M-health

Archive for M-health

Transforming Health at Montana HIMSS Annual Spring Conference

Possibly the most interesting thing in healthcare technology is the breadth of scope that health tech needs to cover, and the talks at the HIMSS Montana annual spring conference represented that with talks about security, how to find money for projects, consumer engagement, and how to create a state-wide initiative for healthcare IT. Just like the state of Montana, talks covered a lot of territory.

 

 

 

Here’s a small review of what attendees experienced:

Voice Technology

I had the honor of kicking off the HIMSS Montana Chapter “Transforming Healthcare” conference with an introduction to how voice technologies show promise in patient care. There’s still a lot of concern in the industry about what these voice assistants are tracking, and the speaker immediately after me talked about a surgeon using Alexa to play music in the operating room (a non-compliant use as Alexa might be ‘listening’ to the conversation). However, today’s news that Comcast is also getting into the voice healthcare game shows that there is real promise and high stakes. If you’re interested in this topic you might want to check out our white paper on considerations for designing voice interfaces for patient care, or join me at Voice Summit in Newark this fall for a workshop.

Security

Not surprisingly security remains a hot topic in healthcare, probably because of the surface area of devices and IOT devices. While bad actors and hackers remain a constant threat, people and process are as important, and speakers stressed that often breaches are not malicious but when people don’t follow proper process like the backup company driver who left a van full of backup tapes in his driveway overnight where it was broken into.

Interestingly according to Fred Langston, CISSP, CCSK Executive VP of Professional Services CI Security, imaging systems account for almost 50% of security alerts, possibly because the systems involve both hardware and software, and have often been installed for years. EMRs are seen as relatively safe, and other risks come from devices, attached to the hospital network, where manufacturers have stopped upgrading or patching devices, or simply stopped support for them. The reason is that any sort of software or firmware upgrade requires new FDA certification, which may be cost prohibitive on a discontinued product. There are startups trying to solve this problem, however the FDA may also want to reconsider the unintended consequences of their certification program.

Generally, it takes 205 days within a hospital system until a compromised asset is detected. Decreasing this time and the time from the realization of the compromise and fix (known as dwell time), should be the goal of all IT departments. Hiring a security consultant organization may be the best bet for the broad scope of monitoring that needs to happen.

Finding Money for Innovation

Dianna Linder, MPA, FACHE Director of Grants and Program Development, Billings Clinic is a grant-writer who has been successful at finding funding sources for innovative projects. Much like targeting sales, donor targeting involves figuring out the value proposition you can offer to a particular donor. The Billings Clinic has a shark-tank day where everyone comes with their projects to request funding. Projects are stack-ranked and budget is applied. For those that don’t get budget, Linder looks for other sources like grants. She warns that grants are best used for projects that are new experiments and where the headcount is not part of the spend since they cannot ensure someone of a job when the grant money runs out. A great example of a use of grant money was for building an intake facility for mental health, so that people did not languish in the ED. This program used staff that were already at the system and proved successful enough that it became operationalized the following year.

At Wellpepper, we’ve seen a few projects start with grants, like the one that the Schultz Foundation provided to EvergreenHealth to kick off a patient engagement project that has since been operationalized. Grants for research projects like the one with Harvard are also interesting.

Consumer Experience

Ben WanamakerHead, Consumer Technology & Services from Aetna made us promise not to blog or tweet about his session where he shared some results from Aetna’s partnership with Apple’s smart watch. So, go see for yourself how the application uses behavioral economics and design principles to reward people for healthy behavior.

Building a State-Wide Healthcare IT Strategy

Did you know that 10 states have a state-wide healthcare IT strategy? No? Neither did I. These strategies, when aligned with Medicare and Medicaid initiatives can help drive adoption and support for healthcare technology, innovation, and modernization initiatives. The benefits of the roadmaps are to focus on healthier residents, and freeing information. Another important benefit is funding that is matched by the federal government. While this type of program may be out of reach for the average healthcare technology enthusiast, knowing that they exist can offer opportunities to align with larger initiatives.

Posted in: Adherence, Behavior Change, Health Regulations, Healthcare costs, Healthcare Disruption, Healthcare Policy, Healthcare Research, Healthcare Technology, Healthcare transformation, HIMSS, M-health, patient engagement

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Way Way Beyond HCAHPs: Cleveland Clinic’s Patient Experience Summit

It was the 10th year for the Cleveland Clinic’s innovation & empathy conference, a journey at Cleveland Clinic which started from a question from an MBA student to then CEO Toby Cosgrove asking if the Clinic’s physicians learned empathy.

