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Introducing Sugarpod by Wellpepper, a comprehensive diabetes care plan

We’re both honored and excited to be one of five finalists in the Alexa Diabetes Challenge. We’re honored to be in such great company, and excited about the novel device our team is building. You may wonder how a team of software folks ends up with an entry with a hardware component. We did too, until we thought more about the convergence happening in technology.

We were early fans of the power of voice, and we previewed a prototype of Alexa integration with Wellpepper digital treatment plans for total joint replacement at HIMSS in February 2017. Voice is a great interface for people who are mobility or vision challenged, and the design of Amazon Echo makes it an unobtrusive home device. While a mobile treatment plan is always with you, the Amazon Echo is central in the home. At one point, we thought television would be the next logical screen to support patients with their home treatment plans, but it seems like the Echo Show is going to be more powerful and still quite accessible to a large number of people.

Since our platform supports all types of patient interventions, including diabetes, this challenge was a natural fit for our team, which is made up of Wellpepper staff and Dr Soma Mandal, who joined us this spring for a rotation from the University of Georgia. However, when we brainstormed 20 possible ideas for the challenge (admittedly over beer at Fremont Brewing), the two that rose to the top involved hardware solutions in addition to voice interactions with a treatment plan. And that’s how we found ourselves with Sugarpod by Wellpepper which includes a comprehensive diabetes care plan for someone newly diagnosed, and a novel Alexa-enabled device to check for foot problems, a common complication of diabetes mellitus.

Currently in healthcare, there are some big efforts to connect device data to the EMR. While we think device data is extremely interesting, connecting it directly to the EMR is missing a key component: what’s actually happening with the patient. Having real-time device data without real-time patient experience as well, is only solving one piece of the puzzle. Patients don’t think about the devices to manage their health – whether glucometer, blood pressure monitor, or foot scanner – separately from their entire care plan. In fact, looking at both together, and understanding the interplay between their actions, and the readings from these devices, is key for patient self-management.

And that’s how we found ourselves, a mostly SaaS company, entering a challenge with a device. It’s not the first time we’ve thought about how to better integrate devices with our care plans, but is the first time we’ve gone as far as prototyping one ourselves, which got us wondering which way the market will go. It doesn’t make sense for every device to have their own corresponding app. That app is not integrated with the physician’s instructions or the rest of the patient’s care plan. It may not be feasible for every interactive treatment plan to integrate with every device, so are vertically integrated solutions the future? If you look at the bets that Google and Apple are making in this space, you might say yes. It will be fascinating to see where this Alexa challenge takes Amazon, and us too.

We’ve got a lot of work cut out for us before the final pitch on September 25th in New York. If you’re interested in our progress, subscribe to our Wellpepper newsletter, and we’ll have a few updates. If you’re interested in this overall hardware and software solution for Type 2 diabetes care, either for deploying in your organization or bringing a new device to market, please get in touch.

Read more about the process, the pitch, and how we developed the solution:

Ready When You Are: Voice Interfaces for Patient Engagement

Alexa Voice Challenge for Type 2 Diabetes: Evolving a Solution

 

Posted in: Behavior Change, chronic disease, Healthcare Disruption, Healthcare Technology, Healthcare transformation, M-health, Managing Chronic Disease, patient-generated data

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In Defense of Patient-Generated Data

There’s a lot of activity going on with large technology companies and others trying to get access to EMR data to mine it for insights. They’re using machine learning and artificial intelligence to crawl notes and diagnosis to try to find patterns that may predict disease. At the same time, equal amounts of energy are being spent figuring out how to get data from the myriad of medical and consumer devices into the EMR, considered the system of record.

There are a few flaws in this plan:

  • A significant amount of data in the EMR is copied and pasted. While it may be true that physicians and especially specialists see the same problems repeatedly, it’s also true that lack of specificity and even mistakes are introduced by this practice.
  • As well, the same ICD-10 codes are reused. Doctors admit to reusing codes that they know will be reimbursed. While they are not mis-diagnosing patients, this is another area where there is a lack of specificity. Search for “frequently used ICD-10 codes”, you’ll find a myriad of cheat sheets listing the most common codes for primary care and specialties.
  • Historically clinical research, on which recommendations and standard ranges are created, has been lacking in ethnic and sometimes gender diversity, which means that a patient whose tests are within standard range may have a different experience because that patient is different than the archetype on which the standard is based.
  • Data without context is meaningless, which is physicians initially balked about having device data in the EMR. Understanding how much a healthy person is active is interesting but you don’t need FitBit data for that, there are other indicators like BMI and resting heart rate. Understanding how much someone recovering from knee surgery is interesting, but only if you understand other things about that person’s situation and care.

There’s a pretty simple and often overlooked solution to this problem: get data and information directly from the patient. This data, of a patient’s own experience, will often answer the questions of why a patient is or isn’t getting better. It’s one thing to look at data points and see whether a patient is in or out of accepted ranges. It’s another to consider how the patient feels and what he or she is doing that may improve or exacerbate a condition. In ignoring the patient experience, decisions are being made with only some of the data. In Kleiner-Perkin’s State of the Internet Report, Mary Meeker estimates that the EMR collects a mere 26 data points per year on each patient. That’s not enough to make decisions about a single patient, let alone expect that AI will auto-magically find insights.

We’ve seen the value of patient engagement in our own research and data collected, for example in identifying side effects that are predictors of post-surgical readmission. If you’re interested, in these insights, we publish them through our newsletter.  In interviewing patients and providers, we’ve heard so many examples where physicians were puzzled between the patient’s experience in-clinic or in-patient versus at home. One pulmonary specialist we met told us he had a COPD patient who was not responding to medication. The obvious solution was to change the medication. The not-so-obvious solution was to ask the patient to demonstrate how he was using his inhaler. He was spraying it in the air and walking through the mist, which was how a discharge nurse had shown him how to use the inhaler.

