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Postcards from HIMSS M-Health 2015

HIMSS M-HealthIt’s been a busy couple of weeks at Wellpepper with both the AAKHS annual conference and HIMSS M-Health Summit at the Gaylord Convention Center in National Harbor where Wellpepper was honored to have won the Venture+ Pitch along with CirrusMD. This was our second year attending the conference and we noticed that the hype for digital health is a bit lower and perhaps that represents market maturity. It could also be that organizations are in the thick of implementation and don’t have the success stories to tell yet. We believe in digital health and are rolling up our sleeves so will take this feeling that we are moving to incremental change as a positive sign.

Venture+: The Market Is Maturing

We participated in the Venture+ Pitch last year as well which was won by fellow our fellow Springboard Alumna Prima-Temp. Prima-Temp was the clear winner last year, already raising their Series B. However, there were a ton of startups with only an idea. This year the criteria was that startups have revenue before applying, and the competition was held in two parts, the first an invitation-only session where 11 startups pitched and panelists talked about the market opportunity in general, and then a final round with 4 excellent startups and really tough questions from the judges. We were a bit earlier on our journey than a couple of the other startups in the final pitch so were honored to be recognized along with CirrusMD.Clinic of the Past and Present

Interestingly the startup area on the tradeshow floor was almost entirely made up of a new class of startups. So, while the market for M-Health may be maturing somewhat, there are still new entrants attracted by the promise of disruption.

Incremental Progress and Show Me The Evidence

I was only able to attend Day 1 Keynotes, and I heard that the Day 2 keynotes were great, especially by Shahram Ebadollahi of IBM Watson Healthcare. On Day 1, with the exception of an excellent presentation from Dr. Wood from Mayo Center for Innovation (disclosure: as part of winning the Mayo ThinkBig challenge we have the opportunity to work with CFI for the next year), most of the presentations were quite low-key. The main problem was the voice of the patient was missing: the focus was on initiatives or technology. I timed it. 1.5 hours into the keynote and we heard the first end-user story, and it wasn’t really a patient, it was a blind runner who used FitBit.

Dr. Wood shook everyone out of complacency and called out for a faster adoption of healthcare innovation, pointing out how basic things like patient treatment rooms have not changed dramatically in the last 50 years. He asked the audience to consider going beyond patient-reported outcomes and consider the outcomes that matter to patients. What would the system look like if we paid for health rather than healthcare, and we paid based on people being able to reach their own self-defined goals? Digital health is an enabler of this new system, but really, it’s about taking a patient or people-centered approach to health and to care.

What Patients WantAgain, maybe it’s a sign of market maturity, but the conference this year seemed more evolutionary rather than revolutionary. Themes from previous years were expanded on. For example, Judy Murphy of IBM talked about how consumer expectations expectations are fueling demand for m-health. People expect the same level of transparent and always available technology to manage their healthcare as they get from any other consumer experience.

HoneyBee and IPSOs announced the launch of the Global M-Health Survey which also pointed to ubiquity and consumer expectations and desire for M-Health. (The final survey results will be available in Q1.)

In a number of sessions Apple Research Kit was heralded as a major breakthrough for clinical trials. While the speed with which Research Kit was able to sign up study participants is certainly turning traditional research recruits on its head, the same limitations are still there: no HIPAA-compliant server infrastructure and selection-bias for those with more expensive devices. Interestingly, one of the greatest benefits for researchers seems to be the standardization of the informed consent process. (Note that Duke University will be open-sourcing the platform infrastructure they built in recognition that not all organizations have the skills and resources to build something like that.)

Interesting, how what was deemed such a major innovation at the time of release (less than a year ago), also seems a bit incremental. Again, we will take the glass-half full approach and say that we are reaching a market maturity where the gains are more incremental, although at next year’s conference we would really like to see more clinically-validated mobile health applications, and also more patient stories, preferably told by the patients themselves.

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

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Decreasing the Patient Survey Burden for Total Joint PROs

At Wellpepper we believe strongly about the value of patient-reported outcomes, especially when they are delivered as part of the patient care plan. However, the recent trend towards collecting PROs for reimbursement, plus HCAHPS and other surveys can result in some over-surveying of patients. We were pleased to hear at AAHKS that there is a movement to decrease the number of questions for total joint replacement with a proposal of using a HoosJr and a KoosJr. Outcomes-mobile.screen3

The HOOS and KOOS surveys are standard, validated survey instruments that are commonly used for measuring hip and knee function. We’ve heard that CMS is moving towards requiring these measures for evaluating outcomes of TJAs and other surgical procedures. A group of surgeons representing the major American orthopedic associations (American Association of Hip and Knee Surgeons, the American Association of Orthopedic Surgeons, The Hip Society and The Knee Society) has recently proposed shortened version of these surveys to lower the patient data collection burden. Details were presented at the 2015 AAOS and AAHKS conferences. These shortened versions are being called HOOS Jr. and KOOS Jr. Note that these are different than the lesser-used HOOS-PS and KOOS-PS physical short form surveys. The updated surveys are designed to be used standalone or in combination with a general health survey like VR-12, or PROMIS 10 Global. The number of questions is reduced from 40 to 6 (for HOOS) and from 42 to 7 (for KOOS), while retaining reliable, responsive output scores. With a patient completion time of under 3 minutes, these shortened surveys should dramatically aid in increasing survey response rates. Wellpepper supports HOOS and KOOS today, and looks forward to supporting HOOS Jr. and KOOS Jr. as soon as scoring rules are released.

Posted in: Health Regulations, Healthcare Technology, Outcomes, Patient Satisfaction

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Value-Based Bundles for Total Joint: The Glass Is More Than Half-Full

The bundles are coming! The bundles are coming! While many health systems have been delivering care in value-based bundles for some time, the broad implementation of bundles was made a reality when the Centers for Medicare and Medicaid announced the Comprehensive Care for Total Joint proposal to go into effect in early 2016. Navigating this new world, was the focus of the session “The Business of Total Joint Replacement: Surviving and Thriving” at the American Association of Hip and Knee Surgeons annual meeting. This was one of the best sessions we’ve attended on this topic: both realistic and optimistic about the opportunity to impact patient-centered care and change. This is a long post because the session was jam-packed with information, and I was only able to attend the first part. Heads must have been reeling for those who were fortunate to attend the entire 5-hour session.

The session was kicked off by Mark I. Froimson, MD, MBA EVP and Chief Clinical Officer of Trinity Health who took questions from the audience to start the day to ensure that their needs were addressed. A survey of the room showed that roughly half of the attendees were surgeons or physicians and the rest of the audience was comprised of included administrators, nurses, and physical therapists involved in care. This was apropos as much of the theme of the conference was about how care teams will need to work together across settings in a new patient-centered model to deliver on care.

