Managing Chronic Disease

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Engaging Patients and Impact to Clinical Workflow

One of our goals at Wellpepper is to enable patients to self-manage and we know that if given the right tools, they will do so. While we strive for that exceptional patient experience, we also put a lot of effort into streamlining clinical workflow for onboarding and monitoring patients.

Patient Onboarding

The process for inviting a patient is meant to be simple with a minimal impact to clinical workflow. Capturing basic patient demographics and assigning the appropriate care plan(s); a process that takes 30 seconds to complete. Typically, a scheduler, navigator or health coach will invite patients when they have been identified for an interactive care plan. Ideally, this is done prior to the patient coming into the clinic, but depending on the care plan, this can place at the front desk or in the patient’s room. EMR integration is another way Wellpepper can help streamline this process. You can read a bit more about some of our EMR Integration options in my post about deployment options (here).

Patient Monitoring

Our professional services team will work with your clinical teams to understand all the scenarios where you want to know what your patients are doing when they’re not in the clinic. Using Alerts & Notifications and Machine Learning, we can help make sure that you’re focusing your time on the patients that need help.

Alerting & Notifications

Our sophisticated rules engine enables health systems to build out simple or complex alerting scenarios. These alerting scenarios will generate an alert and notify the care team.

Patients reporting a symptom or side effect is the most commonly used alerting scenario. Our analysis has found that in surgical scenarios, patients that report a symptom or side effect within 3 days after surgery are 3 times as likely to readmit within 30 days. By alerting the care team that a patient is experiencing a symptom or side effect, a care team member can take action and possibly prevent a readmission.

Other Alerting scenarios may include things like patients not doing their exercises, or reporting a blood sugar reading out of the target range.

Machine Learning

One of the areas that we apply machine learning to help streamline clinical workflow is in our HIPAA-compliant messaging system, which allows communication between patients and their care team. Our analysis has shown that 98% of the messages that patients send are not urgent, and 70% of them don’t need a response. Our message classifier looks for the 2% that are urgent and escalates those to the care team.

It’s important to understand all of the points where patients may reach out for help and optimize workflow accordingly. This is another area where integrating with the EMR can help.

For more information on how to streamline clinical workflow while still providing a great patient experience, please email me at

Posted in: Healthcare Disruption, Healthcare motivation, Healthcare Technology, Healthcare transformation, Interoperability, Managing Chronic Disease, patient engagement

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Alexa Voice Challenge for Type 2 Diabetes: Evolving An Idea

For the past couple of months some of our Wellpepper team, with some additional help from a couple of post-docs from University of Washington, have been working hard on a novel integrated device, mobile, and voice care plan to help people newly diagnosed with type 2 diabetes as part of our entry in the Alexa Diabetes Challenge.

Team Sugarpod

This challenge offered a great opportunity to evolve our thinking in the power of integrating experiences directly into a person’s day using the right technology for the setting. It also provided the opportunity to go from idea to prototype in a rapid timeframe.

Our solution featured an integrated mobile and voice care plan, and a unique device: a voice powered scale that scans for diabetic foot ulcers, a leading cause of amputation, hospitalization, and increased mortality, and is estimated to cost the health system up to $9B per year.

During the challenge, we had access to amazing resources, including a 2-day bootcamp held at Amazon headquarters during which we heard from experts in voice, behavior change, caring for people with type 2 diabetes, and a focus group with people who have type 2 diabetes. We also had 1:1 sessions with various experts who had seen our entry and helped us think through the challenges of developing it. After the bootcamp, we were assigned a mentor, an experienced pharmacist and diabetes educator, who was available for any questions. Experts from the bootcamp also held office hours where we explored topics like

Early Prototype Voice Powered Scale & Scanner

how to help coach people in what they can do with an Alexa skill, and how to build trust with a device that takes pictures in your bathroom.

As we evolved our solution, we were fortunate to have support from Dr Wellesley Chapman, medical director of Kaiser Permanente Washington’s Innovation Group. We were able to install the device in a Diabetes and Wound Clinic. We used this to train our image classifier to look for foot ulcers, and compare results to human detection, and also to test the voice service. We used an anonymous voice service as Alexa and the Lex services are not currently HIPAA-eligible.

We gathered feedback from diabetes educators, clinicians at KP Washington, and across the country, and from people with Type 2 diabetes. While not everyone wanted to use all aspects of the solution, they all felt that the various components: voice, mobile, and device offered a lot of support and value. As well, we determined that there is an opportunity for a voice-powered scale and scanner in the clinic which could aid in early detection and streamline productivity. Voice interactions in the clinic are a natural fit.

Judges and Competitors: Alexa Diabetes Challenge

The great thing about a challenge is the constraints provided to do something really great in a short period of time. We’re so proud of the Sugarpod team, and also incredibly impressed with the other entries in this competition ranging from a focus on supporting the mental health challenges faced by people newly diagnosed with Type 2 diabetes to a specific protocol for diet and nutrition, to solutions that helped manage all aspects of care. We enjoyed meeting our fellow competitors at the bootcamp and the final, and wish we had met in a situation where we could collaborate with them. We also appreciated the thoughtful feedback and questions from the judges, and would definitely have a lot to gain from deeper discussions with them on the topic.

Stay tuned for more on our learnings through this challenge and our experiences with voice.

Posted in: Healthcare Disruption, Healthcare Technology, Healthcare transformation, M-health, Managing Chronic Disease, Outcomes, patient engagement, patient-generated data

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Introducing Sugarpod by Wellpepper, a comprehensive diabetes care plan

We’re both honored and excited to be one of five finalists in the Alexa Diabetes Challenge. We’re honored to be in such great company, and excited about the novel device our team is building. You may wonder how a team of software folks ends up with an entry with a hardware component. We did too, until we thought more about the convergence happening in technology.

We were early fans of the power of voice, and we previewed a prototype of Alexa integration with Wellpepper digital treatment plans for total joint replacement at HIMSS in February 2017. Voice is a great interface for people who are mobility or vision challenged, and the design of Amazon Echo makes it an unobtrusive home device. While a mobile treatment plan is always with you, the Amazon Echo is central in the home. At one point, we thought television would be the next logical screen to support patients with their home treatment plans, but it seems like the Echo Show is going to be more powerful and still quite accessible to a large number of people.

Since our platform supports all types of patient interventions, including diabetes, this challenge was a natural fit for our team, which is made up of Wellpepper staff and Dr Soma Mandal, who joined us this spring for a rotation from the University of Georgia. However, when we brainstormed 20 possible ideas for the challenge (admittedly over beer at Fremont Brewing), the two that rose to the top involved hardware solutions in addition to voice interactions with a treatment plan. And that’s how we found ourselves with Sugarpod by Wellpepper which includes a comprehensive diabetes care plan for someone newly diagnosed, and a novel Alexa-enabled device to check for foot problems, a common complication of diabetes mellitus.