By providing patients with useable and personalized instructions and then tracking the patient experience in following instructions and managing their health, you can close the loop. Combining this information with device data and physician observations and diagnosis, will provide the insight that we can use to scale and personalize care.

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

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Consumerization Is Not A Bad Word

When you say consumerization, especially with respect to healthcare, people often jump to conclusions about valuing service over substance. There’s a lot of confusion over the meaning of consumerization, whether it’s possible in healthcare, and whether it’s happening. I recently had the privilege of speaking at the Washington State Health Exchange’s Annual Board Retreat on this topic. (Perhaps you saw it, the event was live-streamed to the public. 😉 ). The Health Exchange is pondering questions of how to attract new users, how to better serve their needs, and how to make the experience more useful and engaging. And, this my friends is consumerism, or at least one facet of it: user focus, better service, understanding needs. Doesn’t sound bad at all, does it? In fact, it sounds like something any good service or organization should be doing for its customers.

Consumer-centered pain scale. Baymax from Disney's Big Hero Six

Consumer-centered pain scale. Baymax from Disney’s Big Hero Six

And there’s that word, customers. That’s the debate. Are patients really customers? Not really, often they don’t have a choice, either because of their insurance coverage or from the necessity of an emergency where decisions are often made for patients. However, patients, and everyone else for that matter (except people in North Korea), are consumers, and they judge healthcare experiences both service delivery and technology as consumers. Think of it like this, your patients will judge your experiences through the lens of any other service they’ve interacted with. Fair or not, they will do that. Why do they do this? It’s human nature to remember positive experiences and try to seek them out. Although there’s another reason: high-deductibles are also driving people to examine where they are spending their healthcare dollars, and they evaluate based on outcomes, convenience, and the overall experience.

Since healthcare technology is my area of expertise, let’s stick to that rather than critiquing hospital parking, food, or beds. (Although these are often things that impact HCAHPS scores.) Consumerization when applied to health IT means that patients have an expectation that any technology you ask them to engage with, and especially technology you ask them to install on their own devices, will be as usable as any other app they’ve installed.

Consumerization also impacts internal health IT. Doctors were the first wave, when they pushed using their own devices to text with other providers within the hospital setting. (In IT this is often referred to as “bring your own device.”) The pager became obsolete and replaced with our own always on, always connected mobile devices. (Sadly, the fax machine, like a cockroach, keeps hanging in there.)

Patients are also bringing their own devices, and using them in waiting rooms and hospital beds. We’ve had patients reporting their own symptoms using Wellpepper interactive care plans from their hospital beds. This presents an opportunity to engage, and at a low cost: they are supplying the hardware. The final wave of consumerism will happen when clinicians and other hospital staff also demand convenient, usable, and well-designed tools for clinical care.

Consumerization is late to arrive in healthcare IT. Other industries have already reached tail end of this wave, and have already realized that technology needs to be easy to use, accessible, interoperable, and designed with the end-user foremost. However, consumerization is coming, both from internal staff demands and patients. Technology, healthcare IT, and the people that build and support it are facing scrutiny, being held to higher standards, and becoming part of the strategic decision-making healthcare organizations. This is a great thing, as it will result in better clinician and patient experiences overall, because at its core consumerism is about expecting value, and ease and getting it, and who doesn’t want that?

Posted in: Healthcare Disruption, Healthcare Technology, Healthcare transformation, Interoperability, M-health, Outcomes, Patient Satisfaction

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Realizing Value In Patient Engagement

Patient engagement has moved from a theory to a reality, which means that evaluation criteria as evolved as well. It also means that instead of the early pilots where innovative organizations intuitively took the leap because helping patients self-manage just made sense, for enterprise-wide deployments questions of return-on-investment, and where and how to realize value are crucial.

Our customers are realizing value in 3 key areas:

Improving patient outcomes and satisfaction. This is practically a table stakes issue. If a solution doesn’t improve outcomes and patient satisfaction, don’t deploy it. We work closely with researchers, and analyze our own data, and in a randomized clinical study conducted by Boston University’s Center for Neurorehabiltation, people with Parkinson Disease showed positive physical outcomes and 9/10 patient satisfaction. We see these high levels of patient satisfaction in studies, and in real-world patient scenarios.

“This program has empowered me, lifted my morale, renewed my hope, and given me tools. Thank you for helping me regain my life!”

Parkinson’s patient, Boston University Center for Neurorehabilitation

Increasing access to care. Time is money, especially for specialists. We’ve been able to decrease follow-up visits by 10% because patients were able to self-manage. This means that the specialists had more appointments available for new patients, and were able to decrease wait times for referrals.

Decreasing and avoiding costs.  Through our automated message classifier, we’ve determined that 70% of patient messages in the system do not require a follow up. This decreases the need for unnecessary outreach to patients, while patients still stay on track. Other hard cost reductions are in the administration of patient reported outcome surveys—automating these processes deliver better completion rates, and frees your staff for more important tasks.

Possibly the most important way to decrease costs is to decrease readmissions. By analyzing patient-reported symptoms post-surgery, we are able to determine patterns that indicate a higher risk of readmission. Catching these issues early can prevent readmissions and deliver better outcomes.

You should see value in each of these three areas when deploying an enterprise-wide patient engagement solution. However, where you see the most value depends on a number of factors: 1. Your practice and reimbursement model. 2. The patient population. 3 The service line. We’ve found however, that one area of value will be the tipping point for either your organization or your patients.

For a consultation on return on investment and value of patient engagement, contact sales@wellpepper.com.

