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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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Telehealth 2.0: Our picks for Orlando

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

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

Sunday

Monday

Tuesday

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

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

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EvergreenHealth: Evolving Care Outside The Clinic for Better Outcomes

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

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

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

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

User Experience

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

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

Outcomes

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

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

Total Knee Replacement Patient at EvergreenHealth

Technology

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

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

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Wellpepper attends Episodes of Care Summit at Cambia Grove

Last week, Wellpepper CEO, Anne Weiler and I attended a half-day Episodes of Care Summit put on by Cambia Grove. It was great to see payers, providers and technologists come together to focus on initiatives that directly impact the patient experience. Here are some of our takeaways:

Horizon BCBS of New Jersey is an episodes of care pioneer

Focus on retroactive bundles before proactive. Episodes of care and bundled payments are often used interchangeably. An episode of care typically refers to a payment made retrospectively while a bundled payment typically refers to a payment made prospectively. Horizon BCBS of New Jersey first launched retrospective pilots in 2010 (total hip and total knee replacements). In this model, savings are shared with the physician or practice once quality benchmarks and patient experience thresholds are met and costs come in below budget. After 7 years of scale and success, Horizon is now launching more immediate, risk-based, prospective initiatives in 2017.

Drive success through quality. Horizon piloted with over 200 quality metrics with member-specific, risk-adjusted financial targets. Metrics are key in driving success. Identify 3-5 standard quality metrics and 2-4 episode-specific metrics.

Community involvement is imperative

It’s great to see continued focus on community involvement in innovation and healthcare. The Bree Collaborative is an excellent example of bringing together community and industry leaders to identify and promote strategies that directly impact patient outcomes, quality and affordability. Wellpepper firmly believes in the work that the Bree Collaborative is doing. In fact, our total joint and lumbar fusion care plans follow Bree recommendations.

The Episodes of Care Summit held breakout sessions that mapped out the ideal episode of care/bundle experience through the lens of people, process and technology. Think of people, process and technology as a three-legged table. Remove one leg and the table falls. If the three legs are not the same size, the table does not function properly. Effort needs to be allocated equally across people, processes and technology to drive behavior change. Reimbursement seemed to take a precedence in every conversation rather than the patient’s needs or the provider’s care. Until this mindset is fixed, it’s hard to focus on what healthcare is really about. Dr. Hugh Stanley, from the Bree Collaborative did an excellent job bringing the focus of the conversation back to the patient.

Memorable quotes from breakout sessions:

  • “Patients need to be at the center of episodes of care.”
  • “We need to capture patient satisfaction in real time.”
  • “I’m blown away I can get more info on a dog bed than a provider.”
  • “We need to rebuild the patient deductible and copay mindset.”
  • “The payer community has a responsibility to share information to publicize data that drives provider readiness.”
  • “Creating episodes vs bundles benefits providers and ultimately patients.”

Posted in: Healthcare Policy, Healthcare Technology, Healthcare transformation, patient engagement, Patient Satisfaction, Uncategorized

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Using AWS with HIPAA-Protected Data – A Practical Primer

When we started building the Wellpepper platform four years ago, we thought carefully about how to build for privacy and security best practices as well as HIPAA compliance, since we work with customers in the healthcare industry. We chose to build the system entirely on Amazon Web Services (AWS), and learned a few things in the process about building HIPAA compliant applications on AWS. Hopefully this will be helpful to others considering AWS as the home for their healthcare online service, whether you’re a software company hoping to sell to healthcare systems (as a “Business Associate” in HIPAA terminology) or an internal development team at a health system (a “Covered Entity”).

It’s Not Rocket Science

As you probably already know, the Health Insurance Portability and Accountability Act (HIPAA) is made up of several parts. Usually when IT people talk about “HIPAA compliance”, they are talking about the Title II Security Rule which governs privacy and security practices for electronic protected health information (ePHI).

Many of the requirements in the HIPAA Security Rule are simply best practices for security and data privacy that have been written into law. Things like encrypting traffic travelling over a network. Anyone building good, secure software, should be following these principles anyway. You need to be informed of the requirements, and you need to make sure you establish ongoing practices for maintaining security and privacy, but it’s not rocket science. In fact, your health system (or healthcare customers) may actually have more stringent or additional data security requirements to what is required by HIPAA.

Our experience is that HIPAA isn’t a major departure from what we would have built anyway.

