexadiabeteschallenge.com and follow the Challenge at @ADchallenge.                                                                   

###

Contact: Emily Hallquist

(425) 785-4531 or emily@luminary-labs.com

Posted in: Healthcare Technology, Healthcare transformation, patient engagement, Press Release

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Ready When You Are: Voice Interfaces for Patient Engagement

We started experimenting with voice as a patient interface early this year, and showed a solution with a voice-enabled total-joint care plan to a select group of customers and partners at HIMSS 2017. Recently we were finalists in the Merck-sponsored Alexa Diabetes Challenge, where we built a voice-enabled IOT scale and diabetic foot scanner, and also a voice-powered interactive care plan.

Over the course of the challenge we tested the voice experience with people with Type 2 diabetes. We also installed the scale and scanner in a clinic, and we found that clinicians also wanted to engage with voice. Voice is a natural in the clinical setting: there’s no screen to get in the way of interactions, and people are used to answering questions. Voice is also great in the home.

However, voice isn’t always the best interface which is why we think multimodal care plans including voice, text, mobile, and web can deliver a more comprehensive solution. Since it’s easier for someone to overhear a conversation than look at your smartphone or even computer screen, mobile or web are often better interfaces depending on the person’s location (for example taking public transit), or the task they need to do (for example, reporting status of a bowel movement). We do think that voice has many great healthcare applications, and benefits for certain interactions and populations.

In our testing, we found that both patients and providers really enjoyed the voice interactions and wanted to continue the conversation. They felt very natural, and people used language that they would use with a human. For example, when asked to let the voice-powered scale know when he was ready to have his foot scan, one person responded with:

“Ready when you are.”

This natural user interface presents challenges for developers. It’s hard to model all the possible responses and utterances that a person would use. Our application, would answer to ready, sure, yes, and okay, but the “when you are” caused her some confusion.

Possibly the most important facet of voice is the connection people have with voice is extremely strong, and unlike mobile voice is not yet associated with the need to follow up, check email, or other alerts. (Notifications on voice devices could change this.)

“Voice gives the feeling someone cares. Nudges you in the right direction”

Creating a persona for voice is important, and relying on the personas created by the experts like the Alexa team, is probably the best way for beginners to start.

“Instructions and voice were very calm, and clear, and easy to understand”

Calm is the operative word here. Visual user interfaces can be described as clean, but calm is definitely a personification of the experience.

Voice is often seen as a more ubiquitous experience, possibly because using fewer words, and constantly checking for the correct meaning are best practices, for example “You want me to buy two tickets for Aladdin at 7:00 pm. Is this correct?” We often hear pushback on mobile apps for seniors, but haven’t heard the same for voice. However, during our testing, a senior who was hard-of-hearing told us she couldn’t understand Alexa, and thought that she talked too quickly. While developers can put pauses to set the speed of prompts and responses in conversation, this would mean that the same speed would have used for all users of the skill, which might be too slow for some or two fast for others. Rather than needing to build different skills based on hearing and comprehension speed it would be great if end-users could define this setting so that we can build usable interfaces for everyone.

While this was our first foray into testing voice with care plans, we see a lot of potential to drive a more emotional connection with the care plan, and to better integrate into someone’s day.

People need to manage interactions throughout their day, and integrating into the best experience based on what they need to do and where they are provides a great opportunity to do that, whether that’s voice, SMS, email, web, or mobile. While these consumer voice applications are not yet HIPAA-compliant, like our tester patient said we’ll be “ready when you are.”

Posted in: Behavior Change, Healthcare Technology, Healthcare transformation, patient engagement

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What Motivates You, May Not Motivate Me

At Wellpepper our goal is to empower people to be able to follow their care plans and possibly change their behavior, so we think a lot about how to motivate people. Early on when working with Terry Ellis, Director of the Boston University Center for Neurorehabilitation, wanted to make sure that our messages to patients that may struggle with adherence were positive. She works with people who have Parkinson’s disease, and stressed that while they may improve symptoms they would not “get better.”

Last week I had a similar conversation with an endocrinologist about diabetes care plans. People with chronic diseases are often overwhelmed and may take a defeatist attitude to their health. Feedback and tools need to be non-judgmental and encouraging. Ideas like “compliance” and “adherence” may not be the way to look at it. Sometimes the approach should be “something is better than nothing.” And humans, not just algorithms need to decide what “good” is.

Am I good or great?