Currently in healthcare, there are some big efforts to connect device data to the EMR. While we think device data is extremely interesting, connecting it directly to the EMR is missing a key component: what’s actually happening with the patient. Having real-time device data without real-time patient experience as well, is only solving one piece of the puzzle. Patients don’t think about the devices to manage their health – whether glucometer, blood pressure monitor, or foot scanner – separately from their entire care plan. In fact, looking at both together, and understanding the interplay between their actions, and the readings from these devices, is key for patient self-management.

And that’s how we found ourselves, a mostly SaaS company, entering a challenge with a device. It’s not the first time we’ve thought about how to better integrate devices with our care plans, but is the first time we’ve gone as far as prototyping one ourselves, which got us wondering which way the market will go. It doesn’t make sense for every device to have their own corresponding app. That app is not integrated with the physician’s instructions or the rest of the patient’s care plan. It may not be feasible for every interactive treatment plan to integrate with every device, so are vertically integrated solutions the future? If you look at the bets that Google and Apple are making in this space, you might say yes. It will be fascinating to see where this Alexa challenge takes Amazon, and us too.

We’ve got a lot of work cut out for us before the final pitch on September 25th in New York. If you’re interested in our progress, subscribe to our Wellpepper newsletter, and we’ll have a few updates. If you’re interested in this overall hardware and software solution for Type 2 diabetes care, either for deploying in your organization or bringing a new device to market, please get in touch.

Read more about the process, the pitch, and how we developed the solution:

Ready When You Are: Voice Interfaces for Patient Engagement

Alexa Voice Challenge for Type 2 Diabetes: Evolving a Solution


Posted in: Behavior Change, chronic disease, Healthcare Disruption, Healthcare Technology, Healthcare transformation, M-health, Managing Chronic Disease, patient-generated data

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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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LAM Conference – A patient’s perspective

Dr. George Pappas, LAM Regional Clinic Director

Last weekend, my husband and I attended the Regional TSC and LAM Conference at Swedish Medical Center in Seattle, WA. This conference covered current research developments, treatment options, and patient education. I attended because I wanted my husband to learn more about Lymphangioleiomyomatosis (LAM), because I am a patient. The LAM Foundation defines LAM as “a rare lung disease that usually strikes women during the prime of their lives… this disease is characterized by an abnormal growth of smooth muscle cells, especially in the lungs, lymphatic system, and kidneys.” LAM occurs almost exclusively in women, and it is usually misdiagnosed for years, often as asthma, emphysema, and/or bronchitis. LAM is considered a progressive disease, which can lead to lung transplantation 10 years post diagnosis or for some, like me, it progresses slower. Treatment with a mTOR inhibitor, Rapamune, may improve lung function, which was all the buzz at this conference, but unfortunately there is no cure.

This conference was coordinated by the patient advocacy networks, The LAM Foundation and TS Alliance, and was designed to provide patients with the opportunity to interact with the LAM scientific community, physicians, and patients. I have to be honest, I was surprised to see a packed room because there are only 3-5 LAM patients per million women in the world. I later learned that newly diagnosed patients traveled from as far as Alaska with their loved ones for the same reasons as I: to learn more about clinical drug trials, to ask questions, and meet other ‘Lammies’. This mutual interest was palpable during the presentation by Dr. Ray Yeung, a surgeon and renowned LAM expert. Hands were flying up with questions. Dr. Yeung spoke about the pros and cons of clinical trials, and the pathogenesis of Angiomyolipomas (AML) and LAM. Dr. Yueng had a great amount of positive energy for what he has learned about LAM through his research and it was awesome to hear from a scientist about the importance of patients getting involved in clinical trials.

After the session with Dr. Yeung, we had lunch and I got to talk to a very lovely woman that worked as a Patient Relations Advocate for Lundbeck, a pharmaceutical company that sponsored the conference. Her role was to bring the face of the company to the patient advocacy foundations and their patients, and in return be the voice of patients in order to always keep us in the forefront of the company’s mission. I was particularly impressed with this, especially coming from the pharmaceutical industry, which tends to get a bad rap as being money centric. I continue to be awestruck with her grace, attitude, and lovely disposition, and how she didn’t once talk about her company, but wanted to know more about ME, not my disease. I really hope that our talk (and the fact that I thanked her repetitively) and the other conversations she had with patients that gathered around us, made her journey worth it.

On the drive home, she really got me thinking about how important her role is, and how the information she gathered will be priceless to both Lundbeck and to the LAM community; what she learned cannot be found in any search engine or book. I believe there is a huge disconnect between patients and some of the key players in making us… well, not patients anymore. The folks that advocate for us are so important because not only do they form an overarching understanding of disease, research treatments, help us keep symptoms under control, argue with the insurance companies, help us manage setbacks, etc., they also help us realize there is meaning to getting up in the morning and living life knowing we are not alone. It’s like having a big mama bear always looking out for you, so you can focus on you and not your disease.

Upcoming events…
The International Rare Diseases Research Conference & LAMposium, Cincinnati, OH, Sept 22-25, 2016
LAM Regional Conference, Cleveland Clinic, November 5, 2016.

Posted in: chronic disease, Clinical Research, Managing Chronic Disease, Patient Advocacy, patient engagement, Rare disease, Research, Seattle

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Different System, Same Challenges: Long-Term Care Perspective From Canada

Kristin Helps, our Director of Client Operations, and I had the opportunity to speak about delivering Empathetic Care for Seniors Through Technology at the annual BC Caregiver’s Association Conference in Whistler, BC. The BCCPA is the representative body for long-term care, skilled nursing, homecare and retirement facilities in the province of British Columbia in Canada. These types of facilities are mostly privately run, by both for-profit, and charity organizations, as opposed to acute care which is run by provincial and regional authorities. While this was a BC organization and conference, delegates came from across the country, and ranged from individual home care works, to facility owners, to university professors and researchers.

For the most part we heard similar challenges to those encountered in the health system in the US:

  • Communication between care settings
  • The struggle to deliver patient-centered care
  • Decreasing reimbursement for homecare
  • Enabling staff to operate at the top of their license

At the same time, people expressed a desire to age in place, and the health system wanted to be able to support this. While 80% of Canadians cited wanting to die at home, only 40% actually do.