Posted in: patient engagement, Patient Satisfaction

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Evaluating A Patient Engagement Solution

In the past year, patient engagement has evolved past pilots to enterprise-wide deployments, and standards are emerging to evaluate patient engagement platforms. We definite patient engagement platform as a comprehensive system to enable patients to participate in their care, follow treatment plans, and get support from their care team. These patient interactions may occur outside the clinic or inside the hospital setting or clinic. What’s key is that they occur on the patient terms, and the patient device.

Here’s a checklist to get you started, and you’ll find in this check-list why your EMR will not deliver a compelling patient engagement experience.

  • Engagement: The first job of a patient engagement system, is of course, engaging patients. You should expect significantly better uptake in user interactions from a patient engagement system than from your patient portal. What percentage of patients login and use the platform? Do they show the ability to engage patients over time? Are there statistics for engagement for different patient demographics?
  • Usability: Patients are consumers, and their expectations for usability of your application are the same as for any other application on their devices. Can you deliver an experience on par with great consumer applications? Can patients of all ages and abilities use the application without help?
  • Multi-modal Interactions: This is a fancy way of saying that the system needs to support different ways of interacting with patients, for example, SMS, email, web, mobile application, and emerging technologies like voice. Can the system deliver patient interactions in ways that are appropriate for the patient and the content?

multimodal patient interactions

  • Interoperability: Your patient system will need to interface with other systems, like your EMR, scheduling, referral management, and possibly even billing systems. Interoperability needs to be built in from the initial design of the system. Does the patient engagement system have an API? Does it charge extra for application integration interfaces? If the answer to either of these is no, you don’t have an interoperable.
  • Scalability: Scalability takes two forms. Does the system help you to scale care? Can you see more patients, or see patients more efficiently because they can self-manage? Does it provide recommendations for providers and alerts that are at the right level for the interactions? The second form of scalability, is in interventions. Point solutions may address one type of intervention very well, but both patients and health systems need to manage multiple problems. Does the system scale to any type of intervention?

You’ll notice that this list does not include HIPAA compliance: that’s a given. Security and the protection of PHI are table stakes that any good system can show you before you start the rest of the evaluation.

In addition to the technical and usability criteria, your patient engagement solution needs to deliver on value. Determining value will be different for each organization, but we have some tips to help you make the case for yours.

Posted in: Adherence, patient engagement

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Trends That Survive Healthcare Reform

While many aspects of the Affordable Care Act drove significant new opportunities, innovation and change in healthcare, this recent article from Harvard Business Review points out that there are trends that are not dependent on the system. In particular they identify three trends that are not dependent on the act in its current form:

  1. Aging population
  2. Technology adoption
  3. Discoveries in life sciences

However, we think there are at least three more that will mean that the momentum in technology innovation and a patient-centered approach will continue.

  1. Consumer focus: High deductibles are driving two types of behavior. Patients are acting more like consumers and are shopping with their healthcare dollars. Healthcare organizations are trying to attract patients and better understand their experiences and pathways through the organization. The expectation of good and real-time service is high.
  2. People are getting less healthy: While we would like to see this change on its own, through diet and exercise, the fact is that people are not eating well or active enough, and the rates of diabetes and pre-diabetes are increasing. By 2030, it’s estimated that over 470M people world-wide will have pre-diabetes.
    Leading causes of death

    Leading Causes of Death from http://www.independent.co.uk/news/health/the-things-most-likely-to-kill-you-in-one-infographic-a7747386.html

  3. Value stays top of mind: Our healthcare costs cannot keep rising indefinitely, and experiments in value-based payments have shown to work. Payer/provider organizations are looking to deliver better outcomes at lower costs, and patient self-management and self activation can help with that.

While patient engagement is not the only solution, we believe activated people and patients are an under-utilized source of positive health outcomes. Regardless in of changes in the healthcare act, that will remain true.

Patient engagement has been a mantra for those seeking to reform health care, as it’s widely accepted that patients who are engaged in their own health care have better outcomes. Frank Baitman & Kenneth Karpay

 

Posted in: Healthcare Policy, Healthcare transformation, Outcomes, patient engagement, Uncategorized

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Mary Meeker’s 2017 Healthcare Trends Report Shows Opportunity

An annual highlight of Recode’s CodeConf is Mary Meeker’s internet trends report. Last year, I had the pleasure of hearing her in person, and I’m not sure I’ve ever heard a presentation with so much good data, presented so quickly. This year, I wasn’t able to attend, but she also ran out of time for some of the most important slides for a healthcare entrepreneur like me. Based on a quick run-through of the deck, these three slides struck me. (If you want to see the full section on healthcare, it starts at Slide 288.)

Not surprising that consumers expect digital health services, or that Millenials lead in most categories. It’s also not surprising that Boomers have sought the most remote care–they have probably sought the most care overall. It might be interesting to see this pro-rated by care usage. That Boomers are not looking at online reviews is very interesting given how much attention the surgeons we work with give to them.

 

 

 

 

 

 

 

 

 

 

 

 

Even with all their consumer device troubles, Samsung squeaks above Apple, and Facebook and Amazon both with a tremendous amount of data about you, are still reasonably well trusted. Both Microsoft and Google have tried and failed previously to own your personal health record, but they are well positioned to do so. What would also be interesting is to see these trust levels against traditional healthcare companies like GE or Johnson & Johnson.

 

 

 

 

 

 

 

 

 

 

 

 

EHR adoption is not surprising since it was mandated through meaningful use. It’s a bit depressing to look at the 2004 stats, and think back to which parts of your life weren’t digital in 2004, and compare that to your medical records. However, the biggest opportunity we see in this slide is dramatically expanding the data points available by tracking patients outside the clinic. Physicians are making decisions with only a few data points when there is so much richer information available through patient-entered and patient generated data.