Here’s an example, non-healthcare related of algorithmic evaluation gone wrong. Rather than applauding me for being in the top tier of energy efficient homes, the City of Seattle, says I’m merely “good.” There’s no context on my “excellent” neighbors, for example are they in a newly built home compared to my 112 year old one, and no suggestions on what I might want to do to become “excellent. (Is it the 30-year old fridge?) I’m left with a feeling of hopelessness, rather than a resolve to try to get rid of that extra 2KW. Also, what does that even mean? Is 2KW a big deal?

Now imagine you’re struggling with a chronic disease. You’ve done your best, but a poorly tuned algorithm says you’re merely good, not excellent. Well, maybe what you’ve done is your excellent. This is why we enable people to set their own goals and track progress against them, and why care plans need to be personalized for each patient. It’s also why we don’t publish stats on overall adherence. Adherence for me might be 3 out of 5 days. For someone else it might be 7 days a week. It might depend on the care plan or the person.

As part of every care plan in Wellpepper, patients can set their own goals. Sometimes clinicians worry about the patient’s ability to do this. These are not functional goals, they represent what’s important to patients, like family time or events, enjoying life, and so on. We did an analysis of thousands of these patient-entered goals, and determined that it’s possible to track progress against these goals, so we rolled out a new feature that enables patients to do this.

Patient progress against patient-defined goal

Success should be defined by the patient, and outcome goals by clinicians. Motivation and measures need to be appropriate to what the patient is being treated for and their abilities. Personalization, customization, and a patient-centered approach can achieve this. To learn more, get in touch.

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

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Disruptive Innovation, Sparks of Light, or the Evolution of Care: Recap of Mayo Transform Conference

In what has been a roller-coaster year for healthcare legislation, it’s the annual touchstone of the Mayo Clinic Transform Conference provided a welcome opportunity to reflect on where we are. This conference, sponsored by the Mayo Clinic Center for Innovation attracts powerhouse speakers like Andy Slavitt and Clayton Christensen, and yet manages to fly under the radar. This year’s theme was about closing the gap between people and health, so the social determinants of health were a key topic, as was whether disruption alone would solve the problem.

Dr Robert Pearl

This was my third year attending, and second year speaking at the conference, and I’ve noticed a trend: the conference starts by articulating the problem, and building up solutions and creative ways to reshape the problems over the course of the two days. This year the conference was deftly moderated by Elizabeth Rosenthal, MD,Editor-In-Chief of Kaiser Health News and author of “An American Sickness.” Rosenthal, an MD herself, and former NYTimes journalist, peppered her moderation with real-world examples of both waste and inefficiencies and effective programs based on her investigative journalism.

I’ve been wanting to write a blog post for a while that riffs on the theme of “You Are Here” trying to outline where we are in the digital evolution in healthcare, but it’s clear that we don’t know where we are, digital or otherwise: too much is currently in flux. There are points of light with effective programs, and things that seem very broken. The panel I was on, was titled “Disruptive Innovation” and I’m afraid we let the audience down, as while we are doing some very interesting things with health systems, we are not turning every model on its head. We work with providers and patients to help patients outside the clinic. Truly disruptive innovation would work completely outside the system, which leads to the question, can health systems disrupt themselves or will it come from entirely new entrants like say Google, Apple, or Amazon?

Dr. David Feinberg of Geisinger reads from debate opponent Dr. Robert Pearl’s book

Clayton Christensen, the closing keynote speaker, likens hospitals to mainframe computers, and basically says they will be overtaken by smaller more nimble organizations, much like the PC and now smartphone revolution. Organizations like Iora Health who holistically and preventatively manage a Medicare Advantage population are the epitome of these new entrants, and we’ve seen some hospitals struggle this year, but will they go away entirely? The answer to this question may lie in the excellent debate session “Is The US Healthcare System Terminally Broken” hosted by Intelligence Squared and moderated by author and ABC News Correspondent John Donovan.

 

Shannon Brownlee, senior VP of the Lown Institute and visiting scientist at the Harvard T.H. Chan School of Public Health, and Robert Pearl, MD, and former CEO of the Permanente Medical group were arguing that the system is broken, vs Ezekiel Emmanuel, MD, Senior Fellow Center for American Progress, and David Feinberg, MD, CEO of Geisinger.

While prior to the debate the audience favored the idea that the system is irreparably broken, by the end, they had come around to the idea that it’s not, which would point to the ability for healthcare to disrupt itself. The debate

Is Healthcare Terminally Broken

The final audience vote

was ridiculously fun, partially from the enthusiasm of the debaters, and because the topic was so dear to all attendees. You can listen to the podcast yourself. However, the posing of the question set up an almost impossible challenge for Pearl and Brownlee: they had to argue the patient is terminal, but without any possible solution. No one in the room wanted to hear that, and so when Emmanuel and Feinberg were able to point to innovative programs like the Geisinger Money Back Warranty or Fresh Food Pharmacy that just needed to find scale, the audience latched onto the hope that we can fix things, and we all have to believe in these points of light, to face each new day of challenges.