Questions fielded showed that the audience had done their homework and included concerns about business models and outcome tracking for revisions. The Baby Boomer’s desire to stay active has resulted in earlier joint replacements which means revision surgery in the future. Audience members were concerned that revisions wouldn’t have as strong outcomes and they would be penalized by that. Participants from smaller organizations asked whether there were other metric tracking schemes they could participate in to offset the Meaningful Use incentives if they weren’t able to participate. (We have an idea: how about reimbursement for engagement with digital patient treatment plans?) Complex cases were also of concern: the system needs to ensure that systems will not be penalized for complex case that may also have weaker outcomes. Without risk adjustment for complex cases which are more likely be done at large in-patient facilities rather than ambulatory surgery centers, some organizations could be unfairly penalized.

Risk-sharing

Dr. Fromison handed the session over to the extremely optimistic Kevin J. Bozic, MD, MBA, Chair of Surgery and Perioperative Care, Dell School of Medicine. While value-based the goal of bundled payments is to improve outcomes and lower costs, Dr. Bozic spoke directly to the audience about the value for them: in the current fee-for-service model, the best surgeon gets paid the same as the worst. There is no incentive for efficiency. In the new model, surgeons that can deliver better outcomes at lower costs will be rewarded accordingly.

Interestingly though, the team-based medicine approach and the focus on surgical prep and post-operative care, means that it’s not clear which physician in the team will see the benefits of performance bonus: the primary care or physiatrist, the anesthesiologist, or the surgeon. This will be interesting to watch play out. In the past some surgeons considered their work to be finished after the surgery and others stepped in for post-acute care. As well, there was discussion about how to get hourly workers in the care team on board and aligned with the new models. As we’ve talked to countless organizations and individuals about the move to value-based payments, the common theme is that the patient outcome driven approach is better for patients: perhaps this can be the rallying cry for alignment.

This team-based partnership is not just within an organization or care team. Since 40-50% of costs of a total joint replacement are in post-acute care, surgeons and health systems must partner with post-acute care facilities. We’ve observed this trend directly with both inpatient and outpatient rehabilitation joining health systems and creating new ACOs to share risk.

Dr. Bozic handily turned the negative connotations of risk-sharing on their heads, when he was asked whether these new models were just a measure to shift risk to the providers. His answer was a positive “Yes” and encouraged the audience that providers were really the only ones who could manage performance and appropriateness of care. Note that payers still bear the risk of who gets a disease (although with more health systems focusing on wellness this could change), while providers bear the risk for the outcomes. Because of this, Bozic recommended that a strong physician needed to lead the change and own the bundle implementation within a health system.

Outcomes, Outcomes, Outcomes

Today with the focus on outcomes it’s hard to believe that a surgeon from Massachusetts General, largely seen as the father of outcome tracking, was run out of town and eventually lost his license for suggesting that physicians should track and be accountable for the outcomes of the interventions they performed.

Refreshingly, Dr. Bozic asked the audience to go beyond standardized outcome tracking as it relates to reimbursement, and consider which outcomes matter most to patients. We’re excited about this idea as we track outcomes both based on standardized outcome measures like the HOOS and KOOS (and soon the Hoos Jr & Koos Jr) but also at the task level and soon based on the patient’s own goal.Outcomes-mobile.screen4.jpg Outcomes-mobile.screen5.jpg

Without data transparency and sharing, improvement can’t happen. Finding out where the waste is in the 100-300% variation in inpatient total joint cost is key. Dr. Bozic is suspicious of organizations that boast that they are better than average on all measures: he believes that they are actually are unaware of their flaws and not driving a culture of continuous improvement.

We’ve been at surgeon-focused conferences before, and the booths that were busiest were those promoting joints and surgical instruments. Dr. Bozic told the audience they needed to be evaluating vendors that could help them collect, measure, and act on outcomes, which was music to our ears.

Patients and Prevention

The third speaker was Dr. David Halsey, MD from Vermont, who echoed many of the themes of the previous speakers, especially in the need for outcomes, but also posited a question we haven’t heard before, Dr. Halsey asked who better to do population health for arthritis than orthopedic surgeons? In our travels, we think that both physiatrists and physical therapists might want to join in that population health management, however, if it starts with the surgeons then they would be more incented to try other approaches before surgery, which can be accomplished through preventative care. Preventative care includes patient education and shared decision making and requires new tools to involve and engage patients in their care. It also includes making the patient’s goals front and center to improve care, and understanding and managing their expectations. Today’s patients have higher expectations to have a high level of mobility post surgery, and a low level of pain. Physicians need to engage with patients both to understand and to manage their expectations.

Moving Forward

While we’ve heard some people grousing about the squeeze that is being put on orthopedics through the CCJR, this glass-half-full group sees this as an opportunity for orthopedists to lead the way and actively engage with CMS. Data collection and transparency are the way to do this, and the current tools (aka EMRs) don’t cut it. (While this is our message at Wellpepper, it came directly from the speakers: times are changing!) Expectations are that other specialties will follow the total joint guidelines, spinal surgery is considered to be next, so orthopedists have the opportunity to set the standard for how value-based bundles are implemented in their organizations, while collecting and analyzing real-time data and leading an interdisciplinary team of course. Onwards! We’re ready!

Posted in: Health Regulations, Healthcare Disruption, Healthcare Policy, Healthcare Technology, Healthcare transformation, M-health, Outcomes

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Certified Health IT provision proposed by CMS

Finding that you have to be hospitalized again has got to be frustrating enough, but learning that it could have been avoided has to spark a cocktail of emotions for all involved. It’s not rocket science that avoiding readmission is dependent on strong discharge planning practices; i.e. seamless transfer of vital information and strong communication between a hospital and post-acute care facility. Furthermore it’s hard to sidestep statistics; the cost of readmission for Medicare patients is over $26 billion a year and approximately 2.6 million seniors are readmitted within 30 days. What? As a tax payer and a friend of many Medicare patients, I am troubled… that is a lot of individuals and money!

So naturally my next question is: What is the government doing about it?! CMS published a proposed rule in the federal register last week that includes the implementation of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT) and a revision of the discharge planning requirements (IT interoperability orientated). There are 21 discharge planning data requirements; these patient centered data elements are what a certified health IT system should provide to a PAC facility in order to enable seamless transition of care. I especially like the bullet: ‘patient’s goals and preferences’; I think this is very important for many reasons… one being that after a few patient interactions, clinicians will get a good feel of what is important to the patient through discussion. It takes time to build this knowledgebase because it requires that all important human ‘touch’.

