patient engagement

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Voice: The most natural user interface for healthcare

There’s so much promise, and such a natural fit for voice in healthcare that unlike electronic medical records, we should not have to mandate its use. If anything, right now we are being limited by the lack of HIPAA controls rather than end-user demand. If the sessions at the recent Voice Summit, which was focused broadly on voice tech, and the upcoming Voice of Healthcare and Voice Summit at Connected Health conferences are any indication, there are many natural use cases, and a lot of pent-up demand.

With so many concerns about documentation and screens getting between patients and physicians, and the ability to deliver empathy, and to rapidly learn from interactions using natural language processing, and artificial intelligence, voice seems a natural fit and unobtrusive interface that could leapfrog traditional interfaces.

The Healthcare track at Voice Summit showed some of this promise, but also pointed out that we are still early days. Many solutions are pilots or prototypes, and I had the distinct impression that some of today’s HIPAA workarounds would not stand up to a detailed audit. Despite Alexa’s sponsorship of the conference, Google’s strong presence, and both companies push into all things healthcare, both were mum on whether or when their consumer voice devices might be HIPAA compliant. Regardless, healthcare organizations and technology vendors alike are charging forward on new scenarios for healthcare, and you can see by the diversity that if even a few of these end up being the “killer app” it’s a big opportunity.

Patient Care

Rooming: Waiting for a physician to see you in an exam room is often a wasted opportunity. A voice interface in the clinic room, could help further pinpoint why a patient is having a visit or educate pre and post visit on medical issues. Or simply having a voice assistant capture the questions that a patient has during a visit might go a long way to improving the visit.

Inpatient stay: The combination of voice assistants, wifi, and tablets could completely replace expensive and proprietary systems for inpatient patient engagement. We’re already seeing use cases for anonymous interactions with voice devices to order food, check the time, or find out the time of the next physician visit.

Long-term care: Alzheimers and dementia care are cited as the poster child for the benefits of voice in long-term care facilities. Unlike human caregivers, voice assistants never get tired of answering the same questions repeatedly. There are so many times you don’t want Saturday Night Live to predict the future, but with this one they got it right.

Patient Engagement

If we define patient engagement as interactions outside the clinic, then the opportunities today fall into three main categories triage (or eventually diagnosis), education, and self-management.

Triage Skills: Today we see some basic triage skills from organizations like Mayo Clinic, and Boston Children’s Hospital where you can check some basic first aid, or ask common questions about children’s health. While there are approximately 1,000 healthcare skills, most likely there will be a few winners or “go-to” experiences here from leading healthcare organization or trusted publishers like WebMD. (Interestingly, the presenter from WebMD was one of the more skeptical on voice experiences for patients at the Voice Summit, possibly because of the complexity of the information they present through text, video, and images on the Web.)

Health Education: Chunking content into manageable bites is currently being touted as the best practice for education material through voice. However, this is an area where the interactivity that’s possible through voice will be necessary for stickiness. If you think about the best podcasts, they use different techniques to both engage you and also impart knowledge: interviewing, verbatim quotes, sound effects, interjections, and expository material. To get engaging and sticky health education content, publishers will have to think about how to test for knowledge, advance explanations, and interact with the end-users. Since we can only remember 5 things at a time, simply chunking content is not going to be enough to make the delivery of health education through voice stick.

Reminders and Interactive Health Tasks: As we’ve seen from our testing, where voice interfaces may have the most impact for patients is in helping them complete health tasks for example, in medication adherence, simple surveys, or check-ins and reminders of basic information. Given that the voice interface is a natural in the home, checking in with a voice assistance on when to take medication, or tracking meals is an easy way to engage with a care plan. As well, cloud-based interactive voice response systems could call patients with reminders and check-ins.

Clinical Notes

Conquering the pain of charting is possibly the closest term opportunity for voice in healthcare. With every increasing workloads, and the need to capture information digitally for both care and reimbursement, the EMR has been blamed for physician burnout and lack of job satisfaction. Microsoft recently partnered with UPMC to use their Cortana voice assistant to transcribe clinical notes during a patient/provider interaction. Others attacking this space include SayKara, Robin, and incumbent, Nuance Communications. With HIPAA compliance, it’s hard not to imagine Amazon and Google looking at it as well.