Posted in: Health Regulations, Healthcare Disruption, Healthcare Legislation, Healthcare Policy, Healthcare Technology, Healthcare transformation

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Alexa Voice Challenge for Type 2 Diabetes: Evolving An Idea

For the past couple of months some of our Wellpepper team, with some additional help from a couple of post-docs from University of Washington, have been working hard on a novel integrated device, mobile, and voice care plan to help people newly diagnosed with type 2 diabetes as part of our entry in the Alexa Diabetes Challenge.

Team Sugarpod

This challenge offered a great opportunity to evolve our thinking in the power of integrating experiences directly into a person’s day using the right technology for the setting. It also provided the opportunity to go from idea to prototype in a rapid timeframe.

Our solution featured an integrated mobile and voice care plan, and a unique device: a voice powered scale that scans for diabetic foot ulcers, a leading cause of amputation, hospitalization, and increased mortality, and is estimated to cost the health system up to $9B per year.

During the challenge, we had access to amazing resources, including a 2-day bootcamp held at Amazon headquarters during which we heard from experts in voice, behavior change, caring for people with type 2 diabetes, and a focus group with people who have type 2 diabetes. We also had 1:1 sessions with various experts who had seen our entry and helped us think through the challenges of developing it. After the bootcamp, we were assigned a mentor, an experienced pharmacist and diabetes educator, who was available for any questions. Experts from the bootcamp also held office hours where we explored topics like

Early Prototype Voice Powered Scale & Scanner

how to help coach people in what they can do with an Alexa skill, and how to build trust with a device that takes pictures in your bathroom.

As we evolved our solution, we were fortunate to have support from Dr Wellesley Chapman, medical director of Kaiser Permanente Washington’s Innovation Group. We were able to install the device in a Diabetes and Wound Clinic. We used this to train our image classifier to look for foot ulcers, and compare results to human detection, and also to test the voice service. We used an anonymous voice service as Alexa and the Lex services are not currently HIPAA-eligible.

We gathered feedback from diabetes educators, clinicians at KP Washington, and across the country, and from people with Type 2 diabetes. While not everyone wanted to use all aspects of the solution, they all felt that the various components: voice, mobile, and device offered a lot of support and value. As well, we determined that there is an opportunity for a voice-powered scale and scanner in the clinic which could aid in early detection and streamline productivity. Voice interactions in the clinic are a natural fit.

Judges and Competitors: Alexa Diabetes Challenge

The great thing about a challenge is the constraints provided to do something really great in a short period of time. We’re so proud of the Sugarpod team, and also incredibly impressed with the other entries in this competition ranging from a focus on supporting the mental health challenges faced by people newly diagnosed with Type 2 diabetes to a specific protocol for diet and nutrition, to solutions that helped manage all aspects of care. We enjoyed meeting our fellow competitors at the bootcamp and the final, and wish we had met in a situation where we could collaborate with them. We also appreciated the thoughtful feedback and questions from the judges, and would definitely have a lot to gain from deeper discussions with them on the topic.

Stay tuned for more on our learnings through this challenge and our experiences with voice.

Posted in: Healthcare Disruption, Healthcare Technology, Healthcare transformation, M-health, Managing Chronic Disease, Outcomes, patient engagement, patient-generated data

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Who Defines Value?

Pharma companies have recently jumped on the value bandwagon with proposals for value-based drug pricing based on outcomes and effectiveness. They have started to enter contracts with payers for specific drugs based on the impact the drug has on the condition the drug is treating.

This is a step in the right direction, and much better than pricing based on maximizing shareholder value, but value is in the eye of the beholder, and the patient is a key stakeholder. Shared decision making does a good job defining what’s important to a patient. The goal of shared decision making is to choose courses of care that offer the best outcome to the patient, and can consider some of the following:

  • Is this procedure my only option? What are alternative types of treatment?
  • What are the possible outcomes and side effects of each option, including the option of doing nothing?
  • What is the estimated cost of the procedure and any related follow-up care or medication?

Source: Center for American Progress

Simply, value can be defined by the following.

The challenge of the equation is in the definitions of acceptable outcomes and costs. Here are a few things that people might consider when evaluating a drug or a course of care.

  • Inconvenience or effort: How much does this disrupt their life? Does it prevent the person from doing other things?
  • Cost: How much does it cost? This could be in monetary terms, time, side effects, or quality of life.
  • Outcome: What is the expected outcome and how closely does it align with the outcome that’s important to me?