One of the big differences we noted at this conference was that speakers and participants were calling on the Federal government to step in and fix many of the problems in a way that we don’t often see in the US. Another difference was that participants were looking globally for solutions to challenges, particularly in dementia care.

Looking Globally for Dementia Care

This was our first time at this conference and veterans told us that the previous year was quite focused on analytics, while this year the focus was on dementia care. While not primarily our area of expertise at Wellpepper, we heard about a number of innovative initiatives to improve care, including a novel approach by the government of Japan. Japan decided to characterize dementia as a social problem rather than a medical problem and trained bank tellers and grocery store clerks to recognize the signs of dementia. It was thought that these people were most likely to see problems, for example if someone was unable to understand how to pay bills or buy groceries. Considering that many with early onset dementia are quite successful at hiding changes from their loved ones, this idea is quite interesting. It also puts the responsibility for care back into society rather than relying on medical facilities that often distance the rest of us from the challenges of aging.

Basketball courts at Aegis Living Seattle

Basketball courts at Aegis Living Seattle

The Butterfly Household Model of Care, which was initiated in the UK, but has been implemented in Alberta with some success, is another novel idea. People with dementia often don’t know what day it is or what they had for lunch, but they do have vivid internal experiences, often remembering happier times of their lives. Butterfly Households are designed to stimulate people with dementia with bright colors, and also to stimulate memories with areas designed to invoke feelings of the past, for example an ice cream shop or an area with old photographs. The idea in a Butterfly home is to meet patients where they are, and caregivers report much joy in delivering care and significantly fewer of the violent behaviors often associated with dementia.

While not a designated Butterfly Home, you can see some of these techniques in action at Aegis Living in Capitol Hill, Seattle. Here are a couple of pictures from when I visited last fall. In an outdoor area they have a car and a garden shed designed to stimulate conversation and fond memories, and an old-gym styled basketball court, where you can shoot hoops sitting down.

Invoking memories at Aegis Living Seattle

Invoking memories at Aegis Living Seattle

To find out more about the topics in this post:

Bank Tellers Act Serve as Caregivers in Aging Japan

BC Caregivers Association

Butterfly Household Model of Care

Aegis Living Capitol Hill Seattle

If you’re interested in learning more about our talk on delivering empathy through technology, contact us.

Posted in: Aging, Behavior Change, chronic disease, Healthcare Disruption, Healthcare motivation, Healthcare transformation, Managing Chronic Disease, Seattle, Uncategorized

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Every Patient Has a Story

I have just returned from my first Beryl Institute Patient Experience Conference 2016 (PX2016), and I’m inspired. At Wellpepper, we are focused on empowering the patient to feel ownership and accountability to participate in their healthcare journey. The Beryl Institute and their members are doing the same and it was great to connect with so many like-minded people. The PX2016 conference is just one way they bring together this community.

PX2016 is 6 years young and attended by mostly caregivers, nurses, doctors, regular people who were touched by a personal health experience and now are in the field, and patients. With only 1000 attendees, it’s possible to form relationships. There was lots of hugging, sharing, pictures and overall excitement to be in Dallas. I met several newbies and like me, they were inspired too.

The conference opened up with a real life patient story. Les, a heart attack survivor, told his story of how he was participating in a sculling exercise and went into cardiac arrest in the middle of the water. The following chain of events happened that allowed him to be standing in front of us to tell his story. A retired nurse was on board and jumped into action to do CPR (she was filling in for her friend who couldn’t make it), the bowman had his cell phone to call 911 (typically he doesn’t bring it on the boat), another rower in his own boat happened to be near the dock gate and had a key to unlock the gate (usually locked because it was 5:30AM) which allowed the paramedics to get to Les. If there was one break in that chain, Les would not be with us. He went on to share his experience about his care at UCLA Medical Center and how every touch point from the people on the boat, to paramedics, to the care team made a difference in his recovery. By this time, there was not a dry eye in the place. It was all about why we in this profession of healthcare really do want to make a difference in the patient experience.

This lead to the theme that every patient has a story. From the other keynotes to the sessions I attended, this theme was pervasive. The focus of PX 2016 is to share stories, best practices and ideas on how to bring together interactions, culture and perceptions across the continuum of care.

In the session, Removing Complexity from the Post-Acute Care Patient (one of our passions at Wellpepper), it became clear that the long term care model needs to be reinvented for simplicity. True simplicity comes from matching the patient’s experience with the patient’s expectations. As an example, The New Jewish Home is renaming its post-acute rehabilitation to The Rapid Recovering Center which supports setting a different tone for the patient and ultimately in their experience. When a patient is sent to a post-acute rehabilitation center it can suggest a long and difficult recovery. But, naming it the Rapid Recovery Center aligns with the patient’s expectation of wanting to get better as soon as possible.

Another session that hit close to Wellpepper’s core values was how University of Chicago puts family and patients first in their patient experience strategy. Enhancing Patient Experience and Engagement through Technology Innovation by Sue Murphy, RN, Executive Director- Patient Experience and Engagement Program and Dr. Alison Tothy, Associate CMO – Patient Experience and Engagement Program at University of Chicago suggest the ability to capture real-time opportunities for engaging patients in their care and in their service expectations with innovative technology and techniques can lead to overall happier patients. Such technologies like rounding, discharge call centers and interactive patient care have led to substantial outcome improvements. However, just implementing technology did not solve the patient experience challenge. A culture shift in the staff was required which inspired them focus on individualized care for each patient. Combining a culture shift with innovative technology has allowed the University of Chicago to increase patient satisfaction scores, reduce readmission rates and improve outcomes. Furthermore, leadership is engaged and excited about the power of technology to improve the patient experience.

To bring it to a close, we were inspired by another personal patient story from Kelly Corrigan. She is a New York Times best-selling author who shares her most personal stories, including her health challenges. She has had more than her share of health encounters between herself and her family. She read an excerpt from her book, The Middle Place, where her and her Dad where both diagnosed with cancer in the same year. It was a compassionate and funny rendition of when she just starting her chemotherapy sessions and her Dad came across country for support. She talked about how in the middle of crisis, magnificent can happen. She was amazed to witness how all the people around her, including herself, able to conform into the new reality – cancer. Although a happy ending for her, not so much for her father. He passed away last year. She emphasized how at the end of her father’s journey, she made a point to thank all the caregivers for they really did make a difference in a very difficult time. Then looking out at all of us in the audience at that moment, almost with a tone of authority, she challenged us to hold on to the feelings of why we went into healthcare.

For some of us, it was a personal experience. For others, it was the opportunity to make a difference. Regardless, as Kelly so eloquently put it, people want to feel as if they have been felt and be a good listener because every patient has a story.