Posted in: Healthcare Research, Healthcare Technology, Healthcare transformation

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T2 Telehealth aka ATA 2017 aka ATA 23: Part 2, How Did We Get Here and Where Are We Going?

This was my second trip to Orange County Convention Center this year, so it was hard not to compare and contrast the annual American Telemedicine conference to HIMSS, the biggest health IT conference. As well, it was my third time at the ATA conference, back after skipping in 2016, and the gap made it easier to reflect on previous years as well.

The ATA annual is almost 10 times smaller than HIMSS, which makes it a lot less exhausting and easier to focus. There’s not a feeling that for every second you’re talking to someone you’re missing out on talking to someone else equally as interesting and valuable. (There is no shortage of interesting people, just a more manageable group.) The size also makes it a bit easier to talk to people as they’re not rushing off to walk a few miles across the convention center to the next session.

The first year I attended, 2014, the tradeshow floor was full of integrated hardware and software solutions, and Rubbermaid was even a vendor selling telemedicine carts. It was almost as though the iPad hadn’t been invented.  It was the year that Mercy Virtual launched their services as a provider of telestroke and telemonitoring for other health systems. A provider as a vendor caused a bit of a stir on the tradeshow floor.

By the next year, the integrated hardware and software vendors were dwindling, but talks were largely still given by academics and were focused on pilot projects that while showed success, talks often ended with a plea for thoughts on how to scale the program.

ATA evolved out of an academic conference and that’s still quite prevalent in the presenters who are often from academic medical centers, and reporting on studies rather than implementation. Data was important in all sessions, but measurement of value was inconsistent. In addition to academic medical centers, most leaders in telehealth seemed to be faith-based not-for-profits, like Mercy and Dignity, and as well as rural organizations where the value was clear.

That said, a welcome addition to this year’s content was two new tracks on Transformation and Value. I spoke in the Value track at ATA, along with Reflexion Health and Hartford Healthcare about the value of telerehab in total joint replacement, and we were able to share data points from real patient implementations, in addition to clinical studies. (If you’re interested, in the Wellpepper segment, get in touch.)

Although, harkening back to the day 1 keynote, the definition of value depended on the business model of the telemedicine platform being implemented. There’s no question that telestroke and neurology programs, and telebehavior programs deliver value especially in rural areas without direct access. At Wellpepper, we’ve seen definite results in post-acute care, both in recovery speed and readmissions.

In other sessions the value was not as clear and no one was able to fully refute the study that when offered the choice, patients used telemedicine in addition to in-person visits, thus driving up costs. In fact, the director of telemedicine for a prominent healthcare organization confirmed that patients were using televisits for surgical prep when they could have just read the instructions given to them. (Or interacted with a digital care plan like Wellpepper.)

As with every technology conference the voice of the patient was absent, with the exception of head of Mercy Virtual Randall Moore, MD who started all his presentations by introducing us to patient Naomi who was able to live out her life at home, attend bingo, and enjoy herself due to the benefits of the wrap-around telemedicine program that Mercy put In place. Oh, and it cost a lot less than the path of hospital admissions she’d been on previously. Sounds like triple aim, and what we all need to aspire to.

So, based on the keynotes, the sessions, and the show floor, I’d characterize this year’s conference as a world in flux, like what’s going on elsewhere. There was a sense of relief that the ACA had not been repealed. HIMSS took place before the proposed repeal and replace plan died, and there was a lot more fear and uncertainty. Vendors and providers alike are looking to strengthen the value chain. Unlike HIMSS, there was a lot less hype. Machine learning and AI were barely mentioned except in keynotes possibly because telemedicine is still largely a world of real-time visits, and extracting meaning from video is a lot harder than from records. We see promise, people want to do the right thing, but it’s not clear which direction will help us ride out the storm.

 

Still trying to figure out what this has to do with Telemedicine. Look better on realtime visits?

Posted in: Healthcare Disruption, Healthcare Legislation, Healthcare motivation, Healthcare Policy, Healthcare Technology, M-health, Prehabilitation, Rehabilitation Business, Telemedicine

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T2 Telehealth aka ATA 2017 aka ATA 23: Part 1, The Eye of the Hurricane

While there is a focus on transformation, value, and outcomes going on, if the keynotes are any indication it may be a rough road ahead for telemedicine.

“It’s the 23rd year for the American Telemedicine Association conference, why are we still talking about how to get paid?”, admonished Pamela Peele, PhD economist and Chief Analytics Officer of UPMC during the opening keynote of the annual conference of the American Telemedicine Association.

Pamela Peele at ATA2017

Pamela Peele at ATA2017

“Especially since, as this audience knows, telemedicine is the best thing since sliced bread?

Why indeed? Well, it’s complicated. The problem is that each person in the value chain, the payer, the physician, the healthcare organization, the patient, and the patient’s closest adult daughter (aka primary caregiver), only see the value of one slice of that loaf of bread, and we collectively as purveyors of telemedicine have to sell the entire loaf. There’s no clear solution to this problem. However, with unsustainable costs of healthcare, and increasing consumerization we have got to figure it out. The taxpayer is bearing the brunt of the costs right now, and Peele characterized the shift of baby boomers to skilled nursing facilities as a hurricane we are unprepared for. One way out is to keep people at home, and for that we need Medicare to fund a cross-state multi-facility study to determine efficacy, value, and best practices. Fragmentation of trials is keeping us from wide scale adoption.