You can hear him tell the story himself, and it’s personal for him.

And, if you haven’t seen Cleveland Clinic’s quintessential video on empathy, be sure to check it out.

Dr Toby Cosgrove at Cleveland Clinic

This year, Dr Cosgrove was back to talk about what Google could learn from healthcare and visa versa, as he is a newly appointed advisor to Google Health. As a surprise, he was interviewed by the same student who asked the question so many years ago. Not surprisingly, Dr. Cosgrove believes that healthcare needs to embrace big data, and care outside the clinic. He didn’t have much to offer about what Google could learn, but we’d say protecting personal data would be the biggest thing.

Possibly because he’s no longer running a physician organization and yet he is a physician himself, Dr Cosgrove was pretty blunt about the biggest barrier to transform an organization to deliver empathetic care: the doctors themselves.

Dr Victor Montori at Cleveland ClinicAnother notable keynote came from Mayo Clinic’s Dr. Victor Montori, an endocrinologist, and author of Why We Revolt: A Patient Revolution for Kind and Careful Care. Dr Montori asks us to question our biases, assumptions, and language. He decries “industrial healthcare” where we “provide care.” Care is already a verb. He advocates a person-centered approach where the goals and needs of the individual, not billing or the organization are center. Dr. Montori talked about the phenomenon of doctors doing volunteer travel vacations in other countries because it gets them back to why they became physicians: to care for people.

 

The example of a woman struggling to understand her medication, and make good food choices while being aware of her culture reminded me of visiting my mom when she was in a rehabilitation hospital. When we started bringing homecooked meals and even restaurant takeout, she ate. Physicians couldn’t understand her weight loss and hair loss, blaming it on medication. The problem was the terrible nutritional value and taste of the food.

Patient Stories

Patient stories were a key feature in the conference, while backing research up with data is important, it’s the stories that people remember.

How Walmart Started a Movement of Engagement

The power of human stories was prevalent in the presentation from Walmart’s David Hoke, who has created a movement of better health activities within the Walmart employee base, a challenging job when some stores have 100 per cent employee turnover. To create a movement that inserted a healthy virus into stores, David turned to military strategy:

  • Compelling reason to join
  • Place to join
  • Have to have something to do
  • Have something to share with people they love
  • People follow people

Instead of going directly to digital health, the program was designed to be analog to have the broadest reach, and to overcome people’s fears of being tracked. The program featured story booklets in breakrooms that highlighted other employees journey’s to health. Participants described thinking “well if that person can do it, so can I” after reading the stories, and seeing videos of successful program participants.  By the way, if you’re a Walmart customer, you can also join the program, which is now available digitally as well as analog.

Nebraska Medicine’s Situational Interviewing

Observational patient interviewingIn order to find the patient stories, you have to ask the right questions, and HCHAPs isn’t doing that. We see this all the time at Wellpepper: You need to talk to patients to get the story behind the data points. In this example, a patient had rated Nebraska Medicine highly for caring about her. Rather than just accepting this as praise, researchers dug deeper and asked how the patient perceived this, and the patient’s example was of a nurse who noticed she had dry skin and applied lotion. Another patient rated the facility high on cleanliness because he saw a physician pick up some garbage in the patient’s room. The key takeaway from this session was that patients infer intent.

Geisinger Longitudinal Patient JourneyGeisinger’s Longitudinal Patient Record

Chanin Wendling from Geisinger talked about their implementation of a CRM to be able to track a longitudinal patient experience. Knowing when and where patients are interacted with by the health system will go a long way towards understanding their overall experience.

Wellpepper Digital Intervention for Seniors

Dr. Jonathan Bean from Harvard, talked about why interventions for seniors are so important, and how design impacts whether someone is considered “able” by sharing an example of a cross walk timer being decreased so that slower people could no longer get across the street. Dr. Bean the Director of the New England GREC at the VA, professor at Harvard, and our research partner at Wellpepper, and we were extremely proud when he presented results of the REACH digital intervention using Wellpepper that reduced ED visits in seniors by 73%. We’ll share more when the study outcomes are published in the journal of PM&R.

Financial Impact of Care

Another theme that bubbled up in so many sessions at the conference is the financial impact of care, and the intertwined aspects of financial and physical health. A few key points:

  • Walmart has introduced a banking/payday loan application for employees so that they don’t have to pay the exorbitant rates of quick loan companies.
  • People cut back in other areas of their lives to pay for healthcare
  • 95% of patients want to talk to their provider about healthcare costs but providers aren’t equipped to do so. They don’t want to talk to the health plan or billing/collections department.