Such patient and provider experiences are now being taken advantage of, therefore the idea of patient involvement during discharge planning provides better outcomes (therefore lower readmission) is not new, but the idea of assisting patients when selecting Post-Acute Care (PAC) providers by sharing data on quality and resource use measures, is relatively. The proposed provision also puts a time frame on when to start discharge planning; discharge planning must begin within 24 hours of admission/registration and discharge plan must be completed “before the patient is discharged home or transferred to another facility”. I have faith in our system and that this quoted remark is not new, but perhaps the first time formally written by the IMPACT committee!

I think it is also important to point out here the Community-based Care Transitions Program (CCTP) that was implemented by the Affordable Care Act in February 2012 allocating $300 million in funding to reduce readmissions. An annual report of the CCTP program success can be found here. The report concludes “Only one site had a significant reduction in readmission…” but goes on to say that not all sites entered the program at the same time, therefore this information isn’t reliable. With that said, I cannot help but wonder if the certified Health IT system would have been required already to contain the 21 data elements during electronic transmission during discharge planning (for several years mind you) these 46 Community Based organizations (CBO) would of had lower readmission rates. In 2017 when the CCTP initiative is over, I hope we learn of it’s effectiveness and it helps millions of Americans.

Posted in: Healthcare Policy, Healthcare Technology, Interoperability

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Press Release: Wellpepper Venture+ Forum Winner

CirrusMD And Wellpepper Named Venture+ Forum Pitch Competition Winners At 7th Annual mHealth Summit

WASHINGTON, Nov. 11, 2015 /PRNewswire/ — CirrusMD Inc., and Wellpepper were named the winners of the 2015 Venture+ Forum Pitch competition for startups at the mHealth Summit. They were among four companies selected to deliver live pitch presentations during the ‘final four’ competition Tuesday evening. The finalists were selected from a field of eleven digital health startups who presented during the first round of live competition held on Sunday at the Summit.

The 2015 Presenting Companies were chosen based on criteria for demonstrated impact and quantifiable results for improving health care delivery and outcomes.  The Venture+ Forum provides a recognized platform for health entrepreneurs, fostering commercialization of innovative health technology solutions to advance healthcare delivery.

“The Venture+ Forum has become an anticipated event for health technology startups, with tangible results for pitch competition winners,” said Richard Scarfo, Director, mHealth Summit, and Vice President, Personal Connected Health Alliance (PCHA). “Venture+ Forum is designed to support the startup community, investors and entrepreneurs, and advance innovation in health technology. Congratulations to CirrusMD, Wellpepper and each of the finalists.”

CirrusMD develops “closed loop” virtual care solutions for value-based healthcare, with a unique telemedicine methodology that ensures continuity of patient care and enables full data integration over multiple communications channels – text messaging, phone and video chat.

Wellpepper is a clinically-validated mobile patient engagement platform, and is used in orthopedics, rehabilitation, trauma and burns, pain management and neurology at hospitals and clinics. It enables healthcare professionals to create and prescribe custom treatment plans based on their own best practices and protocols, and personalize them for each patient.

The first Venture+ Forum event of 2016 will be held at the HIMSS Annual Conference taking place February 29-March 4 in Las Vegas, as part of its mission to promote innovation in health technology. PCHA will also host the 2nd annual HX360 event at HIMSS16, inviting health system executive leaders, innovation teams, entrepreneurs, investors and technologists to explore technology-based solutions to challenges in healthcare delivery and operations, as well as new business models, novel partnerships and approaches to sustaining innovation.

About the mHealth Summit
The mHealth Summit is the global convener of the expanding mobile health ecosystem, exploring the disruptions, challenges and opportunities of the integration of mobile and wireless technologies into the healthcare system, and in consumer and patient engagement, for the delivery of better health outcomes. The 7th Annual mHealth Summit will take place November 8-11, 2015, in Washington, D.C. Focusing on four fundamental platforms – technology, business, research and policy – the mHealth Summit is presented by HIMSS, in partnership with Continua, the Foundation for the NIH and the mHealth Working Group. mHealth Summit is part of the Personal Connected Health Alliance (PCHA), an international non-profit organization established by Continua, mHealth Summit and HIMSS to represent the consumer voice in personal connected health. Visit the mHealth Summit for more information; and follow at @mhealthsummit.

 

Posted in: Healthcare Technology, M-health, Press Release

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Is Seattle Ready For A Seismic Shift In Healthcare?

The plans to open the Cambia Grove, a health care innovation center, were first announced about this same time last year at the 25th Annual Governor’s Life Sciences Summit. Nicole Bell, executive director of Cambia Grove was then quoted saying, “Why couldn’t we be for health care what we are for coffee, aerospace, for online retail and for independent rock-and-roll?”IMG_2081

A year later and timed perfectly to coincide with the 17th Annual National Institutes of Health (NIH)/SBIR/STTR Conference, Cambia Grove announced results from the 9 page “Report on Health Care Innovation in Washington State.” This report effectively established a baseline for the economic impact of health care innovation sub-sector in Seattle. Based on the numbers, it seems as though Seattle is poised to compete with rival health care hubs like Boston and the Bay Area.

IMG_0412Here are a few of the more impressive stats. Pay levels are for this sub-sector of this industry are 8% higher than average with $2B in compensation, not to shabby. Apparently these employees are amazing rock stars with 300% more productivity than an average worker and they create $6.8B in direct output?!?!? With this astounding productivity that 8% doesn’t seem like quite a commensurate salary increase.  While there are 22,500 jobs across the state, it is not surprising that over 80% of them are concentrated in Seattle. After Nicole Bell revealed these report highlights, she commented that it would make sense to create or convert even more jobs in to this thriving job sector. I guess we bike riding, coffee drinking, online shopping, wearing jeans and Tevas to work Seattlites must really be on to something here.

I am absolutely thrilled to have taken a path that is leading me into this new sub-sector of healthcare innovation and start-ups where evidently I’ll be working in the land of serious overachievers. As a RN, I’m no stranger to long hours and hard work. Coming from traditional healthcare institutions where the norms are grueling 12-hour shifts, you literally have to ask someone if you can go pee because you can’t leave your patients unattended and you learn to ingest your lunch in under 5 minutes.

IMG_0413As much as working in traditional healthcare has taught me clinically, I couldn’t imagine moving into a healthcare IT analyst role after completing my Masters degree in Clinical Informatics. I imagine if I stayed, I’d probably end-up stuck in a cube trying to unscramble the EHR mess or analyzing already broken workflows attempting to integrated a new piece of technology that never went through any real usability testing by actual healthcare workers who would be suing it. Having used both Epic and Cerner products, I was like “I told you so!” after reading articles about the recently published JAMA reporting the lack of adherence by EHR vendors to conduct usability testing. I digress. My point is I’m waiting with bated breath for the lagging traditional healthcare industry to get the swift kick it needs by the younger, more ambitious and more productive innovation sub-sector. The report is effectively calling out to health innovators in Seattle that the time for a seismic shift is now…in healthcare, hopefully not literally a seismic shift in Seattle. Either way, Seattle Health Innovators prepare yourselves, let’s get ready to compete with Boston and the Bay Area.

