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The HIMSS Flu

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


From Session: PGHD End User Experience: Patients and Providers

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

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

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

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HIMSS 2018: We’re having a party in your house!

From the opening keynote of HIMSS 2018, you could tell things were going to be different. Unlike last year, where actors touted the marvels of flash drives and backup storage, this year kicked off with singers from The Voice. Not sure how to interpret their music choices, though, I’m sure Leonard Cohen never envisioned his anthem Hallelujah pumping up 45,000 healthcare IT experts.

Keynote speaker Eric Schmidt executive chairman of Alphabet, admonished the crowd to get to the cloud, any cloud, even Google Cloud’s competitors. He also described a scenario with an assistant named Liz, listening in on a doctor/patient visit and transcribing notes. Ironically, this exact scenario was announced by Microsoft the week before. I’ve witnessed shifts to digital and cloud before in other industries, and it does take a village, so Eric calling on the power of the technology and being rather vendor agnostic is a good sign. That said, there were a few things in his talk that might have ruffled his audience. First, where were the partners? In the utopia of voice and cloud for healthcare that Schmidt described the only partner referenced was Augmedix, poster child for Google Glass, and absolutely no healthcare system examples. Which makes sense, as when asked by HIMSS president emeritus, Steven Lieber for his parting words to the crowd, Schmidt said:

“You’re late to the party.”

Which is an interesting comment at as he was a guest keynote speaker at a healthcare IT event and representing big tech, so you could interpret this to mean:

“You’re late to the party (that we’re throwing in your house).”

As the keynote emptied in a mass stream to the tradeshow floor, I eavesdropped on a number of conversations, and many people weren’t too happy about the message: “they (aka tech) don’t understand how complicated our lives are.” It’s an interesting conundrum, because Google et al have solved some pretty complicated problems making sense of what we’re all looking for online, a problem of completely unstructured data, and yet, as recent Facebook incidents show, there can be a lack of respect for people’s data and privacy that is crucial for any type of healthcare deployment in big tech.

The tradeshow floor itself showed a lot of new entrants, including booths from Lyft and Uber, who previously had only partnered with companies like Circulation for medical transportation, and a much larger Google Cloud and Amazon Web Services presence than the previous year. Microsoft and IBM have been at the healthcare party for a long time, and have settled in.

Big tech is indeed at the party. Who else is at the party? Purveyors of security and in particular block-chain crypto were definitely there. We saw APIs hanging around the punch bowl, this time invited by the new Blue Button 2.0 initiative, unlike previous years as the date of big tech.

Who wasn’t at the party? Patients. On the one hand, we’ve found that the digital patient experience and patient engagement is now mainstream, and our research partner Tamara Deangelis from Boston University Center for Neurorehabilitation was awesome talking about patient/provider messaging at the patient engagement summit. At the broader HIMSS conference, it seemed only vendors were representing patients. Most of the patient invitations must have gotten lost in the mail.

One CIO I talked to suggested that there was a different feeling at HIMSS this year and that this is the year we’ll look back and see that things really changed for healthcare IT. We’ve seen an acceleration of the shift to the cloud for new patient-facing applications, and a rapid realization of a need for an overall patient digital strategy. All heartening, especially since it will take everyone at the party to accomplish this transformation, debutantes and charming hosts alike.

Until next year’s party, cheers!

(Footnote: The actual Google Cloud party had a long line immediately, so some people heeded Schmidt’s words about not being late for the fantastic view of the Bellagio fountains, poke bowls, and open bar. The party was predominantly male, which hopefully isn’t part of the vision. Of course, it was at the same time as the Women in Healthcare IT event, which I heard was awesome. Perhaps a poor party choice on my part.)

Posted in: Healthcare Technology, Healthcare transformation, HIMSS, Interoperability

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