This was my first time at the summit, but it won’t be the last, especially as it evolves to encompass more aspects of patient experience outside the clinic, and through non-traditional methods like chatbots, virtual assistants, and virtual reality.

It’s hard to encapsulate all the learning at the conference, and no one person can attend all the sessions, but MobiHealth News has a great recap of the keynotes and individual sessions as well.

https://www.mobihealthnews.com/content/patients-more-vulnerable-other-consumers-technology-must-keep-human-empathy-center

https://www.mobihealthnews.com/content/north-america/without-co-design-technologys-healthcare-potential-wasted

https://www.mobihealthnews.com/content/north-america/providence-st-joseph-patient-engagement-begins-call-center

https://www.mobihealthnews.com/content/patient-stories-inspire-new-digital-tools-singapore-health-systems-sutter-health

Posted in: Adherence, Healthcare costs, Healthcare Disruption, Healthcare Research, Healthcare Technology, Healthcare transformation, HIMSS, M-health, Outcomes, patient engagement, Patient Satisfaction, patient-generated data, physician burnout

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The HIMSS Flu

As usual HIMSS was an overwhelming whirlwind of meetings, opportunities, and information. We had a great show at Wellpepper, and were impressed by a few things. First we heard a lot less about wanting the EMR to do everything. People have realized that especially for all of the patient-facing digital experience, that there need to be interoperable solutions, that are designed with the needs of the end-user in mind. Another thing we noticed was less hype that any one technology (AI, blockchain) was going to be the savior of healthcare. It seems like the market is maturing and there’s an understanding that technology is a key underpinning but only when it’s solving real problems for patients and clinicians. John Moore from Chilmark, who was attending his 11th HIMSS has a great take on this.

Each year, we come away from HIMSS with something we didn’t expect. While it’s usually new leads, partnerships, or competitive intelligence, this year for me, it was the HIMSS flu. Being in a conference center full of technology to diagnose, manage, connect with, and treat sick people, made it seem like a solution should be close by. Ironically, I had meetings with a number of physicians who said that it looked like I had the flu, but couldn’t treat me because they weren’t licensed in Florida. Also, my primary care physician couldn’t help me for this reason as well.

After seeing CirrusMD tweet at my friend and fellow patient-centered care advocate Jan Oldenburg with an offer of a consult, I thought that telemedicine might be the answer.

MDLive came through with a visit code, and I signed up. The sign-up process was pretty painless although an option to clarify where I was physically versus where I lived might have been helpful.

Once I signed up, the app told me it would notify me when it found a physician. This was the slightly confusing part, as when I exited the app and opened it again there was no record that I was in a queue for an appointment, so I started trying to sign up again. Eventually, a video visit came through while I was trying to re-register.

My doctor looked like she was taking calls from home, from the video. Unfortunately, video didn’t work very well from the HIMSS floor—not surprising given the status of the network, so we switched to phone. After a 10 minute conversation, she concluded I had the flu (she was right), and prescribed Tamiflu.

As Jan also found out when she had her asthma attack, the pharmacies near the convention center weren’t actually pharmacies, that is they didn’t offer prescription medication. For Jan it was an expensive Uber to pick up her prescription. For me it was finding a pharmacy that would be open between Orlando and Tampa where were were headed for customer meetings on Friday. By the time I got the prescription, it was 7 hours later, and with Tamiflu the timing matters.

While I was thankful to get care, here are a number of points of friction that made it more difficult than it needed to be, and also show how healthcare really hasn’t adapted to the needs of people:

  • State-based licensure makes telemedicine prohibitive. It also means that you can’t get care from your primary care or other specialists if you’re traveling. Kind of ridiculous that because the patient is physically in Florida suddenly the physician is not licensed to practice.
  • Pharmacies need more delivery options. Even locally, I’ve ended up at pharmacies that don’t take my insurance. Driving around when you’re sick is annoying, and showing up in person when you’ve got the flu is unhelpful for everyone else there.

On the licensure, it’s slow going, but states are starting to have agreements to solve this. On the delivery options, Amazon-drone delivery can’t come fast enough. Overall, the experience wasn’t terrible, and the technology worked but it certainly wasn’t seamless or convenient, and I probably infected a bunch of people while trying to get care. I’d like to apologize to anyone I may have passed the flu along to. I’m not the type to work when sick, but when you’re on the road it’s hard not to.

Also, we’d like HIMSS and all conferences to consider pop-up urgent care. The bandaids in the first-aid room weren’t enough.

Posted in: Healthcare costs, Healthcare Disruption, Healthcare Technology, HIMSS, M-health, patient engagement, Telemedicine

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See you at HIMSS19

HIMSS19 is a couple weeks away and we have a lot to be excited for!