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

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Disruptive Innovation to Improve Mental Health Care

Health Innovators Collaborative, University of WA Bioengineering
Dr. Jurgen Unützer, Chair of UW Psychiatry and Behavioral Sciences

The Health Innovators Collaborative seminar that I attend last week by Dr. Unutzer gave me an emotional whirlwind, which is ironic because the subject was mental health. That afternoon I innocently put my boots on and galloped down to the university in my VW Beetle and waited for the seminar to begin by eating an apple in the front row. I had no idea what was in store for me in the next 60 minutes or so. I would have cowardly slumped down into my chair if this was a talk taking place outside of Washington… because I am so ashamed about how we brush our mental illness folks under the rug. My jaw almost dropped in shock; we are ranked 48 out of 51 to have the correct resources available for our mentally ill with only 20 psychiatrists in Rural Washington. Dr. Unutzer argued that we spend more money on preventing auto accidents and homicide, when the rate of suicide is much higher- there is a suicide every 15 minutes in our country and 2-3 a day in Washington.

IMPACT- Collaborative Care Model

After giving us such somber news he talked at great lengths about ‘working smarter’ in order to close the gap of inadequate mental health professionals. One of the largest treatment trials for depression, Improving Mood–Promoting Access to Collaborative Treatment (IMPACT) was spearheaded by Dr. Unutzer and his colleagues. They designed IMPACT to function in two ways; “The patient’s primary care physician works with a mental health care manager (can be a mental health nurse, social worker etc.) to develop and implement a treatment and the mental health care manager and primary care provider consult with psychiatrist to change treatment plans if patients do not improve.” The IMPACT study was started over 15 years ago when the use of EMRs and video conferencing were just starting to become ‘mainstream’. Therefore in a way this study was the forerunner in utilizing a multi-based ‘high tech’ mental health patient care platform; population registry/database (tracking tool of patients PHI, treatments, etc.) psychiatric consultation (video), treatment protocols and outcome measures (I feel I am writing about Wellpepper!). The video consultation takes place between the patient and a remote psychiatrist typically after treatments protocols are administered in the primary cares office with little or no patient improvement. This is imperative especially in Washington where half of the counties don’t have a single psychiatrist or psychologist.

There is a great JAMA article written on the outcomes of the IMPACT program (I am proud to say I did my homework on the positive slides presented and not the slippery slides) that really nails out the particulars in the normal scientific journal fashion. As always I shot to the bottom of such article for the ‘results and conclusions’ because I knew this one was going to be great, I had a sneak peak last Wednesday. After a year 45% of the 1801 patients studied had a 50% or greater reduction in depressive symptoms from baseline compared with 19% of usual care participants! Furthermore this study reduced healthcare costs; $6.50 saved for every $1 invested, with the most being saved in inpatient medical and pharmacy costs. In conclusion having a system that provides population based care, that is patient centered, has target treatment solutions, and is evidence based leads to more efficient modes of getting a patient in and out the door with positive results.

I exhaled what a clever man you are Dr. Unutzer to present your slides in such an order, from negative/scary to positive/uplifting, it’s almost like you are a psychiatrist and now how the mind works, oh wait you are!! Thank you for a wonderful talk, it was superb and always nice to learn something new!

Next seminar is “Bad Language, Worse Outcomes” with Jeremy Stone, MD MBA on November 3.

Posted in: Healthcare Disruption, Healthcare Research, Healthcare Technology, Healthcare transformation, Interoperability, Outcomes, Seattle, Telemedicine

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You Could Get Well Here: Touring Mayo Clinic

Mayo Clinic Center for InnovationDuring the recent Mayo Clinic Center for Innovation Transform Conference, attendees had the opportunity to take tours of various Mayo facilities.

I was able to tour the Center For Innovation, where we will be working periodically over the next year as part of our prize for winning the Mayo and Avia Think Big Innovation challenge, and the Center for Healthy Living. A third tour, of the new Well Living Lab was sold out before we could get tickets.

Spirituality is part of health at Mayo

Spirituality is part of health at Mayo

The Well Living Lab is a research center where the health impacts of daily living can be tested. For example, researchers expect to study the impacts of air quality or lighting in office buildings on employee health. Tour organizers told me that the paint was still drying on the center as they start the tours so I’m sure we’ll be hearing more about this innovative center in the future.

Mayo Clinic Center for Innovation Tour

The Center For Innovation houses two main areas, one a clinical space where real patients and care teams can test different types of exam room configurations and equipment, and the other more like a typical software or design office. Pictures were limited in this area, so you’ll have to imagine from my descriptions.

All the walls in the clinical space are magnetic, enabling different types of room configurations on the fly. Even the artwork is affixed with magnets, so I suppose it’s possible to also test the effect of different artists as well. When medical teams work out of the CFI space, they are testing not just the patient experience but whether these new configurations make teams more productive or collaborative. The CFI has found a number of improvements to care are possible with better room configuration, and noted that clinics and exam rooms have changed very little since the 1950s.Human Centered Design

A few innovative examples include:

  • A kidney-shaped table encourages more collaboration and communication between doctors and patients
  • Separate consultation and exam rooms offer many benefits in both communication and efficiency. Patients are less stressed, more able to absorb information, and ask questions in a consultation room rather than sitting on a table in an exam room. Two physicians can share one exam room when there are two consultation rooms and therefore they can see more patients in only 1.5 times the space of a normal exam room.
  • An open plan office where all of the care team, nurses, medical assistants, schedulers can work encourages team collaboration and also empathy as each member has much better insight into what the others are doing.
    How Patients Experience Services

    How Patients Experience Services

At the CFI, we learned about projects that have recently been completed (although they were mum on work in progress), like a project to overhaul post-discharge instructions for total joint replacement. This is a hot topic lately as CMS moves to value-based bundles for reimbursing these procedures it’s even more important to manage care outside the clinic, and do to that patients need to understand what they need to do. This is a topic near and dear to our hearts at Wellpepper.

Other projects included exer-gaming for seniors, and Project Mars named as a challenge to completely reimagining the Mayo Clinic experience as though they were building a new Mayo on Mars. This experience spans pre-visit to post visit and includes patient care and the patient’s experience in the physical space.