Stay Up To Date

HIPAA was established in 1996, with the final Security Rule being published in 2003. In some cases, the guidance has not kept up with current threats and practices in 2017. If you are developing healthcare software, you should be applying industry best practices in combination with the HIPAA requirements. Your ultimate goal needs to be protecting patient data, not just regulatory compliance. Invest in training yourself and your team and staying current. Some resources we found helpful:

Take Responsibility

Compliance usually isn’t at the top of an engineering team’s list of fun things, so it’s tempting to look for solutions that can abstract away the responsibility. There are a few online healthcare platform-as-a-service hosters that make claims in this direction. Be wary of these. No service can remove your responsibility for compliance.

We decided that using AWS infrastructure services was the best level of abstraction. This let us build new services, host data, and install 3rd party applications in our VPC with high confidence that we were living up to our promises to protect patient data.

In addition to thinking about your software solution, compliance also covers your business practices and policies for things like training, background checks, and corporate device security – securing your people. These are often overlooked areas that are really important, since security researchers complain that people are the weakest link in the security chain. As with your software design, the application of commonsense practices and good documentation will go a long way.

There is no single group that certifies systems as HIPAA compliant. However, HHS can audit you at any time, whether you’re a covered entity or a business associate. You should do your own internal assessments against the HIPAA Security Rule both when you are building new capabilities, and on an annual basis. Augment this with external third party reviews. You’ll want to be able to show summarized reports of both your internal process and a stamp of approval from an external auditor.

HHS produces a tool called the SRA tool which you might find useful in performing security rule assessments: https://www.healthit.gov/providers-professionals/security-risk-assessment-tool. We used this for a couple years, but now just use an Excel Spreadsheet to evaluate ourselves. Bonus: this is probably what your auditor will want to see.

This Risk Toolkit from the HIPAA Collaborative of Wisconsin is a good starting point, and looks very similar to the spreadsheet we use: http://hipaacow.org/resources/hipaa-cow-documents/risk-toolkit/ (look at the Risk Assessment Template).

Share the Responsibility

AWS certifies a subset of their services for HIPAA compliance. This includes restrictions on how these services are used, and requires that you enter into a Business Associate Agreement (BAA) with AWS. This agreement establishes the legal relationship needed to handle ePHI, and ensures that you’ll be notified in the unlikely event that there is a data breach.

When you sign a BAA, you enter into a shared responsibility model with AWS to protect ePHI. AWS largely covers physical security for their facilities and networks. You can view their SOC audit results on request. You own the security for your applications and anything else from the OS on up. For example, if you use Elastic Compute Cloud (EC2) instances, it’s your responsibility to keep those instances patched.

AWS occasionally adds new services to their HIPAA-certified services, so you’ll want to check occasionally to see if there are new services you might be able to take advantage of.

Draw a Bright Line Around Your ePHI

At any time, you should be able to quickly say exactly which parts of your system (which servers, which network segments, which databases, which services) have or store ePHI. These systems are inside your bright line defense perimeter, are subject to HIPAA regulations including breach notifications. That means if you lose data on one of these systems, you need to notify your patients (or if you are a Business Associate, notify the Covered Entity so that they can notify the patients).

EC2, Simple Storage System (S3), Elastic Load Balancing (ELB), when used in accordance with guidelines can be HIPAA compliant. Make sure you read the guidelines – there are usually certain restrictions on usage in order to be covered. Many of AWS’ platform-as-a-service offerings are currently not offered under the AWS HIPAA umbrella (for example Kinesis and Lambda). You can still use these services, just not with ePHI.

Many modern systems designs make use of 3rd party framworks and SaaS offerings for things like analytics, monitoring, customer support, etc. When you are holding and conveying ePHI, you will need to be careful about which dependencies you take. For example, in one of our recent product updates we were considering using an external web & mobile analytics platform to better understand our traffic patterns. We walked through our use cases and decided that while none of them required us to send any ePHI to the analytics platform, the risk of accidentally sending some piece of protected data was too high. So we came up with a different plan that allowed us to keep PHI within our safe boundary and under our direct control. Many of your decisions will be grey-area tradeoffs like this.