Stop by and see us in the Personalized Health Experience, Booth 888-96. Alongside our great partners at Ensocare, we will be showcasing our latest product updates, discussing ROI for patient engagement platforms, promoting care plans based on Mayo Clinic best practices, and sharing our vision for the future of patient engagement.

We have a long list of booths to visit and sessions to attend. Below are some of the topics that we’re particularly interested in this year:

We can’t wait to connect with friends, partners, colleagues and industry leaders to continue the journey towards an amazing patient experience. Hope to see you there!

Posted in: Healthcare Disruption, Healthcare Technology, M-health, Outcomes, patient engagement

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Voice, Podcasts, Partnerships, and Amazon: Wellpepper’s most popular blog posts of 2018

Looking back over the past year, at our most popular blog posts, we suspect that these topics will remain popular in 2019 as well. New technologies and approaches to consumer and digital health have still not reached their full potential, and there’s still lots to learn.

Not surprisingly, a few of our most popular blog posts related to Amazon. In talking with regular people, healthcare organizations, and digital health folks, we find that they are split on whether they want the retail and cloud services giant to get into healthcare, but whatever side of the fence you’re on, there’s no denying they could have a big impact. Right Alexa?

Wellpepper 2018 Blog, Most Viewed Posts

Voice.Health Shows The Promise of Conversational Interfaces

Voice First or Voice And? Dispatches from Voice Summit

This post was actually from 2017, but our CTO’s take on why AWS Lambda serverless architecture is going to be really important for healthcare IT remains a popular topic.

4 Reasons Why the Future of Health IT is Serverless (AWS re:Invent 2017 wrap-up)

We’re also seeing more and more interest in a continuum of care approach: technologies and experiences that span the patient experience, and really help patients and care-givers self-manage, so our announcement of our partnership with Ensocare was also a very popular post.

Ensocare and Wellpepper Streamline Patient Discharge and Engagement

Continual learning is something both technology folks and healthcare folks share, so it comes as no surprise that our round-up of great podcasts for healthcare transformation enthusiasts, was also a popular post.

Podcasts for Healthcare Transformation Enthusiasts

 

 

Posted in: Healthcare Disruption, Healthcare Social Media, Healthcare Technology, Healthcare transformation, M-health, Voice

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Promise, Adoption, and Reality: Dispatches from Connected Health 2018

It’s a rare feat to be engaged, educated, and entertained at the same time, but the Oxford-style debate at Connected Health on telehealth’s effectiveness did all three. Moderated by new Chief Digital Officer for Partners Healthcare, Alistair Erskine, MD, with Ateev Mehrotra, MD debating that telehealth is not effective, and head of the American Telemedicine Association, Andrew Watson, MD debating that it is, the format and discussion delivered a provocative closing session on Day 1 of Connected Health. As decided by the audience, the winner was Dr. Watson, citing effective programs like telestroke, consults and expert referrals, and rural medicine. However, applause for Dr. Mehrotra was also strong, and I suspect that his major points that telehealth has not reached broad adoption, and in fact there have been observations that telehealth is actually increasing utilization as people follow a telehealth visit with an in-person visit. The question is whether that visit wouldn’t have happened and we’d see worse health outcomes, or whether the person had a problem that couldn’t be helped with telehealth.

In another deep dive session on telehealth, “Making Connected Health Work for Physicians”,  Kevin Fickenscher, MD talked about a unique program to train clinicians on virtual visits. Given that the diagnostic capabilities are different, for example, you can’t touch the patient, this makes perfect sense. Questioning and listening skills are going to be more important than physical exam, and observation may be limited by (current) video technology. Also in this session, Ami Blatt MD from Partners, talked about how her young and mobile patients essentially lead her to telemedicine, by insisting that was how they wanted to communicate: the consumerization of healthcare in action. She also recommended to any physicians wanting to deploy a telemedicine solution to make sure that the goals of the program align with the financial incentives available for the hospital.

So, what do we take away from this? Twenty years later, telemedicine is still in the promise stage. Practice and reimbursement needs to change even more to find true breakthroughs, and perhaps we should look at pattern matching to find other successful workflows and outcomes that resemble the benefits for telestroke.