The Adaptation Curve

The Adaptation Curve

“We have got to figure it out” was also the theme of best-selling author and New York Times columnist Tom Friedman’s keynote promoting his new book “Thank-You For Being Late.” Friedman claimed to be more right than the rightest Republican and suggested abolishing corporate taxes and at the same time more left than the leftist Bernie Sander’s supporter suggesting we need an adaptable safety net. His major thesis is that we are undergoing 3 climate changes right now: globalization, climate, and technological. To survive and thrive in this new world, we need to adapt and evolve, and take our cues from Mother Nature, not from some sort of top-down regulation. Like Peele on the previous day, Friedman also sees a hurricane coming and suggests that the only way to survive is to find the eye of the storm not by building a wall.

Adapting and evolving will come in handy with the harder times for healthcare investment ahead predicted by the venture investing panel in the day 3 keynote. Tom Rodgers of McKesson Ventures, and Rob Coppedge of the newly formed Echo Health Ventures pulled no punches, as they tossed of tweet worthy statements like “Don’t tell me you’re the SnapChat of healthcare” and “it seems like there are only 3 business models for telemedicine.” The later was Coppedge’s comment on walking the tradeshow floor. (The models are direct to consumer, platform, and as a combined technology and service.) Rodgers had no love for direct to consumer models or anything that targeted millennials who he deemed low and inconsistent users of services. Platform vendors were advised to surround themselves with services: video was seen as a commodity.

So where does that leave us? Value, value, value. The challenge is that the value is different depending on the intervention, the patient, the payer, and the provider. Preventing readmissions, aging at home, decreasing travel costs, all provide benefits to one or more of the key stake holders. Can we figure out how to reimburse based on slices of value? How do we get together to realize that value? And how do we do it before the hurricane hits?

Posted in: Behavior Change, Healthcare Disruption, Healthcare Policy, Healthcare Research, Healthcare transformation, Telemedicine

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Telehealth 2.0: Our picks for Orlando

File-2016-3478-2017_ATATradeshow_1920_25I am really looking forward to heading to Orlando for the American Telemedicine Conference, aka Telehealth 2.0. Seattle has been under a rain cloud this entire year, and I want to see the sun. I’m also looking forward to sharing our findings in using asynchronous mobile telehealth for remote rehabilitation with patients recovering from total joint replacement. I’ll be speaking with our colleagues from Hartford Health, Reflexion, and Miami Children’s Hospital on Sunday during the first breakout sessions. Hope to see you there!

In addition to the topics about legislation and regulations, it’s great to see these sessions on value, quality, and new treatment models. Here are some of Wellpepper’s picks for the conference.

Sunday

Monday

Tuesday

Now with all this great content, networking and a talk to prepare, when will I see the sun?

Posted in: Adherence, Behavior Change, Health Regulations, Healthcare Disruption, Healthcare Legislation, Healthcare Policy, Healthcare Research, Healthcare Technology, patient engagement, Telemedicine

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EvergreenHealth: Evolving Care Outside The Clinic for Better Outcomes

In 2016 we formally announced our collaboration with EvergreenHealth to deliver interactive care plans for Total Joint Replacement.

“Across our organization, we strive to be a trusted source for innovative care solutions for our patients and families, and our partnership with Wellpepper helps us deliver on that commitment,” said EvergreenHealth CEO Bob Malte. “Since we began using Wellpepper in 2014, we’ve seen how the solution enhances the interaction between patients and providers and ultimately leads to optimal recovery and the best possible outcomes for our patients.”

EvergreenHealth is an integrated health care system that serves nearly 1 million residents in King and Snohomish counties in Washington State, and offers a breadth of services and programs that is among the most comprehensive in the region. More than 1,300 physicians provide clinical excellence in over 80 specialties, including heart and vascular care, oncology, surgical care, orthopedics, neurosciences, women’s and children’s services, pulmonary care and home care and hospice services. With expansion into more rural areas, and a catchment area that serves Seattle’s ‘eastside’ home to Microsoft and other major technology companies, delivering virtual care is both an imperative for an an expectation of EvergreenHealth patients.

Since our initial announcement, we’ve seen thousands of patients complete care plans and outcome surveys, and expanded within the musculoskeletal service line to include preventive care, spine surgery, and general rehabilitation.

User Experience

EvergreenHealth has a white labeled version of the Wellpepper patient application called MyEvergreen and available in Android and Apple App Stores. Clinicians use the Wellpepper clinic portal, and receive alerts to their email inbox if patients report any issues or unexpected outcomes.

EvergreenHealth has deployed care plans based on their own clinical best practices. 

Outcomes

  • Thousands of patients have used Wellpepper interactive care plans at EvergreenHealth
  • Interactive care plan users show higher scores on standardized outcome reports than those tracking outcomes without an interactive care plan
  • EvergreenHealth patients show a higher engagement level than Wellpepper’s overall 70% engagement

I would not want to have another knee surgery without the app. I was 81 and it wasn’t hard for me at all!

Total Knee Replacement Patient at EvergreenHealth

Technology

This deployment used a white labeled Android and iOS application for patients, and a clinic portal for clinicians. Patient invitation is synched with the Cerner medical records software using an ADT feed. Clinicians are notified of patients requiring additional help with an email alert. Wellpepper’s entire HIPAA secure platform was leveraged for this implementation, and EvergreenHealth deployed custom care plans based on their own best practices. They continue to add innovative features as they are added to the Wellpepper platform.

