M-health

Archive for M-health

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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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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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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Wellpepper Receives Seattle Business Magazine’s 2017 Leaders in Healthcare Gold Award for Achievement in Digital Health

We are honored to have been named the Gold Award winner for outstanding achievement in digital health from Seattle Business Magazine’s 2017 Leaders in Health Care!

Thank you to our amazing team and partners!

 

Posted in: Healthcare Technology, Healthcare transformation, M-health, patient engagement, Press Release, Seattle, Uncategorized

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SEATTLE BUSINESS MAGAZINE HONORS 18 INDIVIDUALS AND ORGANIZATIONS AT THE 2017 LEADERS IN HEALTH CARE AWARDS

SEATTLE (March 2, 2017) – Eighteen of Washington’s most accomplished health care leaders were recognized at Seattle Business magazine’s 2017 Leaders in Health Care Awards gala March 2 at Bell Harbor International Conference Center in Seattle.

“In this time of great turmoil in the health care industry, it’s more important than ever to recognize the institutions and individuals who are doing so much to make Washington state among the best places in the nation to receive health care,” said Leslie Helm, executive editor of Seattle Business magazine.

Judges selected gold and silver award honorees in 11 categories. The awards program was supported by presenting sponsor West Monroe and supporting sponsors Seattle Cancer Care Alliance and MacDonald-Miller.

The award winners are:

OUTSTANDING MEDICAL CENTER EXECUTIVE — SEATTLE GOLD: Norm Hubbard, Executive Vice President, Seattle Cancer Care Alliance, Seattle SILVER: Cynthia J. Hecker, Executive Director, Northwest Hospital & Medical Center, Seattle

OUTSTANDING MEDICAL CENTER EXECUTIVE — OUTSIDE SEATTLE GOLD: Preston Simmons, Chief Operating and Administrative Officer, Western Washington Market, Providence Health & Services, Everett SILVER: Bryce Helgerson, President, Legacy Salmon Creek Medical Center, Vancouver

OUTSTANDING MEDICAL GROUP EXECUTIVE GOLD: Dr. Albert Fisk, Chief Medical Officer, The Everett Clinic, Everett

OUTSTANDING MEDICAL DIRECTOR/CHIEF MEDICAL OFFICER GOLD: Dr. Jeffrey Tomlin, SVP & Chief Medical and Quality Officer, EvergreenHealth, Kirkland

OUTSTANDING MEDICAL DIRECTOR/CHIEF MEDICAL OFFICER GOLD: Dr. Peter McGough, Medical Director, UW Neighborhood Clinics, Seattle

ACHIEVEMENT IN COMMUNITY OUTREACH GOLD: Pacific Medical Centers, Seattle

ACHIEVEMENT IN DIGITAL HEALTH GOLD: Wellpepper, Seattle SILVER: SCI Solutions, Seattle

INNOVATION IN HEALTH CARE DELIVERY GOLD: Navos, Seattle/Burien SILVER: Genoa, Tukwila

ACHIEVEMENT IN MEDICAL TECHNOLOGY GOLD: Seattle Genetics, Bothell

ACHIEVEMENT IN MEDICAL RESEARCH GOLD: Dr. Oliver Press, Acting Director, Clinical Research Division, and Acting SVP, Fred Hutchinson Cancer Research Center, Seattle SILVER: Dr. Jane Buckner, President, Benaroya Research Institute at Virginia Mason, Seattle

MEDICAL GROUP PERFORMANCE (in partnership with Washington Health Alliance) GOLD: Group Health Cooperative, Seattle SILVER: Virginia Mason Medical Center, Seattle

JUDGES’ AWARD Dr. Paul Ramsey, CEO, UW Medicine

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Read more about the Leaders in Health Care Awards 2017 at seattlebusinessmag.com.

ABOUT SEATTLE BUSINESS: Seattle Business is an award-winning monthly magazine read by thousands of business executives across the state. It delivers insight into the key people, enterprises and trends that drive business in the Pacific Northwest, providing perspective on the region’s ever-changing economic environment.

Posted in: M-health, patient engagement, Press Release

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HIMSS17 Sessions of Interest

We are thrilled to attend a number of sessions at HIMSS17 with topics pertaining to Wellpepper’s Vision and Goals!

Patient Engagement

Sessions that impact our ability to deliver an engaging patient experience that helps people manage their care to improve outcomes and lower cost:

Insight from Data

Sessions that impact our ability to derive insight from data to improve outcomes and lower cost:

Clinical Experience

Sessions that impact our ability to deliver more efficient experience for existing workflows and are non-disruptive for new workflows:

 

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

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Our Picks for HIMSS17

himss17-exhibitor-ad-design-300x250-copyHIMSS17 is right around the corner and we at Wellpepper have a lot to be excited about! By empowering and engaging patients, deriving insight from the data we collect, and delivering new value to clinical users without major disruption to existing clinical workflows, we can continue to improve outcomes and lower costs of care. At HIMSS17, we look forward to connecting with friends, partners, colleagues and industry leaders to continue the journey towards an amazing patient experience.

Sessions that we look forward to:

Our CEO and co-founder, Anne Weiler, will be speaking at 2 sessions:

  • Anne will be a featured speaker at the Venture+ Forum, where former competition winners will be sharing how their business has grown, lessons learned and plans for the future. Since being named a winner of the 2015 Venture+ Forum Pitch competition, Wellpepper has continued to bridge the gap between the patient and care team and we are excited to share our progress and vision.
  • Anne will also be presenting a session titled, Designing Empathetic Care Through Telehealth for Seniors, which will explore the role of design-thinking in design empathetic applications to deliver remote care for seniors based on studies completed by Boston University and researchers from Harvard Medical School.

Patient engagement expert Jan Oldenburg, who was featured in our August 2016 webinar, will be speaking at 2 sessions:

  • Jan will be presenting a session titled, The “P” is for Participation, Partnering and Empowerment. This session will highlight what it takes to create a truly participatory healthcare system that incorporates patients and caregivers, using digital health technology to reinforce and support participatory frameworks.
  • Jan will also be presenting a session titled, Importance of Narrative: Open Notes, Patient Stories, Human Connections. This session will focus on how Open Notes enhance the patient’s narrative of their journey through their condition and how this both strengthens the patient-physician relationship and empowers patients to take charge of their illness and wellness.

Christopher Ross, Chief Information Officer at Mayo Clinic will be leading a session on Emerging Impacts of Artificial Intelligence on Healthcare IT. This session will discuss how the advancement of Artificial Intelligence (AI) and Machine Learning (ML) are having a profound impact on how insights are generated from healthcare data.

Posted in: big data, M-health, 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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