Secure at Rest and Over the Wire

This is often the first question we see on any healthcare IT security review. How do you protect data at rest and over the wire? Use strong SSL certs with robust SSL termination implementations like ELB. If you terminate your own SSL connections, they need to be well patched due to evolving threats like Heartbleed, POODLE, etc. You may choose to do further application-level encryption in addition to SSL, but SSL should usually be sufficient to satisfy the over-the-wire encryption requirements.

For at-rest storage, there are many options (symmetric/asymmetric) that will depend on what you are trying to do. As a baseline, AWS makes it incredibly easy to encrypt data with AES-256 both in S3 or in the Elastic Block Store (EBS) drives attached to your EC2 instances. There’s almost no reason not to use this, even if you are using additional encryption in other layers of your architecture. AES-256 is usually the “right answer” for IT reviews. Don’t use smaller keys, don’t use outdated algorithms, and especially never try to roll your own encryption.

Good guidance in this area is easy to find:

Logging and Auditing

A key HIPAA requirement is being able to track who accessed and changed patient records and verify the validity of a record. Even if you don’t make this available through a user interface, you need to log these actions and be able to produce a report in the case of an audit or a breach. Keeping these logs in encrypted storage in S3 is a good way to do this. You’ll want to restrict who has access to read/write these audit logs as well.

In addition to automatic audit trails generated by your application-level software systems, remember to carefully keep track of business-process events like granting someone access to a system or revoking access. AWS CloudTrail can help track system changes made to AWS resources like servers, S3 buckets, etc.

Authentication

All healthcare applications will need a way to identify their users and what permissions those users have. HIPAA is not specific about authentication systems beyond being “reasonable and appropriate” (164.308(a)(5)(ii)(D)), but does require that you have good policies in place for this. Here you should follow well-established security best practices.

For starters, you should try not to build your own authentication system. In purpose-built systems, you may be able to integrate into an existing authentication system using oAuth, or SAML (or maybe something more exotic if you’re plugging into some legacy healthcare application). In patient-facing applications, you may be able to integrate with a patient portal for credentials – this is something that will probably show up on your requirements list at some point anyway. If neither of these apply, you may be able to use another identity provider like AWS’ Identity and Access Management (IAM) system to manage user credentials. We briefly tried using consumer-facing oAuth using Facebook, but quickly found that consumers are (rightly) worried about privacy and chose not to use this method.

If you find that you need to build an authentication system, be sure to follow current best practices on things like how to store passwords securely, as well as other tricky areas like password resets.

Since Wellpepper is often deployed standalone before being integrated into other back-end systems, we offer a built-in username + password authentication system. One silver lining to building this ourselves is the ability to build meaningful password complexity rules, especially for patients. Some of the traditional healthcare systems have truly draconian rules that are not only user un-friendly, but actively user-hostile. Thankfully, the best practices in this area are changing. Even the draft NIST password recommendations, updated in August 2016, trade some of the human-unfriendly parts of passwords (multiple character classes) for more easily memorable, but still secure ones (length). Also, consider the difference between health-system password requirements for clinicians with access to thousands of records and those for patients who only access a single record.

Once your users are authenticated, they will need to be authorized to access some set of resources. As with authentication, if you can delegate this responsibility to another established system, this is probably the best approach. If you are adding unique resources with unique access control rules, you will need to make sure that your authorization mechanisms are secure and auditable.

Conclusion

Creating a HIPAA-compliant service doesn’t have to be a big scary problem, but you do want to make sure you have your ducks in a row. If you’re reading this blog post (and hopefully others!), you’re off to a good start. Here are some additional resources that we found handy:

Posted in: Data Protection, Health Regulations, Healthcare Policy, Healthcare Technology, Uncategorized

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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 Checklist

HIMSS17 is only a few days away and we at Wellpepper have our checklist complete!

  • Coffee
  • Chocolate
  • Wellpepper swag bags
  • iOS and Android devices
  • List of partners, colleagues and friends to meet with
  • Wellpepper CEO, Anne Weiler‘s awesome sessions on the books

Venture+ Forum

Designing Empathetic Care Through Telehealth for Seniors

The “P” is for Participation, Partnering and Empowerment

Importance of Narrative: Open Notes, Patient Stories, Human Connections

Emerging Impacts of Artificial Intelligence on Healthcare IT

  • Twitter account primed to follow the following hashtags:

#Engage4Health

#HITcloud

#WomenInHIT

#EmpowerHIT

#Connected2Health

#Aim2Innovate

#PutData2Work

#HX360

#HITventure

#IHeartHIT

See you there!

