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Personal or Population Health? Big Data or Small Data?

Seattle Health Innovator's meetupJune’s Seattle Health Innovator’s Meetup topic was on Innovations in Population Health Management. Interestingly much of the discussion from panelists circled back to the individual patient. It seems that much of this was because the great promise of big data analytics in healthcare and automation and economies of scale through electronic medical records have not been realized. The audience consisted of entrepreneurs building solutions in this area, and innovative and entrepreneurial people within health systems.

The event, at the sleek new Cambia Grove healthcare meeting space, was kicked off by Dr. Wellesley Chapman, Medical Director Innovation and Development at Group Health. Dr Chapman set the stage by defining population health in a highly inspirational manner by referring to The Gates Foundation mission that everyone deserves to live a healthy and productive life. Narrowing in a bit more Dr. Chapman talked about the influences of good health on a population. Interestingly, although population health is largely thought of as a health system problem, the formal medical system only has a 20% influence on the health of a population and a person. Socio-economic factors have a much bigger influence, things like building walkable cities that encourage activity and community, access to healthful foods, and education. Unfortunately with healthcare representing 18% of the US GDP, there is a misallocation of funds to the clean up of problems versus infrastructure that will affect the well-being of the whole population. However, even though care delivery is a small part of the overall picture and influencers of health, Dr. Chapman enthusiastically encouraged the audience to do what they could to affect change.

The meet up continued with a panel discussion moderated by former Group Health VP of Marketing and now patient engagement consultant, Randy Wise and featuring:

When considering a population health strategy, key factors the panel felt were important were lead time to implement, expected outcomes, costs to patient and payer, and the overall patient experience. Patients are concerned about the quality of their lives, and this needs to be addressed at the primary care level, however, most health systems do not have a primary care strategy. Primary care is reactive rather than preventative, and reactive care is not usually focused on patient goals. Since the health of a population is so varied, at the primary care level, panelist thought “everything could be considered population health” making it difficult to pinpoint specific solutions for care.

When asked about whether big data was improving population health, panelists were negative to neutral, citing Excel spreadsheets used to review data, and the opportunity to know a lot more about patients. However this again came back to the specific saying that the intervention is all about the relationship between patient and provider and asking whether we are enabling patients to follow through with recommendations. (At Wellpepper, we would say there’s a great opportunity to improve here based on many of the care plans and instructions we’ve seen.)

Seattle Health Innovator's MeetupDr. Levine from Iora talked about his experiences training residents in listening skills and the payoff. Compared to a common approach of telling the patient they have limited time and to focus on the top issue, Dr. Levine advocated listening first, ask the patient to recount all their concerns, make a commitment to truly listen and hold the information the patient provided, and then follow up on the most pressing issues. Although the residents were skeptical, this approach yielded significantly faster follow-up as key information wasn’t being uncovered at a later date.

Events like this provide a great opportunity for those enthusiastic about changing healthcare to exchange ideas, and especially for entrepreneurs to learn practical advice from those in the trenches delivering care and trying new models. The big takeaways are that the promise of big data in healthcare is yet to be realized, and because of that population health tools may not be as effective as they could be. While the focus on patient personalization, customization, and meeting the needs of the individual are key, we need to figure out new ways to scale to solve this great problems in health.

Posted in: Behavior Change, chronic disease, Healthcare Disruption, Healthcare motivation, Healthcare Research, Healthcare Technology, Healthcare transformation, M-health, Seattle

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This month [May] in Telemedicine

American Telemedicine Association: This month [May] in Telemedicine
June 2, 2015

Gary Capistrant, Chief Policy Officer, American Telemedicine Association
Jonathan Linkous, CEO, American Telemedicine Association

John commenting on the heat in Washington, D.C.

John commenting on the heat in Washington, D.C.

The annual ATA conference in LA last month had the largest attendance rate that ATA has seen in 20 years. It featured over 500 presentations; the video recordings of every presentation is available for purchase. Our own Wellpepper CEO, Anne Weiler, went to the conference and you can read her blog here. Also in May there were some big changes at ATA; a new president, new officers and members of the board of directors were elected. Their backgrounds are all impressive, thank goodness because we need them!

Telehealth’s exceeding advantages in both entrepreneurial and patient health naturally have lead to several new organizations popping up every year (or every month it seems) that use clinical consultations over the internet/phone. And where there is money to be made and quite literally lives at stake, legality is involved. The Texas medical board ruling prohibiting use of telehealth without previous relationship with patient, or a healthcare professional being present with patient when telehealth is being utilized (Huh, how is that telehealth?) lead to Teladoc filing a lawsuit against TX. Consequentially last Friday the Federal court ‘temporarily’ stopped TX medical board ruling. With that said ATA provides accreditation for online consultation sites to make sure sites are open/transparent, adherence to all relevant laws and regulations and promotes patient safety; however Teladoc isn’t accredited by ATA.