In no particular order, here are some other observations from the conference:

  • Patients are taking a bigger role, whether that was a patient co-presenting in a session on Patient Generated Health data, the Wego Health Awards honoring LupusLady as an activated and collaborative patient, or the society for Participatory Medicine pre-day with patients included, the voice of patients is increasingly being listened to with a real seat at the table.
  • Digital therapeutics and behavioral health are hot. There was a special pavilion on the tradeshow floor dedicated to digital therapeutics where our fellow Seattle health innovators, 2Morrow presented great results from their smoking cessation programs.
  • Patient-generated data is starting to show promise and much greater acceptance by clinicians, particularly in the ability for clinicians and patients to talk to each other. However, we’d still like to see a better connection of data and actionable care plans, and there was still some mention of the data being better because patients cheat when verbally relating data like blood sugar after the fact. Data alone isn’t enough to support patients or change behavior, and it shouldn’t be continued punitive.


From Session: PGHD End User Experience: Patients and Providers

  • There’s a continual blurring of the lines with engagement, particularly member and patient engagement, and there were a ton of new companies in this space (again), all offering to get members and patients engaged. From their overviews it was hard to tell how targeting providers and payers was even different aside from the terminology.
  • Although a full-day devoted to voice interfaces definitely showed it’s a hot topic, AI was definitely the buzzword of the show.

We’re already gearing up for HIMSS 2019 where we hope the buzzword of the show will be “outcomes”. We just heard that our talk on the (really positive) results of the REACH study has been accepted. See you there?

Posted in: Health Regulations, Healthcare motivation, Healthcare Technology, Healthcare transformation, HIMSS, M-health, patient engagement, Patient Satisfaction, patient-generated data, Telemedicine, Voice

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Voice.Health Shows The Promise of Conversational Interfaces

“By embracing voice, healthcare has the opportunity to leapfrog technology from other industries” John Brownstein, PhD, Chief Innovation Officer, Boston Children’s Hospital

Dr. Brownstein was speaking in shared keynote at the Voice.Health summit about why he and other healthcare innovators are so pumped about the opportunity for voice in healthcare. On a later panel Shivdev Rao, MD from UPMC Enterprises described what makes voice a natural fit.

75-80 percent of the signal in a hospital is voice-driven
Shivdev Rao, MD, Vice President, UPMC Enterprises

The one-day concentrated pre-day at Connected Health focused on all things voice tech in healthcare and was kicked off by Klick Health founder and CEO Leerom Segal, who talked about the factors that made this time ripe for voice in the tech industry overall. Putting technology in context is exactly what’s needed at more healthcare events versus a sometimes myopic view of healthcare technology.

So why is voice having a moment?

  • Compute power necessary for processing the large amounts of data that voice creates and requires is now available and relatively inexpensive through cloud offerings from Amazon, Google, and Microsoft
  • Devices are cheap and ubiquitous
  • We’re already trained to expect instant answers but starting to be sensitive to the impact of screen time
  • Voice is seen as more accessible to broader groups
  • And of course, voice is being used as a Trojan horse for commerce (at least by Amazon), for Google it’s for more data

In addition to panels on clinical and consumer impact of voice in healthcare, there was an immersive experience with examples of voice technology in different healthcare settings including clinic, hospital room, operating room, senior home, and an actual home living room. We participated on the consumer panel, and showcased Sugarpod (in the living room since there wasn’t a bathroom.) During the course of the day, and in the keynote at least a hundred potential uses for voice in healthcare were explored. At the same time, participants didn’t shy away from challenges either, like using voice for the wrong purposes like converting pages and pages of web content, or the challenges for people with hearing, cognition, or speech problems to use the devices, all of which can be mitigated with thoughtful voice interaction design, accessibility design, and user testing.

Clinicians have particular concerns about voice. From UPMC, Dr. talked about the challenges of any new and shiny technology in healthcare

As well, similar to what we’ve seen with other technology starting with the real problem of EMR screen time but also including mobile outside the clinic to machine-learning and artificial intelligence, clinicians are concerned about any technology getting between them and their patients. From Robert Stevens, Executive Director and Head of Digital for Novartis summed up what he had heard from physicians “I don’t to be usurped by a smart hockey puck at patient point of care.”

We’re bullish on voice, and agree with Brownstein, that embracing this technology puts healthcare on the cutting-edge technology-wise. It’s also an opportunity for new players, as the incumbents have not proved themselves capable of embracing consumer or end-user centric design that voice requires. We’re also still firmly in the “voice and” camp, looking at voice user interface as one of a number of tools for engaging patients as part of a comprehensive overall digital strategy. Planning and delivering on  a context-aware omni-channel adoption strategy for digital health is another way healthcare has an opportunity to evolve with the overall technology and consumer markets who also haven’t solved this thorny problem.