Posted in: Healthcare Technology, patient engagement

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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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Not Patient Engagement with Jan Oldenburg

When it comes to talking about patient engagement, nationally recognized consumer health information strategy leader Jan Oldenburg of Participatory Health Consulting chooses to delve deeper into what it means to engage patients in healthcare. With her wide range of experience, she focuses on helping organizations create and implement strategies related to patient/provider engagement and activation with a focus on digital health technology.

In this podcast, Ms. Oldenburg addresses a variety of topics ranging from shifting the healthcare mindset to utilizing digital tools to assist physicians.

Also check out more of Jan Oldenburg’s webinars: “Patient Engagement: Creating Digital Programs that Work.”

Posted in: Behavior Change, Healthcare Technology, patient engagement, Patient Satisfaction

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MHealth and Big Data Are Catalysts for Personalized Patient Care

Although there are many complexities wrapped around our healthcare system, Stanford University’s 2016 Medicine X Conference starts finding solutions to improving patient care by focusing on increasing patient engagement and transforming how patients are treated in the system.

Wellpepper CTO Mike Van Snellenberg, who spoke at MedX in September with digital health entrepreneur and physician Dr. Ravi Komatireddy, addressed several important aspects of big data collection.

“Collecting big data is like planting trees. You need to plant the seed of the process or tooling,” says Van Snelleberg. “Over time, this matures and produces data.”

Mr. Van Snellenberg, who has collected and analyzed patient data at Wellpepper, discovered several key aspects of data collection that could improve care continuity for both patient and providers. He shared this to his MedX audience.

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“Wellpepper has already uncovered new understandings about which patients are most adherent as well as indicators of readmissions,” says Van Snellenberg. “That’s very valuable information.”

“We’ve discovered that, as you collect patient-generated data, these types of insights as well indications about the effectiveness of certain clinical protocols will be available to you. This will help allow for providers to encourage positive patient behavior,” he stated.

Mr. Van Snellenberg spoke further at an interview in October about collecting and using patient-generated data.

 

Question: What groups can benefit off the collecting of big data?

Snellenberg: Collecting patient-generated data can ultimately produce better outcomes and patient care for hospital and clinics as well as the patients themselves. The more in quantity and detail, the better it is to help produce good results. Data collection has tremendous value that can allow hospitals and clinics to learn more about their patients in between hospital visits, thereby filling in missing gaps in patient information. We also realized that collecting big data can potentially prevent complications or readmissions by identifying warning flags before the patient needs to return to the clinic.

And as mentioned, analyzing big data has provided us insights about which patients are most adherent. For example, we have found that patients with 5-7 tasks are adherent while patients with 8-10 tasks are not.

 

Q: What are some things you have discovered using patient-generated data?

MS: We were able to make observations on the patterns. We also discovered a strong linear correlation between the level of pain and difficulty of patients.

Traditionally, patient data remained in the hospital. This often left big gaps in knowledge about the patient in between hospital visits. By collecting and data in between visits to the hospital, you can discover important correlations that would not have been discoverable without data.

 

Q: What are some possible methods to collect patient data?

MS: Dr. Ravi Komatireddy, who worked in digital health, suggested several programs such as Storyvine and AugMedix.

Usually, data is collected by patients recording symptoms and experiences on a daily basis in a consistent manner and then managed afterwards. For example, patients themselves tend to keep track of their progress in diaries or using the FitBit to record the number of steps and heart rate.

 

Q: What are some of the most unique aspects about this year’s MedX?

MS: One unique aspect about the MedX Conference is that it provided more opportunities for diverse voices to be heard in addition to health professionals – including a mix of health patients, providers, and educators.

The mindset was also encouraged to change. Some of the convention’s most progressive talks on stage happened when phrases such as “How might we…” and “Everybody included” are brought up in the discussion.

The term “Everyone included” came up most often, pushing for more perspectives outside of JUST the physicians. MedX’s solution-oriented focus proves to be heading down a successful route to improving patient care in the healthcare system as well as acting as the initiative to open doors for new voices to be heard.

Posted in: Clinical Research, Healthcare motivation, Healthcare Research, Healthcare Technology, Outcomes, patient engagement, Research, Seattle

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Mayo Transform 2016: Change

There was method to the madness, but the feedback for John Hockenberry, host and moderator of this year’s Mayo Clinic Center for Innovation Transform Conference at the first night reception was that the keynote was a bummer.