Mayo Clinic Center for Healthy Living

The Center for Healthy Living is an impressive new facility in the middle of Mayo campus. The Center is focused on proactive and preventative experiences for people who want to take action managing their health.

IMG_2373

Yoga studio with a view

This may include executives who believe health and fitness is a competitive business advantage to people diagnosed as pre-diabetes who are motivated not to become diabetic, to people wanting to regain health and strength after cancer treatment. The Center takes a wholistic approach, and guests (as visitors are called) frequently book a week-long package that includes physical assessment, diet, and stress and spirituality consultations.

The living wall

The living wall

Consultations on diet include cooking classes and nutritional information including how to read labels and understand what’s really in your food.

The Center also houses a spa, which is apparently a best kept secret in Rochester. Throughout the center the design is calming, including floor to ceiling windows and a living wall, and it really feels like a place you can get well.

Clients are sent home with specialized treatment programs and recommendations to support their lifestyle changes permanently. The Center has only been open for a year, and ideally will seen clients coming back year over year for a tune up. It’s definitely a place I’d visit again.

More pictures of the Center for Healthy Living.

IMG_2370

The Nutrition Pantry

Guests learn to prepare healthy meals in this kitchen

Guests learn to prepare healthy meals in this kitchen

Rest with a view

Rest with a view

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

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Telling Stories & Busting Myths at Mayo Clinic’s Transform 2015 Conference

We’re just back from Mayo Clinic’s excellent Transform Conference 2015. What struck us about the conference was just how fun it was. Bring together a group of people who are passionate about changing health, and put them in an innovative setting, and some magic happens.Mayo Transform 2015

Here are some other highlights of the conference that made it a stand out:

  • The Host: NPR host John Hockenberry was the MC for the entire conference. His ability to ask hard questions and also provide consistency across the themes and panels was fantastic. He was also able to talk about his own experiences as a patient from an early accident.
  • Mayo Transform THINKBIG Innovation ChallengeStorytelling: The power of story was on showcase from Minnesotan playwright Kevin Kling, to the Pecha Kucha talks, and even the ThinkBig Innovation Challenge, which featured real patients telling their stories to find a match with a startup. The two winning startups (disclosure: we were one of them) also both featured real stories that inspired founders to start the companies. In connecting with other attendees, everyone had a personal health story to share, even though attendees were in the healthcare industries it was the personal stories that resonated the most.
  • Diversity: Very low incidence of panels that were all white men. And not token diversity, these people are leaders in their fields and incredibly inspiring, like Dr. Nadine Burke Harris, founder of the Center For Youth Wellness, and expert on early adverse childhood experiences (ACES) and how they impact future health.
  • Mayo Transform ConferenceMyth Busting: Myths were busted all over the place. Here are some examples:
    • While 10% of people cause most of the costs in healthcare, we’ll all be in the 10% at some point, in the same way that we are in the 10% of spend for other life events like weddings, buying houses, or paying for education.
    • Shame and ritual can both be powerful motivators. Positive reinforcement has it’s place but we always think we’re perfect in the future so today sometimes we need shame to get us to do things we don’t want to. This was from behavioral economist and head of The Center for Advanced Hindsight at Duke University, Dan Ariely.
    • Free telehealth is cost-effective. Or this could also be subtitled: proactive, preventative, and accessible care is cheaper. This is from Oscar CEO Mario Schlosser.
    • Price transparency is not just for patients: how can providers evaluate treatments or drugs if they are unaware of the costs.
  • The Mayo Clinic: It was our first time visiting, and we loved the tours of the Center for Innovation, and the Center for Healthy Living. More on those in a future post.His Holiness, The Dalai Llama
  • Interactivity: From maker labs and nurse maker projects, to the ability to spend time with every speaker immediately after they talked, it was a hands on type of conference. The entire conference was live-streamed as well, and the top tweeter was watching from home!
  • His Holiness, The Dalai Llama: Yes, he was visiting Mayo.

 

Posted in: Healthcare Disruption, Healthcare motivation, Healthcare Technology, Healthcare transformation, Outcomes, Patient Satisfaction

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Accountable Care and HealthIT Strategies Summit 2015: Still early days

Patients and providers both need to be empowered to deliver on the promises of the Affordable Care Act. That was the major theme and takeaway of the recent “Accountable Care and Health IT Strategies Summit” that I attended a few weeks ago in Chicago. I would add to this sentiment that IT needs help to implement technologies that empower these end-users. While not underestimating the importance of making sure technology is secure, and scalable, with too much focus on the back-end, IT can miss an opportunity to help deliver real value and change by putting tools in the hands of end-users.

Since value-based payments require health systems to be able to impact patient behavior outside their four walls, technology (and therefore IT departments) have the ability to play a greater role in helping to monitor and manage patients, and scale healthcare providers. Access to real-time data can also help identify issues and impact patient behavior before small problems turn into big ones.

While some of the stories and sessions at the conference were promising, I came away with the impression that we are still in really early days, and the leaders in this care transformation are willing to take leaps without having all the data. Considering that even with data, it still takes 17 years from innovation to transfer from research to clinical best practice, it seems that some amount of faith is required for this healthcare transformation.

In no particular order, here are a few of my notes from the 2-day conference.

Theme: Population Health 2.0: Accountable Care, Big Data and Healthcare Analytics

Population Health seems the furthest along in this transformation both in the way care is delivered and how technology supports care. Participants on this panel from Partners, Geisinger, and Hackensack University Medical Center, along with population health vendor Wellcentive debated the differences between Population Health 1.0 and 2.0. They even tried to see the future with Population Health 3.0.

Population Health 1.0 was seen as identifying risk and gaps in care, and attempting to plug those gaps. Although many organizations are still in this stage, some haven’t even gotten there yet. The panel saw themselves moving to a more evolved state of Population Health where data is used to drive better care, while responsibility for population health moves to the individual primary care physician rather than being managed in aggregate by remote care teams. However, this type of shift requires engagement by both the patients and the physicians which is still a work-in –progress.

The representative from Geisinger stressed for an effective implementation of population health, a multi-disciplinary team needs to be assembled that includes both clinical and IT. Wellcentive agreed and added that analytics need to be in the hands of end-users so they can make informed decisions.

The panel was also asked to speculate on Population Health 3.0: historical data, data driven decisions, and patient empowerment through data from sensors and surveys were all seen as key.

Honestly, my biggest takeaway from this session is that while some organizations may be claiming it’s time for Population Health 2.0, many haven’t gotten to 1.0, and no one seems to be in agreement on the definitions of each stage. Given today we already have the ability to collect survey and sensor data in the context of care, it seems like we are already have the tools for Population Health 3.0. But, we haven’t implemented the technology to address Pop Health 1.0 & 2.0 to achieve value…..so how can we even look to addressing the road to 3.0?