Posted in: Behavior Change, chronic disease, Healthcare transformation, Managing Chronic Disease, patient engagement, Patient Satisfaction

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Flexible Care for Independent Aging: Don’t Dumb It Down!

I had the pleasure of participating on a panel on technology for aging, along with Honor founder Seth Sternberg and CareTicker founder Chiara Bell during the HX360 event at HIMSS 2016. (HX360 is a “conference within a conference” focused on innovation and C-suite leadership.) The panel was hosted by Jeff Makowka, Director of Market Innovation for AARP, and ranged from topics on entrepreneurship and whether there is a venture rush to technology for aging now to approaches for delivering care for aging in place.

Interestingly, all three panelists were inspired by personal experiences to found our companies. For me, it was poor discharge instructions and lack of continuity of care when my mom was released from 6 months in a long-term care facility. For Seth and Chiara, it was trying to figure out how to enable their parents to age at home. It’s a classic entrepreneurial model to experience a problem and try to find a solution to it, provided the market is big enough, and this market certainly is based only on demographics of the aging baby boomers. Seth and I both made the leap from technology, Seth from Google, and me from Microsoft, and Chiara from a long history in healthcare and homecare.

We were much sharper in real life.

We were much sharper in real life.

Honor’s $20M in funding lead by Andressen Horowitz is proof that Silicon Valley is paying attention to homecare, which can be viewed as important from two aspects: first we need innovative and new thinking to approach these challenges, and second these solutions could require a lot of money. (Although I would posit that we need patient capital in this space, something that Silicon Valley is not always known for. Interestingly, the same week as the panel Dave Chase and Andrey Ostrovsky posted a piece on why Silicon Valley does not belong in homecare. Maybe they should be on next year’s panel.)

The three panelist companies took similar approaches in using technology to scale and empower the people in the process, both patients and caregivers. For Wellpepper it’s about empowering the patient to follow their care plans and get remote support from the healthcare team. Honor and Careticker are more focused on the patient and their homecare team, whether that is professionals or family members. What was similar in the approach was providing information in real-time to the people who need it, and treating everyone in the process with respect. Honor does this by ensuring homecare workers are paid a living wage. Careticker does this by recognizing for people to age in place, the family caregivers need the right information and supports and Wellpepper does this with patient-centered and highly-usable software that is not dumbed down for the aging.

We were perhaps the outlier on this panel as our solution is not aimed specifically at the elderly. However, you could say we are the most representative of the way we need to approach the challenge: we need solutions that are designed with empathy, putting the patient first, and are not categorizing people into “young” and “old.” Well designed solutions and products should can address a broad spectrum of users, and we need to treat those aging in our population as another audience in this spectrum.

Posted in: Aging, Behavior Change, Healthcare Disruption, Healthcare motivation, Healthcare Technology, Healthcare transformation, M-health, Managing Chronic Disease, Patient Satisfaction

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Using Homecare For Positive Change in Healthcare

The week before last, I was fortunate to be invited to attend the Collaborative for Integrated Home Care Aid Innovation Symposium: a group of committed individuals and organizations that passionate about improving healthcare through home care. The goal of the summit, organized by the SEIU union for healthcare workers was to apply the “Triple Aim” principles to home care. With the realization that our current systems cannot support the increase in chronic disease and the aging population, the group was looking for innovative solutions through people, process, and technology, that could provide preventative care and follow-up care in a community setting.

The State of Washington

Washington State CareBill Moss, Assistant Secretary for Aging and Long-Term Support, kicked off the day with a sobering look at the statistics for Washington State. While the number of people in nursing homes has declined by 7,000 since 1993, and more people are cared for in their homes, which provides a better quality of life, the complexity of health issues affecting the population has dramatically increased. In addition to being the preference of patients, at-home care is less expensive. If today we had as many people in long-term care facilities as 1993, it would cost the state an extra $200 M annually, so that’s good news.

Recognizing this benefit, but also understanding the increasing complexity of patients, provides a starting point for improving and supporting the role of home care workers to support more people aging at home. While return-on-investment studies are few and far between, the general understanding of participants is that keeping people out of long-term care facilities can provide financial subsidies to people in long-term care. For example, for the annual cost of one person in a nursing home, $17,500, three patients can be cared for in their homes.Medications Taken By Clients in Washington State

Clinical Care Needs for Washington StateTo support these home care workers and their patients, new training needs to be developed to address some of the top health risks and preventative medicine including nutritional needs, fall risk, and mobility support. By helping people improve their health, we can save money and also improve quality of life.

Continuing on the data wallow, Lili Hay a researcher with Milliman, an independent consulting and actuarial firm, shared a deep dive into the situation in Washington and the complexity of patients that require home care, for example 40% of Medicare patients take 5 or more medications and most have more than one issue.

The Penn Center for Community Health Workers

Next up, Casey Chanton, a social worker and project manager at the Penn Center for Community Health Workers in Philadelphia talked about a unique program for training community leaders as health workers. In dealing with patients from low-income, high-health risk neighborhoods, physicians and patients had both expressed frustration with the gap between what physicians prescribed and the reality of patient’s lives. Physicians might tell a patient to eat a low sodium diet while the patient would be getting most of their meals from a food bank and have little or no control over what they ate. Both felt helpless to bridge the gap. Enter the community health worker. The program trained natural leaders from within these high-risk communities. These leaders visit patients in their homes and help them get the support they needed within the constraints of their own lives.

Not surprisingly, most of the issues were not medical but related to their living situations, income, and access to services. The best recruits to be community health workers were people who listened more than they talked and were non-judgmental. They helped patients set goals that were attainable by using patient-centered goal setting coupled with achievable steps.

Results of the program are impressive and really speak for themselves:

You can learn more about the center and the program here:

Panels on Technology Innovation and Practice Solutions

The next two sessions were panels, one on technology innovation and the second on practice options. There was too much good information for me to summarize everything, so I’ll stick to the major themes.

  • Post-acute care costs are the fastest rising and most variable care costs, so finding a way to manage them is key.
  • Technology is not the solution, people and process are the solution, but technology can help.
  • People of all ages and socio-economic backgrounds can be use technology (although possibly not EMR interfaces—this isn’t a reflection on the people 😉 )
  • If we could start from scratch designing a health system, we would never have designed the siloed-system we have today.
  • Issues of care coordination are causing post-acute care to be the fastest rising cost in healthcare today, even though readmissions are falling
  • Homecare needs to be structured around outcomes not having homecare workers check off task lists
  • Even if the payment models aren’t there yet, we need to take best practices and move forward.
  • Even if all the research isn’t in, we need to take best practices and move forward.
  • Even if healthcare administration isn’t ready for it, we need to take best practices and move forward.