You can see that based on these factors, that healthcare can be a market of one. My idea of value and acceptable outcomes could be very different from yours. And, unfortunately, the patient is not a consumer in a free and transparent market. That said, it is possible to make consumer-like decisions in healthcare.

Let’s look at the value decision I tried to make this past weekend. I fractured and dislocated a finger while playing Ultimate Frisbee. I was pretty sure the finger was dislocated, which shouldn’t be a big deal, so tried to go to urgent care where I expected value based on time, outcome, and cost. Well guess what? Urgent care is not open on a Saturday night. I had a feeling that emergency care would not meet my value criteria of effort, since I expected a long wait, and I got it. On the cost, I did know that the provider I went to was in-network so that wasn’t a big issue, but I still don’t know the total cost if I’d had to pay out of pocket.

Waiting in ED

Waiting

Outcome was great, and the level of care was great. What was not great is that it took 4 hours to get x-rays, pop my finger back in, and splint it. If I had been choosing as a consumer, I’d never have chosen this. With higher deductibles and co-pays, people are making decisions as consumers which is why hospitals advertise wait times, and some are looking at how to completely overhaul the ER, both of which would get us closer to value.

Let’s look at an example on value-based drug pricing. Back when I had the Cadillac of US healthcare plans when I was working at Microsoft, I was prescribed a topical psoriasis drug. The expected outcome was no psoriasis lesions. The cost was $800 for a 60g tube. Since I didn’t have to pay anything out of pocket, I got the prescription. Did it work? Yes. Was it worth it to me? No. I had other creams that cost much less, and worked almost as well. I didn’t end up getting it again—I wouldn’t have paid $800 for it myself, so why should my employer? If cost is not part of the equation, people are making decisions with only partial information, and can’t possibly judge value. Co-pays and transparency can help guide people to consumer-like behavior in healthcare, even in an imperfect market.

What’s the upside? The upside is that we’re having these discussions, and that we can see a shift to value and consumer focus, even without legislation, which is really how it needs to happen. The other thing to remember is that people want to deliver excellent and quality care. Everyone I met during my finger ordeal, from the admitting staff to the x-ray tech, to the resident who was excited to see a dislocation he’d never seen before was excellent, and that defines quality in my mind. Maybe we have less far to go than we thought.

Posted in: Healthcare Disruption, Healthcare Legislation, Healthcare motivation, Healthcare Policy, Outcomes

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Meeting Consumer Expectations in Healthcare

We could talk about this all day, and we do! We’re glad to see healthcare executives start to take ownership of the digital experience, and understand that consumer and patient engagement is key to outcome success.

Consumer expectations are indeed hitting healthcare – hard. Patients are no longer shy about telling physicians and payers what they want and how much they’re willing to pay for it. While these expectations can seem overwhelming to those insiders who have long become accustomed to healthcare’s glacial pace, we shouldn’t be discouraged. These greater expectations can indeed be met, provided we take the time to develop and offer physicians and patients tools that meet their needs and fit their workflows.

Here’s the latest take on this topic from HISTalk

 

Posted in: Healthcare transformation, patient engagement, Patient Satisfaction

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Patient Experience Versus Patient Engagement

As a volunteer session reviewer for the Patient and Consumer Engagement track for HIMSS 2018, I’ve been thinking a lot about the difference between engagement and experience, and also what it means to deliver connected health. While Wellpepper is a platform for patient engagement, a session based on Boston University’s study using Wellpepper with people with Parkinson disease actually suited the definition of Connected Health better and was submitted in that track.

As I’ve been reviewing sessions submissions for the track, I noticed that quite a few focus on patient experience rather than engagement. The difference really is about commitment and action. Patient experience is what happens when someone engages with a health system or physician office. Patient engagement is what happens when someone actively participates in their own care as a patient. You could argue that patients can’t help but be engaged because whatever is happening is happening to them, but it’s a bit more than that. (Also that argument gets a bit existential.)

Both engagement and experience are important. With a crappy experience then people may not engage with you, your system, or their own health. This can be as simple as not being able to find parking. Good experience is the pre-requisite for engagement, but it is not engagement on its own. Engagement happens when you empower the patient and treat them as an active participant in their care.

There’s a continuum from experience to engagement, and often the same digital tools represent both, although both also include the physical experience, and both will help you attract and retain patients but more importantly engagement will also help improve outcomes.

If you’re interested in this topic, this article in NEJM Catalyst from Adrienne Boissy, MD of Cleveland Clinic does much better job than I do of explaining it.

Posted in: Healthcare Technology, Healthcare transformation, M-health, patient engagement, Patient Satisfaction

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