Theme: EMRs and Enabling Technology for ACOs

Another major theme that arose across many sessions at the conference is the limitations of current technology to support the infrastructure of new models of care. While organizations are looking for the EMR to be the Holy Grail, it’s a challenge as most EMRs are built to support older models of care, specifically around billing and reimbursement. Renown Health’s Accountable Care Organization, in Northern Nevada, will look to EPIC to solve some of their technology care needs, but realizes the need for M-health and other care coordination technologies to move up the stack, and exist separately from the EMR will be required.

Many of the participants are either trying to collect and track ACO data in the EMR or build their own systems to engage patients that fed data back into the EMR. Others acknowledged that new systems to directly engage patients need to be built on new technology stacks, although surprisingly one panelist on the Connected Care – How Trends in mHealth, Wearables and Connected Medical Home are Shaping Healthcare keynote boasted about 20-30% engagement rates with paper surveys. Yes, paper.

Theme: Engaging Patients and Providers

For ACOs and the ACA in general to be effective, the consensus at the conference was the need to enable both patients and providers. Adding individual providers into the mix seems to be a bit of a shift in thinking, and one that we’re supportive of at Wellpepper. We know that a key driver of patient adherence is the relationship between patients and providers. With our system, a good provider can influence patients to be over 85% adherent to their treatment plans. Some key ideas at the conference were providers may still need to be convinced of the need to influence patients directly, and that showing them data is the way to do that. However, the method of communication to that patient needs to connect in a way that is of their everyday life routine.

Overall, the conference presented some early wins in the shift to ACOs and value-based payments, but showed that we still have a long way to go and a lot of opportunity to improve care based on data. That said, this was the first conference I’ve been to where IT was front-and-center at the table and able to drive change if they wanted to. We have an opportunity to leapfrog old ways of doing things and implement new systems that have focus on the patient and provider, and are based on data to drive better outcomes. I for one am excited about this new opportunity and how it will change the way we deliver care in the future.

Posted in: Behavior Change, Health Regulations, Healthcare Disruption, Healthcare motivation, Healthcare Technology, Outcomes

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Falls Prevention Awareness Day September 23rd

Last year my 80 year old grandmother fell walking back from my cousins wedding reception, luckily she grabbed onto my sister and broke her fall. Nevertheless as we studied the sidewalk for several minutes only to discover its perfectly flat surface and our tremendous worry… my dear grandmother could think of nothing other than her embarrassment. We later learned from my grandfather that she has fallen several times over the last few months; she shook it off with laughing commentary in the background saying he was exaggerating. Whereas I appreciate her humor, it is no laughing matter. 2.5 million elderly adults are treated in the ER for fall injuries, with one out of five falls result in broken bones. With those statistics I continue to worry about the next time she falls and my sister isn’t there.

Pick up your cars, grandma is coming over!

With that said, today being Falls Prevention Awareness day I cannot help but think of everyone in my life that is prone to falling… which I am sure you are now pondering yourself. So we should all take a minute (or longer depending on how caught up you are on house chores!) and look around our environment for fall hazards and think about prevention. I have a two year old son that contributes a lot to fall hazards with his hotwheels toys strewn all over the house, which makes my house a high risk zone no doubt! I have to ask what’s on my grandmothers floor?! We need to encourage our elderly loved ones to remove fall risk factors in their homes too; broken steps, faulty handrails, uneven pavement, clutter, throw rugs, poor lighting… grandchildren toys! However most of all we need to make sure they are still getting out of the house and do NOT let the fear of falling limit their mobility. Lower mobility is a major fall risk factor due to deteriorating body strength, which in return also influences balance. It is argued strengthening your balance is the single most important factor in avoiding falls. Senior centers across the country teach classes to elderly adults called “Matter of Balance” (I have taught a few in the past!), they are a great way to teach folks about balance strengthening through exercise and awareness of ‘fall-ty’ habits.

Working for Wellpepper and learning more each day about how it is helping patients, I cannot help but think about how mHealth technology could also help with fall prevention. There are several balance strengthening exercises that we do in our ‘Matter of Balance’ classes at the senior center that could be very easily translated onto the mHealth platform. Honestly now that I think about it the whole class could be taught this way, and might even have better results since a lot of elderly adults express interest in the class, but don’t show up because they are too embarrassed about admitting to of fallen, just like my poor grandmother.

Such thoughts of mine have been expressed officially (to say the least!) by Harvard researchers, because today it was announced on Falls Prevention Awareness Day no less, in a press release, that they are utilizing Wellpepper as an patient engagement solution to lower the costs of care and to improve patient mobility skills as well as muscle strength, endurance and power and to decrease the risk for fall-related injuries such as hip fracture. I cannot wait to see how this study plays out, because it could mean a whole world of good for our lovely elderly family members. I cannot help but visualize how cute my grandmother would be practicing her muscle strengthening exercises on an iPad and the great peace of mind my family would have.

Congratulations team Wellpepper for your involvement in making this Falls Prevention Awareness Day a big notch in your ongoing achievement index!

Posted in: Aging, Behavior Change, Healthcare Research, M-health

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This Month [August] in Telemedicine

This Month [August] in Telemedicine

Moderated by:
Jonathan Linkous
Chief Executive Officer,
American Telemedicine Association

Gary Capistrant
Chief Policy Officer,
American Telemedicine Association

This month in Telemedicine webcast was interesting because more than once was the ATA sentiment geared towards realizing the big picture of telemedicine: To help patients. Unless you are lucky enough to work directly with patients that utilized telemedicine on a daily basis, I think sometimes, including myself, we get caught up in the bureaucracy/methodological side of things. Sometimes it takes talking with patient or clinician in order to make me grasp how HIT is improving lives, my life too! So I appreciate the reminder John! At the end of the webcast he asked if you have a personal story of how telemedicine helped you or a loved one ATA needs to hear it, please email John Linkous -jlinkous@americantelemed.org

The main highlight of the first 20 minutes of this webcast focused on the positive trend of telemedicine utilization. Not surprising the younger crowd just beginning their careers in medicine strongly support the use of telemedicine; Medscape conducted a survey and found out that 70% residents had no problem consulting via telemedicine. And maybe because I am of the ‘younger’ crowd (bahaha) I think this is ingenious: the Colorado medicine board is doing away with the rule that patients need to see doctors face to face before utilizing telemedicine; ok so how many times have you gone all the way to the doctor’s office only to get a referral or need blood work done before they can give you a diagnosis/treatment?! Genius! Other interesting facts: 20% of American adults use some technology to track health care (counting steps, migraine triggers & heart rate, etc.) and 57% of households with children access one health portal per a month. Finally big employers are seeing the benefit of telemedicine to cut back on insurance costs; 75% of large employers will be using telehealth as a benefit next year.