During the panels and Q&A we heard from a few of the homecare workers in the audience about the impact they’ve had on people’s lives because they do what’s right and not what’s required. Particularly striking was the story from a woman who talked about caring for one of her patients who needed to go into a nursing home temporarily after surgery. The nursing home was understaffed so the homecare worker visited her patient there multiple times a day to make sure he was being turned in his bed. She did this because she cared about her patient and she wanted to make sure when he was released back into her care he wasn’t in worse condition than when he entered the nursing home. Rather than consider the negative aspects of this anecdote, let’s look at the amazing resource that exists in home care workers who spend more time with patients than their medical professionals and sometimes their families. That was the point of the day: what can we do to help scale this valuable resource and empower them to help patients even more.

Posted in: Aging, Behavior Change, Healthcare Disruption, Healthcare motivation, Healthcare Technology, Healthcare transformation, M-health, Managing Chronic Disease

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The Healthcare System Is Family

Lynda Bennet and Carey

Lynda Bennet and Carey

The Canadian healthcare system has been my extended family since I was born.  I was born with Spina Bifida in the early 1950’s and it has been there to support me through years even to this day. So asking how healthcare affected decisions in my life is like asking me how my parents affected my life… it’s a long, involved, and murky story.

I can’t really remember my toddler years, but even then I had numerous encounters with doctors, nurses, and other medical practitioners. The first real glimmers memory are of learning how to walk on braces and crutches at Sick Children’s Hospital in Toronto. During my hospital stays, I rarely saw my family, as our home was a great distance away.  Even at that early age, I quickly learned that my ‘adoptive caregivers’ were potential ‘friends’… it was this understanding that launched my awareness of the health care system’s influence.

The hospital is where I learned that it didn’t really matter a caregiver’ s age, nationality, or position, as long as you gave them a quick grin and understood they were often busy, they would always be back with time for you. That was also when I learned that if I ate all of my broccoli, there was a picture of Peter Rabbit at the bottom of the dish; that the Italian person who cleaned my room had children my age and when asked would regale me with stories of the mischief they got into; and that that x-ray technician with the dark skin was from a fascinating far away island called Jamaica.

During my elementary school years, I underwent various corrective surgeries. The issue at that time was whether or not to undergo the procedures necessary to walk without braces and crutches. At that time, abandoning boots for shoes similar to my sister’s held a definite appeal and swayed my agreement much more than what might have been best for me in the longer term. Was the result totally my decision or was it collective judgment of the system, my parents, and me? I’m not sure I’ll ever know.

But again, my hospital visits resulted with life experiences and influences beyond the surgeries. That is when I learned how to make a bed with hospital corners (perhaps a ploy to get me to make my own bed or more likely to keep me ‘busy’). It is where I got to play and help feed the babies in the nursery, and when a bout with septicemia meant I was placed in a single room with a television set. (Remember that TV sets on wards were a rarity in those days even on children’s wards.)  One of my most vivid memories was that room crowded with nurses and interns on duty the night that the Beatles were on Ed Sullivan… and yes, I did get to stay up late!

Corrective surgery went on into my teenage years. Severe scoliosis and fear of pressure sores meant that I was on a Stryker frame for six months. The consequence of this hiatus and my changing body structure was relinquishing my braces and crutches for a manual wheelchair. Preference of the wheelchair over the hard work and potential failure to walk again was mostly my decision… the chair so much easier and faster for getting from point A to point B and with four siblings speed was an unwritten necessity. I am fairly certain that if I had insisted on continuing the use of braces and crutches, I would have had the support of my parents and the health care system to do so. Again though, that and subsequent hospitals stays resulted in life experiences and influences I would have never encountered at home. There was the lady in the bed next to me in an oxygen tent who urged me to promise her that I would never smoke (I kept that promise), the Toronto Maple Leaf player down the hall who told me I was the most beautiful person he had ever met (that one definitely left an impression), and that other patient’s visitors who told me that the reason I was born this way was because my parents had sinned.

Over my working career, my encounters with the healthcare system were few other than plastic surgeries for pressure sores. Although, even during this time health care still exerted its influence on my decision-making. Do I work fewer hours to avoid pressure sores or do I invest big money in a revolutionary new seating system? Do I purchase that new titanium wheelchair or face deterioration of my arm muscles? Do I accept a relocation to the United States with my employer and my workmates? (The healthcare system certainly influenced that decision. Although my employer would have provided private healthcare support, they wouldn’t guarantee my job for any length of time. With my medical history, I just couldn’t take the chance of losing the support of the health care system!)

Approaching my senior years has resulted in renewed encounters with the healthcare system: surgeries for a malformation, cancer, and an encounter with Hashimoto’s encephalitis. The health care system continues to exert its influence in my life decisions. At one point, I was living in a lovely sea-side community in British Columbia, when my primary care physician suggested that I needed to move within the coverage area of an emergency hospital. Who would have thought that access to ambulances, the location of my home, and the structure of the Provincial Health Authorities could make such a big difference? But there it was… either move my home into the coverage area of emergency hospital coverage or face the communication and jurisdictional delays between health care authorities, doctors, and hospitals. Needless to say the decision to move was a no-brainer!

What’s ahead? Who knows! Looking back down the path of past years, I think you’d have to agree that the health care system not only directly affected key decisions in my life but also exposed me to experiences influencing life choices well beyond its designated sphere. It is comforting to know that it is still here for me and with any luck we will continue our relationship into the future.

Posted in: Aging, Health Regulations, Healthcare motivation, Managing Chronic Disease

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Infographic: Factors Related to Adherence

Just as no two patients are identical, the factors that affect adherence vary dramatically from patient to patient, and also importantly what type of treatment plan they are adhering to. Adherence to medication is often affected by medication itself: side-effects, contraindications, timing, and the way it is applied. Adherence to a physical rehabilitation program is affected by the function of the patient, very often by the level of pain they feel, and sometimes by the patients own belief in their abilities. Adherence to diet is affected by so many factors including, access to appropriate food and social pressure. Even with these differences, though there are a number of common factors that affect patient adherence, both negatively and positively.

The 2008 study “Factors affecting therapeutic compliance: A review from the patient’s perspective” provides a comprehensive review of research on the subject, and presents this view of the factors.


As a provider, there are some areas that you can influence, and some that are data points that might help inform how you approach the patient. You probably can’t impact their socio-economic situation, but you can understand how it might impact their treatment. For example, how big of a factor is cost or transportation in their ability to adhere to a program? Trying to save money often results in patients trying to take fewer pills than prescribed. We spoke with one arthritis researcher who prescribed swimming for her patients, however, for many of them the cost of a gym membership and transportation to the pool was prohibitive.