Posted in: Exercise Physiology, Healthcare costs, Healthcare Technology, HIPAA, Interoperability, M-health, Outcomes, patient engagement, Prehabilitation, Seattle

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HIMSS 2017 Recap: What’s Hot and What’s Hype

Wellpepper had a great HIMSS 2017 Conference with a very busy booth in the Innovation Zone, a panel on the current state of innovation, and a talk on Delivering Empathy Through Telehealth. Here are a few of our thoughts on the conference compiled from our team.Empathetic Care Through Telehealth

Cognitive and AI: Hype

Starting with Ginni Romety’s keynote, Cognitive and AI were definitely the buzzwords of the conference. Everyone is excited about the promise but it seems like the current status is not ready for takeoff. First, there’s a lot of work to get data out of the EMR, and second, no one seems quite sure what the killer use case is going to be. Immediately before HIMSS, MD Anderson announced that after a $62M investment they weren’t seeing value in IBM Watson and were pulling out of the program. That did not stop them from co-presenting with Mayo Clinic and Watson at the conference. The main use case seemed to be shortening the time to identify cancer patients for clinical trials from 30 minutes to 8 minutes. Another example, which just highlights the sorry state of clincial technology, was to use Watson on top of Epic to help staff figure out how to use features. During the session, Mayo CIO Christopher Ross referred to Watson as a toddler. While all of this was disappointing, it’s heartening that for once healthcare is on trend with the rest of the tech world, and possibly pointing to an accelerated evolution of health IT.

IMG_0611Patient Engagement: Hot

In 2016, patient engagement was also hot, but this year, we’d also say it was real. Buyers visited our booth with checklists of capabilities they wanted to see. Pilots were completed last year, and now they are making platform decisions for patient engagement. We’ve noticed this ourselves in the past 6 months, we’ve seen the patient engagement purchase decision elevated to the C-suite, and the decision being made based on capabilities that will address the needs of all patients and all service lines.

Interoperability: Hot

Compared to the previous year, we saw a lot more talk about interoperability, whether that was EMRs building out APIs and developer programs, the CommonWell Alliance, or talk about how block-chain could be used to both secure and transfer healthcare data. Understanding that data needs to flow with the patient, and also that a heck of a lot of data is being created outside the EMR (in patient engagement solutions for example), is driving a greater commitment to interoperability in the industry.

Healthcare Investment: Hot

The Sharks said so, so it must be hot. The HIMSS Venture+ Investment forum this year had a much more diverse set of pitches than previously, including a social venture. and was won by DiaCardio, a woman-led company from Israel automating evaluation of heart ultrasound.

The Affordable Care Act: Prognosis Unclear

Make no mistake, the potential repeal of the ACA is looming heavy even in health IT. Health systems Boehner, HIMSSare concerned about impact on Medicare and Medicaid revenue. While bundles and value-based care have been quite positively received, the current uncertainty is putting a hold on capital expenditures. (Did we mention that Saas can be accounted for as operating expense?) Possibly the most entertaining speculation on the ACA came from former house speaker John Boehner and former governor Ed Rendell. Rendell suggested that we repeal Obamacare and replace it with the Affordable Care Act. Boehner mused that repealing without a plan would place all the blame and problems with the current system firmly on the sitting government, and recommended that it not be repealed.

The Takeway?

We’re still optimistic. IT is increasingly having a seat at the table within healthcare. Although not all EMR implementations have been seen as a success for clinicians, we are seeing a shift to an expectation of better software for both patients and providers, for data to move smoothly, and the promise of insights and better care when that data can be analyzed and acted on. We’re already looking forward to HIMSS 2018 Las Vegas.

Posted in: big data, Clinical Research, Interoperability, patient engagement

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Population Health and Patient Engagement: A Reckoning Is Coming

Population health and patient engagement should be best friends. To draw conclusions for population health, you need a lot of data, and patient engagement that is, patients interacting digitally with treatment plans and healthcare providers, generates a ton of data. Population health tries to analyze the general to get to the specific and identify patients at risk. Patient engagement starts with the specific patient, and with enough data recorded by those patients, can find general trends.

With patient engagement, the information is real-time. With population health it is backwards-looking. Population health has the richness of the medical teams notes and diagnosis but it is missing the patient perspective. Patient-generated data will have diagnosis if it’s part of a treatment plan prescribed by a physician, but it won’t have the full notes. A blurring of the boundaries between population health and patient engagement presents a way forward to greater insights about both individuals and groups, and can make population health actionable at the individual patient level by providing personalized instructions (with or without care managers).

However, to get to this desired end-state, we need to clear some obstacles, first of which is the idea that patient engagement generates too much data for physicians.

Yes, an individual physician does not want to see or review each data point that a true patient engagement solution generates. However, this information can be extremely interesting to the patient, especially when looking for trends to help self-manage a chronic condition so it is worth enabling patients to collect it. For example, looking at whether certain foods trigger arthritis, or whether certain activities trigger headaches. However, to draw conclusions like this, you must record a lot of data points and in real-time, and this makes physicians nervous. They have enough to do, and not enough time to do it in, so this data cannot add to that workload.

As well, patient-generated data is messy, which can be intimidating, especially in an industry that is looking for deviations from norms. The challenge with patient-generated data is that it can uncover that the long-tail is actually longer than previously thought, that there are sub-groups within previously thought to be homogeneous groups of patients with a similar condition. In the long run, this will result in medical breakthroughs and personalized medicine. In the short run this can be difficult to deal with in the current systems.

the long-tail is actually longer than previously thought

Does that mean that we shouldn’t collect patient-generated data? Not at all. Helping patients track their experiences is a great first step to self-management. Knowing whether they are following a treatment plan, and what their experiences are with that treatment plan can help healthcare systems determine the impact of their instructions outside the clinic.

Although physicians don’t want all this data, healthcare organizations both providers and payers, should want it. Other industries would kill for this type of data. Data scientists and population health managers at health systems should be clamoring for this valuable patient-generated data.