Licensure compacts. Ok guys really? Every “This month in telemedicine” webcast talks about this. What is the hold up?! It is so frustrating to me that if I get ill on vacation in Hawaii (ok dreaming, who gets sick in Hawaii?) I cannot get a consult from my doctor over the phone or the internet. This is silly people and it was clear to me that John thinks so as well. He underscored the importance that ATA supports the federation’s compacts in principal, but has some concerns… it is estimated that it will cost 300 million for the 21% of physicians that have more than one state license. Oh money, yea ok that’s the same old hold up every time. Next time they talk about state licensure compacts I am just going to put a dollar sign in my post… you’ll understand.

Circa 1934. Broadcast to Webcast; Radio Technology to Wireless Telegraphy… and now just ‘wireless’. http://www.cio.noaa.gov/rfm/index.html

Frustration was also heard in John’s voice about the FCC Telecommunications Act of 1996. The last Telecommunications act was in 1934, 62 years it took to write a revision, and it looks like it will take another 62 years at the rate they are going! ATA continues to be disappointed in the Act; the FCC estimated there would be a 400 million a year in spending on broadband linking rural healthcare, last year they approved for 200 million. They have only deployed 100 million; only spending a quarter on what the program was supposed to spend- “they need to step up.” Why John? They have 62 years to spend that!

A big note: telemedicine care for post discharge (knee and hip replacements) isn’t expanded out to Physical and Occupational Therapy for Medicare patients. CMS has waived two of Medicare restrictions: allow any Medicare beneficiary to provide services regardless of where they reside but somehow does not include health innovation- “we will be commenting to CMS” and so they did in a letter dated 9/8 strongly urging CMS “…to allow for PT and OT to provide rehabilitation by telehealth means, otherwise covered by Medicare…”

The ATA Fall Forum is next week (9/16-18) in Washington D.C. (and yes I put in D.C. being from Washington state!) with the highest registration rate ever and the exhibits have sold out. They actually have a ATA meeting mobile app for those of us that cannot make it. With a conference that has “Tele” in the name, I see this as the most logical and sensible way to attend.

Posted in: Healthcare Technology, Healthcare transformation, Occupational Therapy, Physical Therapy, Rehabilitation Business, Telemedicine

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HIMSS Federal & Stage Public Policy Update

Speaker:  Jeffrey R. Coughlin, MPP
Senior Director, Federal & State Affairs
HIMSS North America

This luncheon appropriately took place in the relatively new and beautiful Alder Commons Auditorium on the University of Washington Campus. Jeff briefed me (I cannot speak for others in the room) on Meaningful Use current events (what CMS expected upon inception and the reality of now) and the new incentives to push interoperability. I graduated from UW with a degree in Clinical Informatics in 2011 when CMS was just rolling out EHR incentive program, now 4 years later it is an interesting perspective, the positivity outlook I once saw is fading. In 2011 CMS estimated by 2019 that 100% hospitals and 70% professionals would be utilizing EHRs. As of June 2015 537k eligible professionals and 48 hospitals registered for Medicaid/Medicare incentives; a whopping 31 billion incentives were paid out. With all that money paid, it raised question of what was actually bought with those dollars with only 48 hospitals registered. I am sure Congress and the House will try very hard to find this out exactly!

I know that the carrot and stick approach to EHR incentive payments are producing results in regards to getting eligible professionals and hospitals to get on board with Meaningful Use (MU), I am more drawn to the value of care improvement I can see myself in the works; interoperability. Jeff talked about this subject as well with more interest and I sat up in my chair. After the slides he presented on numbers/facts interlaced with disappointment that CMS is no doubt feeling over MU and EP/Hospitals are actually frustrated by, the subject matter of interoperability I was very happy to see. The Office of the National Coordinator for Health IT (ONC) defines interoperability “… as the ability of systems to exchange and use electronic health information from other systems without special effort on the part of the user.” I believe that EHRs are worthless without the ability to follow patients throughout their lives; we are no longer born, live and die in the same town, even less so go to the same doctor, hospital or clinic our entire lives. Therefore it is more important than ever for the 2015 Interoperability Standards Advisory to “…coordinate the identification, assessment, and determination of the best available interoperability standards and implementation specifications for industry use toward specific health care purposes.” Please check out this wonderful graphic that very nicely lays things out.

Jeff’s closing remarks were centered around how important it is for us to advocate the role Health Information Technology has on creating a healthcare system based upon patient centered care and with National Health IT week coming up October 5-9 what better time to knock on your senators door. Also the HIMSS policy summit is October 7-8 and you can sign up for early bird registration until Sept. 10th.

Posted in: Health Regulations, Healthcare Policy, Healthcare Technology, Interoperability, Meaningful Use

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This month [July] in Telemedicine

American Telemedicine Association: This month [July] in Telemedicine
July 28th, 2015

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

The theme of this Month in Telemedicine webcast was progress; progression from telemedicine not being just an alternative to doctor office visits, but more as a replacement to them. The large amount of funds now being circulated through the market is worthy of making note of in your memory storage box. Here are a few.

Last week SHL telemedicine, an Israel based company, was bought by Shanghai Jiuchuan Investment (Group) Co., Ltd. for $116.34 Million. This event signifies the seriousness of China’s increasing interest in Telemedicine. Also in Asia it was reported that there was a 40% reduction of patients being transferred to Vietnam city hospitals for treatment from satellite provincial hospitals due to telemedicine. Chúng ta nên nhìn vào thị trường Việt Nam Wellpepper?

Station developed by HealthSpot… if you are in Ohio you might see one in your neighborhood Rite Aid.

Also in July Rite Aid launched a pilot project utilizing HealthSpot walk-in stations in throughout the state of Ohio. “HealthSpot stations offer customers convenient access to high-quality, medical care from board certified medical providers using high-definition videoconferencing and interactive medical devices”. Because I am a curious creature, I had to look up where the stations are. Doing a quick search in my sister’s zip code in Florida, I found one in a casino! I will not start with the jokes, but let your imagination ride!

Another Telemedicine company to keep an eye on is Teladoc. On the first of July stocks went from $19 a share to nearly $30 a share. They had predicted the stock would be between $15-17 a share! If that came as a little bit of a shock, this announcement really grabbed me… $570 million investment dollars is now breaking the ground harder in telemedicine (and related entities) than HIT. Specifically mhealth companies raised 214 million, personal health raised 209 million and telehealth raised 152 million, making it 570 million dollars raised in 2nd quarter alone of this year.