And it was. This year’s theme was change, and the keynote highlighted three key areas where we need fast and effective change: climate, diet, and early childhood education.Mayo Transform logo

Will Steger, a lifetime adventure and outdoorsperson and founder of Climate Generation, kicked things off with a dire warning that it was no longer possible to make a living running sled dog tours because the Arctic is melting. This was followed by Karen Watson who talked about the successful DrinkUp campaign to combat the challenge that 75% of Americans are chronically dehydrated from consuming sugared beverages instead of water. The campaign was focused on driving people to reach for bottled water instead of soda, and while this seemed counter to the first session on climate change, she cited that 22 million Americans have no access to potable water so bottled water is a good choice for them. Next up George Halvorson from First 5 California and former CEO of Kaiser Permanente talked about programs the state of California and KP have created for early childhood health and education, noting that the years from 0-3 were crucial for childhood development, and that a child of a working mother is read to for 1,500 hours during this period while the child of a typical Medicaid mother (who could be working) is read to for 30 hours during this period. This year 51% of children will be born to Medicaid mothers.

DrinkUpWhile both DrinkUp and First 5 provided solutions to the problems they raised, the overall impact of the keynote was depressing. While the intention was to catalyze people to change the schedule left us had the tools for making change delivered in sessions on days 2 and 3, which left us to drink our sorrows at the opening night reception (and not with bottled water).

Moving into days 2 and 3 of the conference, we did get tools for thinking differently, and the first session on day 2 provided richly in this area with Roger Martin, former dean of the Rotman School making the case for using both scientific method and rhetoric, and in particularly pointing out the short comings of scientific method if you want to innovate, in particular that it only looks at past data and does not imagine a future. Denny Royal of Azul 7 asked us to get out in nature for creativity, inspiration, pattern matching, by using biomimicry to use nature’s solutions for pressing problems, like how Sharklet used the natural antibiotic properties of sharkskin as inspiration to create a substance that naturally repels bacteria, or considering how to create adhesives that work better when wet, like the silk of the Cadis Fly, and could be used internally during surgery instead of our crude methods today like stiches or stapling. Teri Pipe, of ASU led us on a meditative path by asking us to notice what was happening in this moment, and apply these skills to build compassion and reduce stress in delivering care.img_0055

The day 2 keynote provided us with tools for imagining things that don’t exist, have the courage to quiet our own cleverness and learn from nature, and be resilient and empathetic. Given the day 1 keynote, this was just the antidote to embark on the rest of the conference.

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

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Is Connected Health Entering The Mainstream?

I’m just back from Parks Associates 3rd Annual Connected Health Summit. The summit, which began with a focus on consumer health and devices, is broadening to include the consumer experience in all digital health. Most attendees were from technology, payer, and device industries rather than healthcare organizations, and I was struck that a lot of the discussion of about the data from devices, predictive analytics, and natural language processing was beyond what we’re seeing in implementation in healthcare industries today.

Evolution of Digital Health

Evolution of Digital Health

Possibly because Parks Associates focuses on consumer data, and also that the conference has been consumer-device focused in the past, attendees and presenters included telecommunications companies, and even home security companies. This was my first time at the conference but from the data presented by Parks it seems as though digital health, and consumer focused health has become accepted as inevitable and mainstream. A few examples include ADT, the home security company talking about in-home sensing to enable seniors to stay in their homes longer, and Wal-mart talking about meeting healthcare consumers where they are. All of this is a far cry from traditional healthcare delivery. There was also a belief that digital health and the digital health consumer touches everyone from seniors, to the example that for many homeless people their most prized possession is their mobile phone.

Top takeaways:

  • There is no silver bullet for mobile health, digital health, or sensors.
    • Personalization is going to be key as the drivers for engaging in health are different for each person
  • There is no digital health consumer. Segmentation is very challenging in this market. Parks Associates Research identified 4 consumer groups, and 14 segments within those groups.

Digital Health Segments

  • Technology is currently out-pacing implementation possibly due to a slower transition to value-based care than the speed of consumer technology adoption.
  • People are sometimes consumers and sometimes patients, and this is not mutually exclusive.