Patient-generated data is usually collected in real-time so it may be more representative of the actual current population. The benefit of real-time collection is that further exploration of the actual patient experience is possible and can be used to prevent issues from escalating. With backwards looking data whatever was going to happen has happened, so you can only use it to impact new groups of patients not current groups.Patient-Generated Data

Finally, patient-generated data is less likely to be siloed, like clinical data often is, because the patient experience is broad and often messy and crosses clinical department thresholds (or more simply, patients are usually treated for more than one issue at a time.) Being relatively new to market, patient-engagement systems are built on modern and interoperable technology which also makes accessing data for analysis easier.

So where will we end up? To our team at Wellpepper, it seems inevitable that influencing and understanding patient experience outside the clinic. If you are making decisions for an individual patient with only a few clinical touch points, this is a very thin slice, often with a specific clinician’s specialty lenses on the actual situation. While healthcare systems are currently dipping their toes in the water on collecting and analyzing this data, if they don’t embrace the whole patient, patients will vote with their feet and pocket books towards organizations that are data and technology driven.

Posted in: Adherence, big data, Healthcare Technology, Healthcare transformation, Interoperability, M-health, patient engagement, population health

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The Disneyfication or Consumerization of Healthcare

I had the privilege of participating in my second panel hosted by Curtis Kopf, Senior VP of Customer Experience at Premera, at the recent Washington State of Reform Health Policy Conference. Curtis was formerly of Alaska Airlines and is new enough to healthcare to be able to point out idiosyncrasies of healthcare, and he led the audience, my fellow panelists, Elizabeth Fleming, VP of Group Health Cooperative, Tabitha Dunn, VP of Customer Experience at Concur, and me on a rollicking discussion of who excels in customer service, how to emulate consumer organizations, and how not to emulate consumer organizations.

I enjoy panels as they afford the opportunity to evaluate my own perspective based on the insights of others usually in extremely different roles. This panel was unique as we represented payer, provider, employer, and digital health/technology: practically a cross-section of the industry.

Both over coffee prior to the panel and on the panel, we talked a lot about the influence and guiding principles of Disney as the quintessential consumer experience focused organization. Tabitha had just returned from a holiday trip with her family, and Curtis had the opportunity to attend the Disney Institute for customer service training during his time at Alaska airlines.

Before getting into the takeaways from our experiences and thinking about what to take away from Disney, we started the panel by discussing why consumerization was a topic in healthcare at all.

A number of factors have converged to drive consumer or patient-centric approach we now see in healthcare:

  • 20M newly insured people offered an opportunity that brought new players, like Walgreens, Walmart, Medical One, and Zoom+ into primary and urgent care market
  • On demand services like Uber and constant communication through messaging apps, and the ubiquity of smart phones created an expectation of healthcare on demand.
  • High-deductibles made consumers evaluate more closely how they were spending their healthcare dollars
  • Getting over the hump of initial EMR integration made physicians ask why they couldn’t have consumer-quality tools to do their jobs

Regardless of what happens with the ACA with the incoming administration, we don’t expect many of these things to change, although there may be more competition in primary care as these new players put pressure on incumbents.

How do you react when there is more competition? A customer-centric approach is a good place to start, which brings us back to Disney. As a child, I did a school project on Walt and his empire, but have to admit I didn’t know as much about them as my fellow panelists.

Here are my key takeaways from the discussion:

  • Disney is extremely consistent, which provides autonomy for their staff to make good decisions within the 4 values that Disney holds. Although you may think that the brand is the highest value, it is actually safety. A Disney cast member is allowed to break character only when safety is at risk. Consider this as you think about the healthcare experience: safety and good experience are not mutually exclusive.
  • If you’re going to try to emulate an experience from another industry, make sure you fully understand that company’s or industries core values. The that resulted when executives managed to the HCHAPS survey: Nurses were given scripts to follow rather than making decisions, which is the exact opposite of how Disney actually operates. Nurses should have been given autonomy to work within the values of the health system and the needs of the patient.
  • Disney has an entire underground operations center that supports what guests experience above ground. This supports both the safety but also the experience of the park. Curtis toured this facility while at the Disney Institute. What struck me the most about this was the realization that the hospital has no back-office. We’ve met with administrators in their offices that are converted hospital rooms. First, think how uninspiring this is for employees as an office. Second, these are usually on active hospital floors, so patients experience random water cooler conversation as they are in care.

As an outsider to healthcare, it took me a while to get used to going to the hospital to have meetings, and it still makes me uncomfortable to pass patients waiting in hospital beds in the hallway while I’m going to negotiate a contract. This lack of a “back-office” impacts patients and staff alike, and really extends to every patient interaction. The EMR is essentially back-office software. Why hospitals run their patient-facing experience from this essentially line of business technology is beyond me.

Although at Wellpepper our client is the health system, our most important user is the patient. We want to ensure that the patient experience is as good or better than any popular-patient facing applications, and represents how the patient understands their care. As a result, we are able to enable patients to participate, and self-manage, and still deliver valuable information to help the internal health system operations center be more effective, which is why I’m always happy to talk about the consumer experience in healthcare.

 

Posted in: Behavior Change, Patient Advocacy, Patient Satisfaction, Seattle

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Wellpepper’s Healthcare Christmas Wish List

santa

Dear Santa,

This year for Christmas we would like:

  • Real interoperability between EMRs and other systems so that data flows smoothly from patient to provider applications and between organizations. Make sure it comes with APIs and real reference architectures.
  • Modern, scalable, and reliable healthcare technology so CIOs and IT teams can spend more time innovating and bringing new ideas for patients and providers, and less time keeping systems up and running.
  • Patient-centered care where the goals of the patient are the most important outcomes considered. Make sure patients and providers can communicate about these goals and consider their impact on care.
  • Value-based care where cost and outcomes are evaluated to determine the right course of action. Let’s lower costs of care AND improve outcomes.
  • All people to have affordable healthcare regardless of pre-existing conditions. No one should go without healthcare.
  • When you deliver all the presents, please take away all the fax machines!