If you’d like to talk about how to deliver a consistent and engaging omni-channel experience that improves patient outcomes, get in touch sales@wellpepper.com

If you’re interested in voice, check out our other blog posts on the topic:

Posted in: Adherence, Healthcare Social Media, Healthcare Technology, Healthcare transformation, M-health, patient engagement, Patient Satisfaction, Voice

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Digital Transformation in Pharma: Digital Pharma West

Like the rest of the healthcare industry, the pharma industry is also grappling with lots of data, disconnects from end-users, and shifting to a digital-first experience while grappling with ongoing regulatory and privacy challenges. Actually it’s pretty much what every industry is grappling with, so the good news is that no one is getting left behind in this digital revolution.

In pharma though, the division between commercial and R&D creates both delays and lags in implementing new technology and the regulatory challenges cause specific issues in communication with both providers and patients.

Last week, I was invited to speak at Digital Pharma West about our work in voice-enabling care plans for people with Type 2 diabetes, and also how our participation in the Alexa Diabetes Challenge enabled us to engage with pharma. It was my first ‘pharma-only’ conference, so it was interesting to contrast with the provider and healthcare IT world.

If you think that there are a lot of constituents who care about digital health in provider organizations, pharma rivals that. For example, there was a discussion about the value of patient-facing digital tools in clinical trials. While everyone agreed there could be real value in both efficiencies of collecting data, and engaging patients and keeping them enrolled in trials, a couple of real barriers came up.

First the question of the impact of the digital tools on the trial. Would they create an intended impact on the outcomes, for example a placebo effect? Depending on how the “usual care condition” is delivered in a control group, it might not even be possible to use digital tools in both cohorts, which could definitely impact outcomes.

Another challenge with digital technology in randomized control trials is that technology and interfaces can change much faster than drug clinical trials. Considering that elapsed time between Phase 1 and Phase 3 trials can be years, also consider that the technology that accompanies the drug could change dramatically during that period. Even technology companies that are not “moving fast and breaking things” may do hundreds of updates in that period.

Another challenge is that technology may advance or come on the market after the initial IRB is approved, and while the technology may be a perfect fit for the study, principle investigators are hesitant to mess with study design after IRB approval.

Interestingly, while in the patient-provider world the number of channels of communication are increasing significantly with mobile, texting, web, and voice options, the number of touch points in pharma is decreasing. Pharma’s touchpoints with providers are decreasing 10% per year. While some may say that this is good due to past overreach, it does make it difficult to reach one of their constituents.

At the same time, regulations on approved content for both providers and patients means that when content has had regulatory approval, like what you might find in brochures, on websites, and in commercials, the easiest thing to do is reuse this content. However, new delivery channels like chatbots and voice don’t lend themselves well to static marketing or information content. The costs of developing new experiences may be high but the costs of delivering content that is not context or end-user aware can be even higher.

At the same time, these real-time interactive experiences create new risks and responsibilities for adverse event reporting for organizations. Interestingly, as we talk with pharma companies about delivering interactive content through the new Wellpepper Marketplace, these concerns surface, and yet at the same time, when we ask the difference between a patient calling a 1-800 line with a problem and texting with a problem there doesn’t seem to be a difference. The only possible difference is a potential increase in adverse event reporting due to ease of reporting, which could cause problems in the short term, but in the long term seems both inevitable and like a win. Many of the discussions and sessions at the conference were about social media listening programs for both patient and provider feedback, so there is definitely a desire to get and make sense of more information.

Like everyone in healthcare, digital pharma also seems to be at an inflection point, and creativity thinking about audiences, channels, and how to meet people where they are and when you need them is key.

Posted in: Adherence, Clinical Research, Data Protection, Health Regulations, Healthcare Disruption, Healthcare Policy, Healthcare Research, Healthcare Social Media, Healthcare Technology, HIPAA, M-health, Outcomes, pharma, Voice

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Dispatches from the Canadian E-Health Conference: The same but different

Bear statue in VancouverThe annual Canadian E-Health Conference was held in Vancouver, BC last week. I had the opportunity to speak about the work we’re doing at Wellpepper in applying machine learning to patient-generated data, and in particular the insights we’ve found from analyzing patient messages, and then applying a machine-learned classifier to alert clinicians when a patient message might indicate an adverse event. Our goal with the application of machine-learning to patient generated data is to help to scale care. Clinicians don’t need to be alerted every time a patient sends a message; however, we don’t want them to miss out if something is really important. If you’d like to learn more about our approach, get in touch.

My session was part of a broader session focused on ‘newer’ technologies like machine-learning and blockchain, and some of the other presenters and topics definitely highlighted key differences between the US and Canadian systems.