Hands-free lookup

Voice really shines as an interface when your hands are not free, like driving, dentistry, or when you need to keep your hands clean. Voice is a natural in settings where touching a screen or device can cause contamination or distraction. Simplifeye is tackling this in dentistry to improve charting, and lookup of x-rays, and we expect this to infiltrate all aspects of healthcare.

You may have seen a recent article on why Alexa is not ready for healthcare primetime. With all of these great examples it’s hard to believe it. It turns out that the criticisms in this article basically highlight the current limitations of voice overall (except for HIPAA compliance of course). However, some of the challenges of discovery, context, and navigation, are why we at Wellpepper believe in not just voice, but a “Voice And” future where voice is a key interface that is helped or helps others like screens or even augmented reality. Voice is powerful, “Voice And” will be even better.

Posted in: Behavior Change, chronic disease, HIPAA, patient engagement, Patient Satisfaction, patient-generated data, Voice

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Voice Tech In Healthcare

Voice tech is a hot topic in healthcare, and for good reason. Healthcare is built on personal interactions, and voice technology can replicate and even replace the human interviewing experience. Voice has other valuable benefits in healthcare like being hands-free—for someone who is recovering from surgery and mobility challenged this might mean being able to get information without getting up. In the hospital setting, the hands-free interface has obvious benefits for hygiene.

At Wellpepper we first started experimenting with voice-enabling our interactive care plans in early 2017, and dug deeper into the topic, prototyping voice powered devices and testing with real people as part of our winning entry in the Alexa Diabetes Challenge. I’ll be talking more about this at the Voice Summit July 24-26, 2018 in Newark.

However, voice experiences in healthcare are not new. This week the Seattle Design for Healthcare meetup Ilana Shalowitz, Voice Design UI Manager, from EMMI Systems (part of Wolters-Kluwer) talking about best practices for voice design based her work on their interactive voice response system. This system effectively does outreach through “robocalls” to help influence people’s behavior, like getting them to schedule general health primary care visits, or get a flu shot. The pathways are designed to guide the patient through specific material, ensuring a basic understanding of the topic, and moving to take action (although not actually taking action), since that was not possible in the interface.

While they have been effective at changing patient behavior, the talk got me thinking about the differences between the interaction model for more traditional, non-AI based interactive voice response and the voice assistants like Alexa and Okay Google popping up in the home, the challenges of each, and the opportunities in healthcare.

Interactive voice response (IVR) can provide a structured pathway, which could be akin to an intake form or an interview. However, it doesn’t allow for an end-user driven experience. In her session, Shalowitz talked about designing a path to give the end user the illusion of control, where a yes or no answer to a knowledge question actually ended up in the same place. Compare that to the home voice experiences where the end user can drive any experience. The upside of this experience is that the end-user is in control, which is often not the case in healthcare, and can drive the direction of the conversation.

Here’s a common experience interacting with a Wellpepper care plan.”

Person: “Alexa, tell Wellpepper I have pain.”
Alexa: “Okay, what is your pain on scale of 0-10 where 0 is no pain, and 10 is the worst pain imaginable.”
Person: “Four”
Alexa: “Okay, I’ve recorded your pain as 4 out of ten. Is that correct?”
Person: “Yes.”
Alexa: “Anything else?”

The difference between this and a typical IVR communication is that the end-user is the initiator. However, the drawback with this type of scenario is that the end-user needs to know what they want to do. This is a notorious problem with headless interfaces like voice. In fact, each week, I get an email from the Alexa team that tells me what new thing I can do with Alexa, essentially a print-guide for the voice interface. Discoverability, context, and capabilities remain problems with these interactions even while they put the end-user at the center.

However, the benefits of these new consumer tools is that, they are designed to not anticipate each pathway in advance, and rather than the pre-recorded prompts of traditional IVR, they are learning systems where continual improvement can be made by examining successful and failed intents. We saw this is in our testing when a patient told Alexa he was “ready when you are.”

I’m excited to be heading to the Voice Summit this coming week, where we’ll talk about what we learned in the Alexa Diabetes challenge, and how we’re applying voice to all our patient experiences at Wellpepper. It’s still early days, but we see a lot of promise, and patients love it.