 

Thanks, Santa!

Good luck on your travels around the world on Christmas Eve.

 

Love, Wellpepper

 

PS We care about your health, so we’re leaving you an apple and some carrots for the reindeer rather than cookies this year.

Posted in: Healthcare motivation, Healthcare transformation, patient engagement

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What Keeps Healthcare CEOs Up At Night?

This week I had a double whammy of healthcare value from the comfort of my desk when MATTER Chicago live-streamed their event “What Keeps Healthcare CEOs Up At Night.” In addition to participating online with 40 others and engaging on Twitter on the topic, I’m pretty sure that Accenture charges big bucks to healthcare organizations to present these findings from interviews with over 50 healthcare CEOs. I got great info, some online networking, and no traffic!

So what does keep healthcare CEOs up at night? It seems that there are differing levels of awareness regarding the health of one’s own organization, changes in population health, as well as changes in healthcare in general. Perhaps the only thing keeping them all up at night is the delicate balance in shifting to outcome and value based payments without disrupting today’s revenue streams. It’s a classic innovator’s dilemma, but nonetheless, interviews and research with over 50 healthcare CEOs have shown that only some are effectively straddling these two worlds. Michael Main, managing director at Accenture Strategy, walked the full-house crowd at Matter and 40 of us on the live stream through the research, looking at winners and losers as well as making a few predictions for how the change would happen.

According to presenter Michael Main and the Accenture team’s analysis, only 5 out of these 50 CEOs were actually successfully making the shift to value based care, and of the rest, only 15 were capable of making that shift.

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See full report on Accenture here

To make the shift, Main identified some key criteria:

  • The CEO must have a strong passion for what healthcare can be, not what it is today. He or she must have vision and be motivated to make his or her system the #1 or #2 in their area.
  • The shift from volume to value needs to also include a shift back to volume but with the volume being serving a larger population base, not doing more to each patient. The only way to do this is to really understand a health system’s catchment area and the population. Main used the example of the 1,500 data points that Experian, the credit check company, has on each person and compared that to how few data points health systems have.
  • Care must move from being physician-centered to patient centered, but there must be strong physician leaders on board.

Main also identified barriers to change today:

  • Perverse incentives that reward for doing more to a patient rather than what’s actually best for the patient. Here, Main provided a couple of personal examples, including his father who was admitted to the hospital for 48 hours because of protocol when he would have been better at home waiting for test results.
  • People being worried about their own jobs. Main mentioned working with a nurse’s union on a patient-centered medical home project. Everything was positive until they realized the model would require fewer nurses than first expected. Demonstrating the basic adage that you can’t get someone to believe in something if their own livelihood depends on them not believing it.
  • Too much gray hair in the C-suite. Main believes that many hospital CEOs are too close to retirement to want to tackle the risk. They are looking to ride out the current fee for service world, and hand over the reins when the real change needs to be implemented. Most CEOs estimated the change will take another 7-10 years so they had time to wrap up their retirement packages. (Shades of physicians retiring around the deadlines for implementing electronic medical records.)

As you can imagine, there will be winners and losers in this new world of capitated and value-based payments. Basically, aside from the 20 CEOs that Main identified as either already changing or capable of it, the rest he felt were in the loser category. As care is pushed to the lowest cost delivery, hospitals could lose out if they don’t build integrated networks with primary care and urgent care in addition to emergency and inpatient. Smart CEOs are looking at consolidation by buying the best systems or smaller organizations instead of looking for bargains. They know that those bargain competitors will end up out of business. Winners will figure out how to incubate models that will cannibalize their own business rather that fending off upstarts who are looking to do it to them.

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Winners will have the right leaders who can take a patient-centered approach: both in aggregate and for individuals. In aggregate, they will better understand the patient base they serve in their geography and they will look at treatments that are outcome-driven and patient centered as well as looking at treatments that will impact each individual rather than the standard protocols like what Main described with his father’s treatment.

The Accenture research definitely pointed to answers in the transformation. Unfortunately, it seems like a number of CEOs today aren’t even asking the right questions. And of course, as with every healthcare event for the next while, with the looming threat to repeal the ACA, there are even more questions we need to be asking.

Posted in: Healthcare motivation, Healthcare transformation, Patient Advocacy

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What’s True Now?

 

Health systems and payers alike are scrambling to figure out what the incoming administration means by repealing Obamacare. The payers admitted to having no contingency plans if Trump won. Trump doesn’t have a clear model, and the Republican party has a number of proposals. Some involve changing the names of programs or offering them in a different way. Some involve scrapping large sections of the affordable care act.

Rather than second-guessing what’s to come, at Wellpepper, we are focusing on what’s true now and what will remain true going forward.

We believe these things will continue to hold true:

  • Innovation will continue. If anything we hope that new innovation in healthcare, and technology innovation in particular is driven by market forces rather than legislation which created winners out of what was not always the best technology.
  • Consumer-focus is good. 20M newly insured individuals and high-deductibles helped create a market for new care organizations like local urgent care and patient-focused primary care. This consumer evolution will continue as patients demand that their healthcare dollars deliver good service.
  • Value and outcome focused approaches will be rewarded. Whether it’s traditional payers or self-insured employers, the light has been shone on areas to improve care AND reduce costs. Healthcare organizations have seen investments in outcomes pay off as well.

It’s time for a new patient experience that is real-time, connected, and based on the individual. We need to take advantage of the ability of technology to scale, analyze, and deliver personal experiences to leapfrog the current technology implementations in healthcare and deliver better outcomes and greater value in healthcare.

Posted in: Health Regulations, Healthcare Legislation, Healthcare Policy, Outcomes

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