Aside from the obvious difference of Canada having universal healthcare, there were subtle differences at this conference as well. While the same words were used, for the most part: interoperability, usability, big data, and of course blockchain and AI, the applications were different and often the approach.

Interoperability: Universal doesn’t mean one

Each province has their own system, and they are not able to share data across provinces. Unlike the UK which has a universal patient identifier, your health records in Canada are specific to the province you live in. As well, apparently data location for health records is sometimes not just required to be in Canada, but in the actual province where you reside and receive care. As for interoperability, last we heard, British Columbia was doing a broad roll out of Cerner while large systems in Alberta were heading towards EPIC, so Canada may see the same interoperability challenges we see here if people move between provinces.

Privacy: The government is okay, the US is not

What’s interesting is as a US company, is that whenever we talk to health systems in Canada they bring up this requirement, but as soon as you mention that the PIPEDA requirements enable patients and consumers to give an okay for out of Canada data location they agree that it’s possible. Regardless, everyone would rather see the data in Canada.

What was possibly the most striking example of a difference in privacy was from one of my co-presenters in the future technologies session, who presented on a study of homeless people’s acceptance of iris scanning for identification. 190 out of 200 people asked were willing to have their irises scanned as a means of identification. This identification would help them access social services, and healthcare in particular. The presenter, Cheryl Forchuk from the Lawson Health Research Institute said that the people who participated didn’t like to carry wallets as it was a theft target, that they associated fingerprinting with the criminal justice system, and that facial identification was often inaccurate due to changes that diet and other street conditions can make. When I tweeted the 95% acceptance rate stat there were a few incredulous responses, but at the same time, when you understand some of the justifications, it makes sense. Plus, in general Canadians have a favorable view of the government. The presenter did note that a few people thought the iris scan would also be a free eye exam, so there may have been some confusion about the purpose. Regardless, I’m not sure this type of identification would play out the same way in the US.

Reimbursement: It happens, just don’t talk about it

The word you didn’t hear very much was reimbursement or when you did, from a US speaker the audience looked a bit uncomfortable. The funny thing is though, that physicians have billing codes in Canada as well. It’s just that they are less concerned about maximizing billing versus being paid for the treatment provided and sometimes even dissuading people from over-using the system. Budgets were discussed though, and the sad truth that money is not always smartly applied in the system, and in a budget-based system, saving money may decrease someone’s future budget.

Blockchain: It’s not about currency

Probably the biggest difference with respect to Blockchain was the application, and that it was being touted by an academic researcher not a vendor. Edward Brown, PhD from Memorial University suggested that Blockchain (but not ethereum based as it’s too expensive) would be a good way to determine consent to a patient’s record. In many US conferences this is also a topic, but the most common application is on sharing payer coverage information. Not surprisingly this example didn’t come up at all. If you consider that even though it is a distributed ledger, a wide scale rollout of Blockchain capabilities for either identification or access might be more likely to come from a system with a single payer. (That said, remember that Canada does not have a single payer, each province has its own system, even if there is federal funding for healthcare.)

“E” HR

Physician use of portalFor many of the session the “E” in e-health stood for EHR, which while also true in the US, the rollout of wide scale EHRs is still not as advanced. Cerner and EPIC in particular have only just started to make inroads in Canada, where the a telecommunications company is actually the largest EHR vendor. In one session I attended, the presenter had done analysis of physician usage of a portal that provided access to patient labs and records, but they had not rolled out, what he was calling a “transactional” EHR system. Physicians mostly accessed patient history and labs, and felt that if the portal had prescribing information it would be perfect. Interesting to see this level of access and usage, but the claim that they didn’t have an EHR. What was also interesting about this study is that it was conducted by a physician within a health system rather than an academic researcher. It seemed like there was more appetite and funding for this type of work within systems themselves.

Other Voices: Patients!

Patients on the mainstageDuring the interlude between the presentations and judging for the well-attended Hacking Health finals, and on the main stage, presenters interviewed two advocate patients. While they said this was the first time they’d done it, both patients had been at the conference for years. So while the mainstage was new, patient presence was not, and patient advocate and blogger Annette McKinnon pushed attendees to go further when seeking out engaged patients. Noting that retirees are more likely to have the time to participate in events she asked that they make sure to seek out opinions for more than 60 year old white women.

There was also an entire track dedicated to First Nations Healthcare. Think of the First Nations Health authority as a VA for the indigenous people of Canada, which incorporates cultural differences and traditional practices of the First Nations people. The track started and concluded with an Elder song and prayer.

Manels

Speaking of diversity, I didn’t witness any manels.