From Fee For Service To Value-Based Payments

I had the pleasure of participating on a panel on moving to value-based care with Dr. Alexander Grunsfeld, Chief of Neurology from our customer Sentara Healthcare, and Angie Kalousek  from Blue Cross/Blue Shield of California. Too often value gets lumped into the idea of bundles versus fee for service, instead of considering the triple aim of healthcare and delivering the best patient experience and outcomes cost effectively. Fee for service remains the stumbling block to value-based care and organizations have to straddle two worlds when considering implementing two programs. Those who can effectively cross the chasm from fee-for-service to value-based care will be the ones who succeed in the long run, and especially those who consider options before they are legislated to do so.

Crossing the chasm from fee for service to value-based payments

Crossing the chasm from fee for service to value-based payments

Our headache management project with Sentara started from the need of one neurologist to manage his caseload. He had too many patients and not enough data, and needed a way to identify patients that needed the most help and also to enable patients to self-manage their headaches. Interestingly, though although the problem that he was trying to solve was focused on access, in a fee-for-service world, initial appointments are compensated at a higher rate that follow on appointments, so decreasing the need for follow on appointments could actually increase revenue. In an exact opposite scenario, this project has caught the attention of those in Sentara’s health plan, Optima, and they are looking to use this patient self-management to decrease ER costs by enabling patients to better self-manage.

Audience poll on in-home care

Audience poll on in-home care

Posted in: Adherence, Behavior Change, Healthcare Policy, Healthcare Research, Healthcare Technology, Healthcare transformation, M-health, Managing Chronic Disease, patient engagement

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Patients As Designers Of Their Own Health

Seattle’s grassroots healthcare community continues to gain traction with a new meetup for patient-centered design. Last week’s meeting was generously sponsored by MCG a subsidiary of Hearst Publications who are quite active in the healthcare world with content and education. The panel discussion featured Dana Lewis, a patient-maker who is active in the open source movement for diabetes care and built her own artificial pancreas, Christina Berry-White from the digital health group at Seattle Children’s, and Amy London, Innovation Specialist at Virginia Mason. The group talked about how to effectively get feedback from patients, and how patient hackers like Dana can take poor design into their own hands build tools they need, and ultimately influence large healthcare companies, in this case device manufacturers.

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Dana, Christina, and Amy, photo credit Alina Serebryany

The panel had great advice for understanding and developing products and improving processes for patients, as well as for soliciting feedback from patients. Here are a few of my takeaways.

Tips for developing products and process

  • Understand patient’s goals and desires. Often the goals of the hospital or health system are not the same as the patient’s. After meeting with a group of patient advocates one Virginia Mason surgeon realized that the only outcome that really mattered was whether the patient had a positive experience.
  • Let patients customize their views and experiences. Amy talked about a particular chart where she wanted to see the graph rising to show increasing blood sugar and another user she talked to wanted to see the graph lowering to show insulin lowering and a need for intervention. Amy was confused by this view but created her open source artificial pancreas interface to enables people to choose their own view, and the result was that people who had diabetes looked at it the same way Amy did and parent-caregivers of diabetic children wanted the second view. Which brings us to the next point–
  • Differentiate between users. Patients often have different requirements than their caregivers, whether that’s parents caring for a child or teen, or adult children caring for a parent. As well, the clinical workflow shouldn’t dictate the patient experience.
  • Get feedback early. Amy mentioned meeting with a device manufacturer who showed her an almost ready for release glucometer that was intended to fit in the pocket. She quipped “you obviously didn’t test this with women’s pockets.”

Tips for collecting feedback

  • Build it into the product. Christina from Children’s mentioned that when they switched from reams of paper to an iPad-based tool for patient on-boarding forms the physicians wanted to stop using it because it did not immediately integrate with the EMR. Luckily the tool had a feature to survey users on whether they preferred using it to paper, and the answer from parents was overwhelmingly yes. The digital health team showed these results to the physicians, and the tool stayed in place.
  • Be creative when soliciting feedback. Children’s knew from experience that parents and patients were reluctant to give them negative feedback after a lifesaving experience like an organ transplant, so they used techniques that are often used in brand market research: analogies. For example, they asked teens to describe a digital tool as a car, and found out that their tool was like a pick-up truck to them: useful but utilitarian.
  • Use patients to collect feedback. Patients are also often intimidated to provide direct feedback to healthcare professionals as they see them as authority figures. At Virginia Mason patients who have already had a successful joint replacement visit post-surgical patients to find out how they are doing, and talk about their own experiences. Patients are a lot more candid with each other, and Virginia Mason was able to benefit from understanding the questions they asked the peer ambassadors and incorporate that information into formal programs.
  • Ask the questions at the right time. If you want to understand post-operative experiences ask within a few weeks of the actual experience, not 6 months later.
  • Be aware of selection bias. Patients who volunteer for focus groups are often those who have the time and money to be able to do so. Your feedback may be skewed towards retired patients, and those who are not hourly workers. Consider how you will cast a wide net.