For those of us waiting for a particular practice guideline from ATA, there are now 10-12 Telehealth practice guidelines available on the ATA website and six active workgroups are under development; Teleburns, teledermatology, child mental health, general pediatrics, remote health and data management and telestroke. Please contact ATA if you would like to be involved in a workgroup, it is practicing professionals like you that make these guidelines viable.

If your state has a Telemedicine Parity Law, kudos, but 23 still do not. To be positive, we are getting there, a new milestone was achieved in the laws; Minnesota, Nevada and Indiana this week alone have added their own parity laws. Also in state news ATA added the highly awaited and much needed resource, the ATA State Telemedicine toolkit titled “Working with Medical Boards: Ensuring Comparable Standards for the Practice of Medicine via Telemedicine”. Again this is a call for involvement!

Congress or digress? The three letter difference is slight! But hey three new bills were introduced to Congress since the last webcast that will be interesting to watch; Telehealth Enhancement Act 2015, Amendment to Social Security Act to expand access to telehealth stroke services under Medicaid, and the VETS Act of 2015. The VETS Act of 2015 would permit U.S. Department of Veterans Affairs health professionals to treat veterans nationwide with a single state license. I cannot help but speculate the motives of introducing this bill; are they using the VA as a pilot for licensure compacts for ‘civilian’ physicians, etc.? Let’s hope so and more importantly I hope it goes well and only reaps benefits.

The announcement of a new Distance Learning and Telemedicine Grant from the USDA was mentioned and I wanted to make note of it in case any of our readers qualify. Please check it out here.

The next ‘This month in Telemedicine’ will be announced shortly on the ATA website and as always is free to watch.

Posted in: Healthcare Policy, Healthcare Research, Healthcare Technology, Telemedicine

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Advancements in Diabetes Research: A Salon Dinner for JDRF

This past week I had the opportunity to attend a salon dinner at Seattle’s lovely Canlis hosted by Derek Rapp, CEO of the Juvenile Diabetes Research Foundation (JDRF).

Derek Rapp

Derek Rapp, source

Unlike Type 2 or 3 Diabetes, Juvenile Diabetes, or Type 1 Diabetes is an auto-immune disease so while the symptoms are similar to some of the other two types of diabetes, research into causes and prevention is more closely aligned with other auto-immune diseases like multiple sclerosis. Many autoimmune diseases are thought to be triggered by viruses, and there are some thoughts that this is also true for Type 1 diabetes.

Although this was an informal dinner, Rapp provided some interesting updates to the work the JDRF is doing to find the causes and a cure.

Most of the discussion centered around advancements in care, as Type 1 diabetes care is quite onerous for people who live with it, most of whom have onset of the disease in childhood or early adulthood. Rapp himself has one son who has Type 1 diabetes and another who carries the marker, and many of those in attendance had children with the disease. Type 1 Diabetes requires daily blood tests, hawk-like attention to diet, and insulin injections: quite a burden for anyone let alone children and young adults.

Like all areas of healthcare, diabetes care also has the ability to benefit from big data and from personalized data both for research and to provide better control. An example of a medical device breakthrough that works with both types of data is the artificial pancreas, which will ultimately mimic the function of the pancreas to control blood sugar levels.

Another place information flow can benefit is for relatives, which you can imagine is crucial for helping parents help their children. Providing alerts automatically when blood sugar spikes or drops and enabling parents to see how their children are doing when away from them is another benefit of continuous glucose monitoring.

Other advancements that Rupp shared with the group were glucose responsive insulin that waits in the body until there is excess glucose before being deployed. It works by packaging the insulin within the body and releasing based on reading of a “glucose tag.” Another study in progress is encapsulating a device for insulin within cells so that it can be surgically implanted and not rejected by the body.

The audience was visibly excited by hearing about these developments, but their spirits were dampened slightly when Rapp reminded them that it takes $1B and 14 years for a drug to get to commercialization. One guest also asked whether the same drug companies that made significant revenue from insulin were incented to come up with other solutions. However, between the ability of big data to find connections between information and the current speed of genomic research, Rapp was hopeful. He believes that will be possible to prevent Type 1 diabetes before a cure is found.

Canlis Private Dining Room View

Canlis Private Dining Room View, Source Seattle PI

Posted in: Health Regulations, Healthcare Disruption, Healthcare Research

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