Best Quote

 

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

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HIMSS 2018…See you there!

HIMSS17 in Orlando was a great conference for Wellpepper. We’re looking forward to HIMSS18 in Las Vegas even more!

We have a long list of sessions to attend and booths to visit, but below are some places you’re guaranteed to find us:

Monday, March 5th

  • Hear from Tami Deangelis on how our research partners at Boston University engaged patients outside the clinic and improved outcomes using Wellpepper care plans. She is speaking at the “Remote Patient Messaging for Adherence and Engagement” session from 4:05pm-4:25pm at the Patient Engagement & Experience Summit

Tuesday, March 6th

  • Hall G, Innovation Zone: Booth 9900-78 from 9am-6pm
  • CTO, Mike Van Snellenberg will be demonstrating our voice-powered scale and foot scanner, and integrated diabetes care plan at the Industry Showcase at BHI & BSN 2018 https://bhi-bsn.embs.org/2018/industry-showcase/

Wednesday, March 7th

  • Hall G, Innovation Zone: Booth 9900-78 from 9am-6pm
  • CEO, Anne Weiler, will be sharing the Wellpepper Vision and Mission at HIMSS VentureConnect http://www.himssconference.org/education/specialty-programs/venture-connect
  • CEO, Anne Weiler, will be joining other industry leaders to continue the conversation with CMS toward inclusion of patient engagement and outcomes tracking in the MIPS Improvement Activity for provider reimbursement

Thursday, March 8th

  • Hall G, Innovation Zone: Booth 9900-78 from 9am-4:30pm

We can’t wait to connect with friends, partners, colleagues and industry leaders to continue the journey towards an amazing patient experience. Hope to see you there!

Posted in: Healthcare Disruption, Healthcare Technology, M-health, Outcomes, patient engagement, Uncategorized

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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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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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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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But Will It Fly? What Airlines and Healthcare Organizations Have In Common

What do airlines and healthcare systems have in common? Quite a lot it turns out, from a recent power breakfast featuring Rod Hochman, CEO of Providence St. Joseph Hoag Health system, and Brad Tilden, CEO of Alaska Airlines. In addition to the Pacific Northwest roots of both organizations, both have also undertaken mergers to gain market share and increase physical territory. Both serve a large cross-section of the population, and both are in highly-regulated industries that are not necessarily known for customer service that are grappling with new always connected user experiences and expectations.

The wide-ranging discussion included early inspiration for Hochman and Tilden’s early careers, how to motivate and engage a wide range of employees, and how to deal with competition and lead change. Both leaders had early influences on their career direction. Hochman knew he wanted to be a doctor at 16 when assisting on surgeries (!), and Tilden grew up beside Seatac airport watching planes while his peers were watching girls. Tilden grew his career at Alaska, while Hochman is a practicing rheumatologist, who has worked his way from small clinic to major system. Hochman joked that a rheumatology specialty is much more suited to success in administration than say surgery, equating running a hospital to the patient required in managing chronic diseases.

Airlines and health systems have similar challenges with employee experience. Both types of organizations have highly skilled staff, pilots and physicians, who demand a lot of autonomy. Mistakes in both professions can cause loss of life. The difference is that aviation has moved a lot faster in instituting standard procedures and checklists to improve safety and outcomes. Tilden frequently referenced an Alaska Air crash 17 years ago that impacted their approach to safety, and talked about the ways pilots and co-pilots double check settings. Hochman talked about his hope for quality improvements and better collaboration from the younger generation of physicians who have grown up in a world of checklists and standardization, and said that the ones who only care about being left alone to make decisions will retire.

They also have large teams of people who “get stuff done.” Hochman has banned the term ‘middle management’ since he sees those people as the ones who are making things happen, instead he calls them “core team”, a term that Tilden quipped he’d also start using.Rod Hochman & Brad Tilden

Customer experience was also top of mind for both execs. Tilden talked about Alaska adopting Virgin’s mission of being the airline people love. While he seemed to find some of Virgin’s approach to be a bit edgy compared to Alaska, he said you couldn’t find a better mission. Both grappled with the ease of sharing bad experiences on social media, and indicated that social media monitoring has become a key tool in managing consumer expectations. Hochman, also noted that it all comes back to the individual experience when he described that his staff hate when he has his own annual physical, because his expectations as a patient are much higher than what he experiences, especially with respect to convenience and information flow.

Both are optimistic and passionate leaders who genuinely care about the consumer and employee experience, and had as good a time interviewing each other as the audience did listening to them. This event was sold out, so if an opportunity like this comes up again, sign up early.

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

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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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