Lots of great advice at this event, much of which we already incorporate into our processes and products at Wellpepper, although I definitely got some new ideas and it’s great to see the community coming together to share best practices. My only disappointment with the event was that with a title of Patients as Designers, I expected to see more patients on the panel. While there was a last minute cancellation of a patient-maker, it would have been amazing to have Children’s and Virginia Mason bring one of their patient-designers to be on the panel. Maybe next time?

Posted in: Healthcare Disruption, Healthcare Research, Healthcare Technology, Healthcare transformation, Lean Healthcare, Research, Seattle

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Intelligent Disruption in Healthcare

Two recent webinars tracking recent trends and outlooks on the future of digital health presented interesting perspectives on how the healthcare industry is evolving, but also trigger some concerns about such advancement. The first webinar, Digital Health Tech Vision 2016, hosted by Accenture Consulting, featured Kaveh Safavi, M.D, J.D. (Senior Global Managing Director of Accenture Health) and Jane Sarasohn-Kahn (Health Economist, Industry Advisor and blogger at Health Populi) addressing their prediction of the top five digital health trends in the coming year:

  • Intelligent Automation – the merger of humans and artificial intelligence in a health setting (citing an intriguing example of a company integrating AI into a therapy setting).
  • Liquid Workforce – technology enabling the application of healthcare across geographies.
  • Platform Economy – an economy based on multiple technologies to platform architectures that allow them to work together.
  • Digital Trust – the importance of ensuring patient information isn’t shared improperly by those who have legal access to it.
  • Predictable Disruption – industry leaders agree that the nature of healthcare services will change faster in the next ten years than the last thirty

The second webinar was the MobiHealth News Digital Health 2016 Midyear Review, featuring Brian Dolan (Editor-in-Chief of MobiHealthNews) and Ryan Beckland (CEO and Co-Founder of Validic), who spoke about the past year in digital health, including key acquisitions, policy news, and the importance of patient generated health data in the future.

Both webinars addressed the fact that there is significant consumer demand for digital health innovation. Patients want a more seamless and efficient experience that gives them a better “life-health balance” and does so inexpensively. From the physician point of view, MobiHealthNews pointed out that doctors have about seven minutes on average to spend in person with a patient, most of which is spent doing data entry on a computer, so physicians are looking for solutions that enable them to be more “present during care” and not miss out on any important clinical information. As for healthcare systems, the Accenture webinar touched on the “Predictable Disruption” trend, noting a recent poll showing 86% of healthcare executives feeling pressured to “disrupt” their business model or face disruption from the outside (e.g. companies like Wal-Mart, Apple, Google, and financial service firms are entering the healthcare space).

This high demand for digital health solutions is certainly good news for any companies operating in the space, especially in light of regulations pushing the industry more towards value based care. But is it good news for patients?

With such multipronged pressure facing hospital systems, a concern might be that in trying to keep up with the industry, they too quickly install digital health solutions that aren’t adequately designed for interoperability with other technologies and EMRs and in doing so, could make the patient experience worse. The American Medical Association CEO recently commented on the influx of “ineffective” and “mixed quality” digital health products, going as far as comparing them to modern-day snake oil, and Dr. Sachin Jain, the CEO of CareMore, said that most remote monitoring solutions are not currently working because they aren’t adequately integrated into a system of care, and are just “bolted on” to a current system.

In such a fragmented market, it will be important for healthcare systems to take the time to make decisions based on how well these solutions can integrate with the current systems and EMRs (which aren’t patient-facing, but need to integrate with these new technologies for a seamless patient experience), work with other digital products within the system (achieving the platform economy mentioned by Accenture), and enhance the patient and physician experience and interaction. Perhaps then the industry can claim a new trend: intelligent disruption.

Posted in: Healthcare Disruption, Healthcare Technology, Healthcare transformation, Interoperability, Patient Satisfaction

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