When putting together a treatment plan for a patient, it’s good to keep all of these factors in mind, working with the patient to come up with a plan in which they are most likely to succeed. Tailoring the plan to the patient lifestyle, rather than the other way around.

Posted in: Behavior Change, Healthcare motivation, Managing Chronic Disease, Uncategorized

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Film review: Extraordinary Measures

“The football coach makes more than my annual research budget,” Harrison Ford as Dr. Tom Stonehill in Extraordinary Measures.

We recently attended a screening of the film Extraordinary Measures sponsored by the Washington Biotech Association (WBBA). The film is a semi-fictional account of the real life story of John Crowley’s determination to speed a new drug to market to help manage his childrens’ rare chronic disease. The film, released in 2010, was produced by Harrison Ford, and stars him as “Dr. Tom Stonehill”, an amalgamation of a number of doctors that John Crowley worked with in real life. John Crowley is played by Brendan Fraser. Keri Russell plays his wife Aileen Crowley, and we have no doubt that the real Aileen had a lot more to do in real life than poor Keri in this film who has to deliver unfortunate lines like “the medicines are working. “

Film critique aside, the true story is quite fascinating, and you can find out more on the Crowley family’s website and in the book by Pulitzer-prize winning journalist, Geeta Anand, The Cure. Two of the three Crowley family children, Megs and Patrick have Pompe disease, a rare condition that is related to muscular dystrophy. At the time the film starts, life expectancy for children with this disease is 9 years, and as Megs approaches her 8th birthday, John becomes driven to find a cure. Poring over research late at night, he finds some interesting theories by Dr. Tom Stonehill, and on impulse flies to Nebraska to try to meet the doctor, who turns out to be ornery and eccentric. Also on impulse John promises Dr. Stonehill that he will find funding. He does, and the two manage to set out building a company. However it becomes pretty clear that while Dr. Stonehill most likely has the right solution to manage Pompe, he knows nothing about bringing a drug to market, and while John understands the business side, like how much revenue a Pompe patient will generate over a lifetime, his experience usually takes over after all the manufacturing problems are solved.

The solution comes in the form of a large drug company that buys them out, mostly for Dr. Stonehill’s experience. John and Dr. Stonehill are now rich, and John buys a gigantic house but Dr. Stonehill doesn’t cash his check because he doesn’t believe has earned the money. It’s a bit disconcerting to see the Crowley’s in a multi-million dollar home when earlier in the film they mention that they have $40,000 monthly medical bills, and when earlier they were calling all their friends to fundraise for their foundation. It seems like there might be better uses for the money, and Aileen doesn’t seem all that comfortable with the home that John justifies as “the kids love it.” However, at this point he doesn’t know that a way to manage the disease will be found, so the rationale is probably that they should be happy in their short lives.

John and Dr. Stonehill both try to shake things up a bit at the drug company. John out of desperation to save his children’s lives, and Dr. Stonehill because he’s a maverick. What’s interesting about this segment is that while some of the drug company executives seem cold and clinical, they are trying to follow procedures for the safety of the general public, and John, while driven by love for his family and others like his does face some ethical issues with his close involvement in the drug trials.

If you have an interest in the pharma business or how drugs are brought to market, this is an interesting and enjoyable film. Unlike a similar film also based on true life adventures in big pharma, Love and Other Drugs, this one is suitable for the whole family and children will probably really enjoy it both because it’s based on a real life drama and for the bubbly and determined Megs Crowley who gets some of the best lines, like “My hobbies are video games and penguins.”

Definitely check out this short video featuring the real Crowleys that fills in some of the background details and shows how extraordinary the achievement really is.

If you do watch the film, be on the lookout for a cameo from the real John Crowley in one of the early fundraising meetings.

Posted in: Healthcare Disruption, Managing Chronic Disease

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Innovative Care Models for Prevention, Health Promotion, Fitness and Disease Management

Standing room only at the APTA 2013 Conference

Standing room only at the APTA 2013 Conference

It was a packed house for an excellent session on Innovative Care models at the American Physical Therapy association annual conference in Salt Lake City last week. Any of the 5 presenters could have held their own for the entire session. Together, they provided a powerhouse of enthusiasm, ideas, and motivation to change healthcare practice.

A common theme across all the presenters was that the time is now right for the types of innovative programs they were espousing. Many commented on how they are seeing a lot more acceptance of new ideas and new models of care than when they first embarked on this path. Another common theme was that the data doesn’t lie. Healthcare is in crisis due to the declining health of the American public. Our favorite quote of the session was from Mike Eisenhart from Pro-activity who said “Chronic disease is simply the accumulation of years of bad behavior.” Sad but true that most chronic disease in the United States is entirely preventable. Each presenter showed saddening statistics that supported this view.

Karen Kemmis kicked off the session by reviewing the triple aim of healthcare reform developed by the Institute for Healthcare Improvement:

Triple Aim for Healthcare Improvement

Triple Aim for Healthcare Improvement

She also described changes that are making new care models possible including:

  • Integrated care models, like Accountable Care Organizations
  • Expansion in coverage
  • Changing payment mechanisms
  • Outcome and quality based payments
  • Program integrity

Next up was Jennifer Gamboa, founder and President of Body Dynamics, Inc – a multi-disciplinary physical therapy and wellness center in Falls Church, Virginia. Dr. Gamboa outlined their consistent and unique approach to treating clients, where each healthcare professional applies the same rigorous screening process to access overall health and wellness. This approach recognized that clients choose their treatments, for example, many lower back-pain patients see a registered massage therapist first although they might be better helped by a physical therapist. Rather than bemoaning the lack of consumer awareness, Body Dynamics works with the consumer to access overall health and willingness to change regardless of how they found the clinic. It was a refreshing approach that creates a health team that includes a physical therapist, nutritionist, massage therapist, personal trainer, and counselor, and screens patients based on their movement quality, disease risk factors, fitness, and willingness to change. Body Dynamics is incubating the process now, so Dr Gamboa was not able to share outcomes or recommend how others might use her methodology yet but this is definitely a development to watch.

Jennifer was followed by Margaret O’Neil from Drexel University, who talked about health promotion strategies for children and their caregivers. Dr. O’Neil stressed the importance of motivational interviewing to support behavior change. Motivational interviewing includes expressing empathy, supporting self-efficicacy, accepting resistance, and avoiding argumentation. Open questions and active listening are tools in motivational interviewing. The point of the process is to determine where someone is in their willingness to change, and therefore, the type of intervention that is appropriate. Interventions might need to be psychological before physical. As well, the entire family needs to be involved and parents need to model healthy eating and activity. Dr. O’Neil mentioned that parents often believe that being overweight is inevitable, using the excuse “we’re just a big-boned family.”