Another interesting ‘progression’ tidbit is what John mentioned; the ATA accreditation has 330 registrations in hand, mainly consisting of Healthcare orgs, instead of companies that provided standalone independent telemedicine services. The increase is believed due to the huge gap in services that healthcare orgs provide patients; telemedicine services are frankly quicker to utilize vs. the old way of: calling your docs office, making an appointment that is 2 months away, etc. etc. How often is your smartphone, tablet or computer right next to you a day? It’s okay to admit the truth; we know you sleep next to it! With that said, obviously healthcare orgs are losing patients (literally in their sleep!), so there is a huge spike in healthcare orgs wanting to create their own telehealth services. I ask why? Use an already created wonderful app like Wellpepper! J

To access this videocast recording:
http://services.choruscall.com/links/ata150728

Next Month in Telemedicine [August] webcast will be mentioned here.

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

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MobiHealth News: Digital Health 2015 Midyear Review

Digital Health 2015 Midyear Review

Speakers:

Brian Dolan
Editor-in-Chief MobiHealthNews
brian.dolan@mobihealthnews.com

Ryan Beckland
CEO Validic
ryan@validic.com

Fitbit wearable- price tag $250.

This trend webinar presented by MobiHealthNews was packed full of information, information that many of us have already heard about individually from bigger news reporting agencies, but Brian did an excellent job in a 20 minute recap of the latest market trends. Since as we all know whenever you hear about a market (even your local farmers market!), the mention of money is never far behind, the HIT market is not any different except by the number of zeros, the very many! A whopping quarter million dollar funding increase from last year; $741 million to 1 Billion. If that wasn’t a big enough highlight, get a load of this, FitBit a wearable camera company, debuted its initial public offering (IPO) on the NYSE, raised 732 Million, making it the biggest EVER consumer electronics IPO in history. That is a very BIG deal indeed! With all this money rolling around in the form of connected health devices, therefore all the personal health data in return being generated, the Federal Trade Commission is nervous that HIPPA is not enough. It will be interesting to see what additional training employees, caregivers, etc. will have to do to appease FTC and well patients like myself!

Ryan Beckland, CEO and co-founder of Validic, a “…cloud-based technology platform that connects patient-recorded data from digital health applications, devices and wearables to key healthcare companies”. Validic works with the largest healthcare systems in the world, reaching 160 million individuals in 47 countries. Validic is continuously evolving their services to the accelerated demand and innovation of HIT, and has profited by the ‘recent’ wave of patient generated health information. The focus of Ryan’s presentation was on the behaviorism’s of patients and providers and how they have been changing due to the HIT market trends. Increase options for care has helped patients be more in charge of their care more than ever before, stating that in the not so distant future devices are going to replace the role doctors have in diagnosis and initial doctor appointment. Ryan very clearly laid out the benefits of telehealth, it doesn’t take a rocket scientist to see that telehealth empowers patients, prevents hospital readmissions, reaches patients in rural locations etc. and it can address doctor shortages.

Another noteworthy point that Ryan made is that by 2020 it is expected that the Pharma market will be entirely reshaped by digital health; dubbed Pharma 2020: The vision. Three major trends driving shift is patients expect technology to provide convenient and regular access to their providers, regulatory environment of data access and speed of competition requires more technology enabled solutions. Pharma is pressured to increase patient adherence to drug therapy (currently at 50% adherence!) and seeing how telehealth has been successful in other factors (lower readmissions, etc.) it’s time Pharma takes the reins on their patients’ health as well. I am extremely interested to see what new technologies this market develops/adapts since this is a very wealthy sector in the realm of healthcare.

You watch and listen to the webinar here, where you can also access the slides presented.

 

 

 

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

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The Case for Patient Video in Doctors Visits: Take a Selfie and Call Me In the Morning

The selfie culture and our desire to photo-document every aspect of our lives has started to influence healthcare as well, and patients want to be able to record their doctors visits. The concept is so prevalent that it’s making headlines in the mainstream media.

Patients Press the Record Button, Making Doctors Squirm” from the Washington Post

Why You Should Record Your Doctor’s Visits” from Forbes.

Having a recording of a visit ensures that you don’t miss any information, and you can review it when you get home and are able to provide more attention to the topic. Much of what is said in a doctors visit is missed by patients, by some accounts between 40 and 80% is missed, and an additional half of that information is remembered incorrectly. As we learned during a course from the Institute for Healthcare Improvement, often healthcare providers are not trained in making sure the message is received.

When we ask patients about their experiences, they tell us that they thought they understood the instructions but realized when they got home they really didn’t retain enough or understand enough to comply with the instructions. Patients are often intimidated by healthcare personnel, worried about wasting valuable visit time with questions, or worrying about how what their being told will impact their lives, for example, who will walk my dog when I have my hip replaced? Is it any wonder that the information isn’t landing?

Patient Record on Parking

Patient record in parking garage of major health system

When handout instructions are available, they are often forgotten by patients, or confusing. One healthcare organization we work with conducted an audit of all their patient handouts and discovered that they were at an 18th grade reading level. The recommended reading level for health information is fifth grade, and yet these instructions required a graduate degree!

Patients have a seemingly simple solution to this: record their doctors. Doctors on the other hand have been warned about PHI and HIPAA, so a common ‘workaround’ is to record patients on their own phones. Legal departments hate this because then the patient has a copy of their prescribed instructions but the health system does not. Liability aside, it doesn’t result in good care if everyone is not working off the same information.

Including patient video as part of a HIPAA compliant digital treatment plan is a great way to solve this problem. Patients have a better experience and the health system is able to keep good records.

Patient video can cueing or instructions that is unique to that patient, and they show the patient’s actual experience whether that’s in wound care, using a medical device, or physical therapy. Patients feel a greater sense of connection and accountability to care plans when they are personalized and customized.

For complex instructions like wound care, using medical devices and durable medical equipment, and physical and occupational therapy, patients feel more confident that they can repeat the exercise or instructions at home when they see video of themselves doing it.

There are so many benefits to including custom video as part of a patient’s care plan. The technology is here today, it can be delivered in a HIPAA compliant manner, and it can be stored and easily retrieved. The challenge is that while patients are ready for this, health systems aren’t and the answer is often ‘no’. The risks to the health system, if video is delivered as part of an overall digital patient treatment plan solution are low, but the potential benefits to care are large.

We’ve tracked the evolution of the ‘consumerization of IT’ through other industries. Some have said it can never happen in healthcare, but this is a great example where patients starting to push the envelope and use technology in their care. Let’s hope they are able to convince their doctors as well.

Posted in: Adherence, Health Regulations, Healthcare Disruption, Healthcare Policy, Healthcare Technology, Healthcare transformation, M-health

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Personal or Population Health? Big Data or Small Data?

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

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

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

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

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

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

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

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

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