Next up was Mike Eisenhart from Pro-Activity, who was the most provocative  and tweetable (hashtag #apta2013) of the group. He graduated as a physical therapist and immediately stopped calling himself one because he was told that physical therapists could only treat problems not help prevent them. Instead, Mike built a business around wellness and prevention, specifically in the workplace and now helps to manage the health of over 20,000 people. Pro-Activity provides health assessments and helps employees manage change, resulting in lower insurance costs for employers. Mike is really happy that he’s starting to see other physical therapists take proactive roles in health and wellness.

The final presenter was Cheryl Resnik who quipped that you should find out how funny the other presenters are before agreeing to a panel. She didn’t need to worry, as the story of the USC Fit Families program was extremely compelling. The program, which provides exercise programs and a free physical therapy clinic to low-income families, is located near USC campus in a neighborhood known for a gang with ties to the Mexican mafia and that is a “food desert”. A food desert is defined as an area where it is not possible to buy fresh food. Fast food is often the only or definitely the cheapest option. Resnik recounts needing to buy a scale that measured up to 1,000 pounds to weigh some of her participants, who were mostly teenagers! Fit Families provides individualized and group exercise programs, nutrition counselling, and assessments. It’s funded by grants and volunteer physical therapy students from USC. Students become so engaged in the program they often continue volunteering after they’ve received their credits.

This was one of the best sessions we attended at American Physical Therapy Conference in Salt Lake City. It was amazing to see so many people focused on prevention and wellness both in for-profit and not-for-profit scenarios. At the end of the session, Margaret O’Neil asked the audience how many were inspired to try their own programs, and a number of people who reported previously being discouraged said they were ready to give it a go. We can’t wait!

Posted in: Healthcare Disruption, Healthcare motivation, Managing Chronic Disease, Rehabilitation Business

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A Collaborative Approach to Healthcare

As an individual with a chronic condition, from time to time an incident occurs that makes me think what a wonder it would be if health professionals involved in my care would collaborate more. I am sure that such a collaboration would give me confidence that management of my health is in control.

Depending on my current status, I am seen by a number of healthcare professionals including a GP, urologist, endocrinologist, gynecologist as well as physical- and occupational therapists—I know what a challenge collaboration can be.  In 2011, I was asked to participate in a new program in collaborative care at UBC. The program was looking for mentors with chronic conditions to work with healthcare students from multiple disciplines. When I read that the goal of the program was to encourage health care collaboration, I thought that maybe this program was an opportunity to give back and possibly influence the direction of health care in the years to come.

Collaborative Health Mentors. Image source UBC

I am now in my second year of volunteering for the UBC Interprofessional Health Mentor’s Program. The program offers first year students from various health disciplines the opportunity to collaborate with each other and a chronically challenged individual like myself. In my group, I have first year students from medicine, nursing, physical- and occupational therapy (just 4 of 9 possible disciplines).  As the “expert” in my care and condition having lived with it for 62 years, my role is to help students learn how health care providers can support people with chronic conditions.

We meet 8 times over 16 months including an orientation, group sessions, and a symposium. In our group meetings we are presented with topics to discuss such as: words and meanings; living with and managing a chronic condition; experiences with the health care system; and partnerships, collaboration and shared decision making. It becomes more interesting as the year progresses because the students also bring their life experiences in to the table. They offer their observations gained from their practicums in various health care situations as real examples of how collaboration either works or not.

What do we learn? In the group sessions, I explain my knowledge and life experiences with my chronic condition and how I and the health professionals manage my needs and well-being. As you can imagine, each person in the group, including myself, come to understand the importance of the patient’s role as well of those of their health care professionals as real-life partners in the health care system.

The magnum opus is the symposium. We are encouraged to come up with a display that reflected what we have learned as a group. Try to imagine a hall with 50 poster boards illustrating various aspects of patient-/client-centred, interprofessional teamwork… it was mind-boggling. Subject matter covered the heath care gamut and more: lupus, communication, mental illness, stigma, and aphasia to list a few. To convey the impact of the posters in words is impossible, but all had a similar focus—the patient/user/client and the professional teamwork needed to support them. For a quick impression, here are some pictures of the event.

The program has been a resounding success. The first Health Mentor’s Program was piloted in the fall of 2011 with a 32 health mentors and 92 students from 6 different health and human service programs at UBC. In its second year, the program expanded to 51 mentors and 203 students and 9 disciplines.

For more information about the program, its objectives, participants, and contacts, see:

Posted in: Healthcare Disruption, Managing Chronic Disease

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The Value of Physical Therapy

We’ve participated in quite a few #solvePT tweetchats, and a recurring theme is the need for the physical therapy profession to better market the profession both to consumers and within healthcare as a whole. What’s interesting is that within our experience, everyone we know has seen a physical therapist at one point or another, and seen benefit. Of course, we are active ourselves and so are our friends. We also fall into that category of people who want to remain fit and active as we age.

Once, people did not see a doctor until they could barely get around. “Now patients will say: ‘I can’t exercise. I can’t ride my stationary bike or regular bike or go for walks of one or two or three miles,’ ” said Dr. Mark W. Pagnano, an orthopedist at the Mayo Clinic in Minnesota. NY Times

However, keeping in mind that everyone is not like us, we thought we’d explore the concept of the value of physical therapy and exercise in a few blog posts. Recently, we met with an MD who on the one hand was a huge proponent of preventative medicine, and on the other hand was a bit dismissive of physical therapy. However, he swore by his personal trainer so he definitely sees the value of exercise.

Search for “the value of physical therapy” and the fifth result is:

It may be stated with little fear of contradiction that there is no field of therapeutics less understood and less frequently employed by internists than physical therapy. There are several reasons that account for this unfortunate state of affairs which has its inception in our medical schools.

It’s from 1941, so hopefully sentiments have changed a bit, but the fact that it’s in the top search results is a bit disturbing. A much better resource has been developed by the Canadian Physiotherapy Association, where they outline the types of conditions and interventions where physical therapy can help.

Here’s the list, with links to evidence on how physical therapy can help in each one of these cases.

Tracking exercises in Wellpepper

Tracking exercises in Wellpepper

If you’re like us, accidents and sports injuries are the first areas that come to mind. However, where physical therapy can really shine is in preventative treatments for things like falls and low back pain. Did you know that low back pain causes almost as many work absences as the common cold? Management of chronic disease is also an area where physical therapy can add value. Diseases like arthritis, multiple sclerosis, and Parkinson’s can all be managed through regular movement and exercise. Keeping people moving is key to keeping them from getting worse. We’re working with researchers using Wellpepper for Parkinson’s management and we are hoping the findings can be applied more broadly to chronic disease management.

Recovery from disease is another area, stroke, heart disease, and cancer all need physical therapy to help regain quality of life. The first two are obvious. Healthcare professionals are just starting to realize the toll that cancer treatments take, and are prescribing physical therapy as part of a recovery program. Often people are so weakened that they need help to get muscles back to where they were.

In our experience, people who have been helped by exercise prescription understand the value. The challenge seems to be not enough people know about the possibilities. Direct access, which enables people to see a physical therapist without a doctor’s referral, can help this tremendously. However, in order for people and the profession to see the benefits of direct access, there needs to be more awareness of when it could help.

Posted in: Exercise Physiology, Managing Chronic Disease, Rehabilitation Business

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Prescribing Exercise

Maybe it’s because at Wellpepper we’re quite active–a recent weekend saw us running, skiing and snowboarding, and rock climbing–but it’s a bit surprising to us that the merits of exercise as a prescription for health are still being proven.

Cross country skiing is a great workout!

Cross country skiing is a great workout!

For example, it’s not regular practice for doctors to tell people to get active. However, many doctors are not active themselves and if they don’t have the experience, then it’s hard for them to recommend the benefits. The US Center for Disease Control recently collated results from a number of studies that showed that doctors who exercise themselves are more likely to prescribe exercise.

The findings showed that active physicians were two to five times more likely to recommend fitness regimens than those doctors who led physically inactive lives. Link to full story.

The NHS in Scotland is piloting an intervention where doctors recommend and prescribe physical activity. Again, a very helpful intervention, but why is it a pilot and not a practice?

Increasing physical activity is a simple, cheap and highly effective way of both staying healthy if you are well, and reducing the health risks of many chronic conditions like diabetes and heart disease. It works at any age. RCGP Scotland is happy to support this initiative, which will give GPs vital information on how to help patients increase activity and improve their health. John Gillies, Chair of Royal College of General Practitioners Scotland. Link to full story

The problem seems to start earlier. The British Journal of Sports Medicine reports that doctors are not taught about the benefits of exercise.

This gap in knowledge means that future doctors will have insufficient knowledge to effectively promote physical activity to their patients, which results in a failure to help combating serious diseases that are linked to insufficient exercise according to the study authors. Link to full story

First Lady Michelle Obama’s “Let’s Move” initiative pinpoints that the problem actually starts a lot earlier.

Thirty years ago, most people led lives that kept them at a healthy weight. Kids walked to and from school every day, ran around at recess, participated in gym class, and played for hours after school before dinner. Meals were home-cooked with reasonable portion sizes and there was always a vegetable on the plate. Eating fast food was rare and snacking between meals was an occasional treat.

This is in contrast to the current situation where diets regularly include junk and where kids are driven to and from school and scheduled appointments. The Let’s Move campaign is looking to change this situation through education on healthy habits: eating well and exercising. Great campaign, just sad that we got to this state.

At Wellpepper we were fortunate to have had active parents, role models, and the encouragement “to get outside when the sun was shining” from a young age.  Added to that the wisdom of Hal and Joanne at Participaction to help instill good habits in our formative years. 😉

We’re building a healthcare technology business starting from exercise program prescription and adherence. It’s been surprising to us that the benefits still need to be proven, but we’re looking forward to helping in that area through the data we collect and resarchers we’re working with.

As Hal and Joanne say, until next time “Keep fit and have fun.”

Posted in: Exercise Physiology, Managing Chronic Disease

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Tips for Managing Arthritis in the Hands

Muscular-skeleto diseases cost the Canadian Healthcare system $33B/year

Hands and Arthritis Workshop by the Arthritis Society

Hands and Arthritis Workshop from the Arthritis Society

Last night we attended a workshop in Vancouver, BC put on by the Arthritis Society about coping with hand arthritis, one of the most commonly affected areas . Although, Jacquie and I both suffer from arthritis we were surprised to learn how little we actually knew about the disease. The Arthritis Society did a great job of filling in the gaps and answering questions that aren’t possible in a brief doctor’s visit.

Some things we learned:

  • There are over 120 forms of arthritis
  • It affects 1/10 people in Canada, and 1/7 people British Columbia.
  • Most sufferers are in the workforce (combating the perception that it only affects the elderly).
  • By the time arthritis can be seen on an X-ray, it’s too late for preventative measures.

We also learned the differences between how osteoarthritis and rheumatoid arthritis cause joint breakdown. Rheumatoid arthritis, the most common form, is the inflammation of the joints and surrounding tissues. When the swelling declines, there is the painful bone-on-bone contact. In osteoarthritis, the fluid between the joints begins to decline, resulting in bone on bone contact and eventual fusing of the bones. Not much fun to look forward to.

Exercises for Arthritic Hands

Exercises for Arthritic Hands

However, there is help! Similar to refrains we’ve heard throughout our journey through the current state of healthcare, prevention is key. The presenter, Joanne Smith, Certified Hand and Occupational Therapist, stressed the need for hand exercises to stave off the progression of the disease. Participants were provided with a handout of hand exercises, which Joanne recommended doing 5 times per day. She stressed that keeping hands mobile is key, a warm up period is always necessary, and no exercises should be done to the point of pain. Even though we know that being proactive is the best way to manage a chronic disease, most people in the audience were already in advanced stages of arthritis. It would be great to see more outreach and awareness for people who might be at risk for future development.

Products for Arthritis Sufferers

Products for Arthritis Sufferers

Some key tips we learned for keeping your arthritis from progressing while getting on with the business of daily life:

  • Avoid repetitive motions
  • Avoid pinching
  • If you are gripping with your finger and thumb, use a “C” shape, which distributes pressure more evenly, rather than a “D” shape
  • Use bigger tools and grips
  • Pace yourself
  • If you can’t do something, trade work with someone who can, for example yard work for baking
Assisted Can Opener: why not make cans easier to open for everyone?

Assisted Can Opener: Why not make cans easier to open for everyone?

The session also highlighted a myriad of products and aids designed to help you open cans, jars, and pill bottles, and reach difficult places. It did make us wonder though, why are so many products to hard to open? We love what OXO Good Grips have done for better design of household items. Shouldn’t everyone have products that are easy and delightful to use?

Posted in: Managing Chronic Disease

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