“Voice gives the feeling someone cares. Nudges you in the right direction.”
Test patient with Type 2 diabetes

Posted in: Healthcare Disruption, patient engagement, Voice

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Investing in primary care

The US healthcare system is an underperformer (highest healthcare spending for the lowest health system performance) compared to the other ten economically advantaged countries primarily due to differences in access, administrative inefficiency, disparities in healthcare delivery, and also due to the illogical underinvestment in primary care. Despite evidence by the Dartmouth Atlas of Health that the regions in which a higher percentage of Medicare beneficiaries receive majority of their care from a primary care physician lends to overall lower costs, higher quality of care, and lower rates of avoidable hospitalizations, the US continues to underinvest in primary care relative to other nations. Because of perverse incentives and overall fragmentation that is rampant in American healthcare, conscious and deliberate effort is needed to keep primary care at the forefront of clinical practice and population health improvement, including:

  • Implementation of quality improvement practices that have a theoretical basis
    According to Harvard Medical School’s Center for Primary Care established in 2011, there are five components necessary in improving primary care including evidence-based change concepts and tools, fostering strong relationships within and across practices, simple systems for reflection and feedback, structured time for team discussion and planning, and regular and meaningful engagement of leaders. The general theme is that quality improvement processes that have been validated (e.g. PDSA cycle) and implementation of driver diagrams that break up larger processes into smaller chunks/concepts have value and are worth the time to problem solve.
  • Prioritizing patient-centered care
    Care should be collaborative with patients’ preferences and values in the context of their socioeconomic conditions being respected. If there is less information asymmetry in clinical practice, then patients can be more active participants in their healthcare. Overall quality would improve with cost savings, as patient engagement research has demonstrated. Truly understanding a patient’s capacity and health literacy will improve a primary care physician’s ability to be effective in delivering patient-centric care.
  • Payer reimbursement for provider innovation in preventive and multidisciplinary care
    Primary care prioritization with the US healthcare system depends on heavy investment from payers because of the nature of reimbursement for clinicians’ time and services. In addition to a value-based compensation model that payers like Blue Cross Blue Shield reward providers with, more creative and interdisciplinary measures could be more payer driven. Humana’s Bold Goal program is a partnership between an influential payer and San Antonio Health Advisory board to partner with HEB grocery stores, community clinicians, and the YMCA to increase patients with diabetes’ better nutritional understanding of their choices. Because of the cost savings involved with more investment in primary care, it would make sense that payers would be incentivized towards this trend.
  • Leveraging of non-clinical members of a team to deliver comprehensive, value-based care
    Substantial evidence suggests that patients do not receive all of the preventive and chronic disease care that the U.S. Preventive Services Task Force advises on the basis of its best evidence because clinicians simply don’t have the time. Oak Street Health is a Chicago based network of value-based primary care centers that developed a clinical informatics specialist program 2014 where technical scribes were able to provide evidence-based recommendations and data support which resulted in improved effectiveness metrics, overall operational efficiency, and physician joy of practice.

Investment in primary care is necessary for the US healthcare system to have improved outcomes. Efforts at the community level, reinforced by theoretical models and financially backed by payers, are necessary in making changes that can yield significant population health improvements.

Posted in: Healthcare costs, Healthcare Policy, patient engagement

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Behavioral changes with deliberate patient engagement

Based on the NEJM Catalyst survey regarding the differences between initiating and maintaining behavior change, in-person social support (followed by virtual social support) ranked the highest in sustaining long-term behavioral changes. Members of the council who participated in the survey believed that continued and consistent contact with patients influenced sustainable changes. The combination of human interaction plus digital tools reinforcing the relationship appear to be the best strategy. Even though there has been a gradual shift away from the fee-for-service culture, it still seems impractical for physicians to invest even more time into patient engagement given current constraints of the healthcare system (e.g. clinicians rarely have enough time to get through all the evidence based teaching necessary let alone focus on other factors seemingly non-clinical). Clinicians often give up motivating and influencing their patients, especially after they see marginal gains (or lack thereof) over the course of several years with patients who have chronic illnesses. You have burned out and cynical clinicians on one hand and patients who love inertia on the other. The irony is that if clinicians were to spend more time towards patient engagement, then there would be more impetus for patients to self-manage and be more accountable in their care and outcomes. Research has demonstrated that patient engagement leads to better health outcomes and reduces overall costs. Ultimately, patients being active participants in their healthcare leads to sustainable, long-term behavioral changes. In order to practice medicine effectively, efficiently, and to allow patients to extract the most out of the healthcare services they receive, clinicians should make attempts at patient engagement in a more deliberate manner with different strategies:

  • Model after other human service businesses

One of the reasons that luxury car dealerships, financial planners, and boutique firms across a range of industries are so effective with their clientele is due to their shameless persistence in engaging with their customers. They seem to be very regimented in their follow-up without it appearing overly contrived. What if clinicians could adopt that kind of style with their patients? A combination of phone calls and digital contact seems appropriate – even leaving a voicemail in the evening as follows could signal enough persistence: “I sent you an email asking you if you’ve ever been tested for Thalassemia about a week ago– I think you are iron deficient for other reasons, but I want to make sure we’re covering all our bases for your condition.  If I don’t hear from you this week, I’ll be discussing this with you at your next appointment in 2 weeks.”

  • Blend a style between a motivational coach and psychologist

Motivational coaches who are very effective typically try to leverage emotional vulnerabilities and emotional language in very explicit ways to enforce change. Psychologists tend to non-judgmentally allow clients to form conclusions by themselves. Clinicians are often balancing these two approaches to avoid both paternalism as well as the snail-paced results of motivational interviewing. Language could be blended, with elements of idealism and also allowing for patient autonomy: “The pain of discipline is nothing compared to the pain of regret. You’ve recently had a lapse, but if you stick with the diet that you initially were so good with, what do you think it will do for your diabetes? Can you imagine what life will be like?”

Clinicians are never at risk of overinvesting in communication skills, as this is necessary to strike the right balance in influencing patients over the long-run. They would benefit from practices and processes in other industries where contact is consistent and maintained over a continuum with the assistance of digital technologies.

 

 

Posted in: Behavior Change, patient engagement

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Healthcare Transformation: Emulating Disney Is Not A Bad Idea

Last week, I had the privilege of speaking to a group of CMIOs about disruption and consumerism in healthcare. We had a lively discussion, with the two main takeaways being that having a broad digital strategy is key, and also that healthcare really needs to find its own way to delivering the things consumers want. While looking to other industries for inspiration is a good way to think about change, blindly implementing strategies without thinking about how to adapt them for your own industry is not a good path.

We started off the discussion with this quiz from Elizabeth Rosenthal, former physician and health editor of the New York Times, and author of An American Sickness. Try it for yourself: it’s fun to try to figure out which is the hospital and which is the luxury hotel. (The CMIOs got 8/12 correct. Can you beat them?)

This prompted a debate about how much environment matters to healing, and why hospitals have no “back office.” Having a calming environment can definitely promote healing, however, it wasn’t clear from some of the images presented in the quiz whether healing or luxury was the goal.

Adopting ideas from other industries without fully understanding their priorities and understand how they might differ from your goals. For example, people may complain about the Disneyfication of healthcare, and point to managing to the HCHAPS survey as driving this and other evils. However, did you know that Disney’s #1 corporate value is safety? Adopting safety as a number one organizational value in healthcare would be completely relevant and appropriate. What has happened with these hotel-like experiences is adopting the surface of what Disney stands for without understanding the core goals and objectives of the experience or of the patient, or even of what Disney is trying to achieve.

Recently I received this in the mail from UnitedHealthcare.

Much has been written about the power of hand-written notes, however, usually within business situations and often from a senior manager to a junior manager. This, however, is not a good use of a handwritten note. It’s so many kinds of wrong, and bordering on creepy, especially since I had just gone for my annual physical.

The pressure to deliver better service, and better outcomes is not going to decrease in healthcare. However, it’s easy to avoid these types of pitfalls by considering what people are really looking for. This might not be the same for all patients, but we think this sets up a good framework to approach consumerization.

In addition to thinking about how your offerings, outreach, and engagement with patients fulfills these needs, going a step further, you could try to think about which one of these is most important to each individual patient, and that’s really the crux of delivering a great patient or consumer experience.

Posted in: Healthcare Technology, Healthcare transformation, Meaningful Use, Outcomes, patient engagement, Patient Satisfaction

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HIMSS 2018…See you there!

HIMSS17 in Orlando was a great conference for Wellpepper. We’re looking forward to HIMSS18 in Las Vegas even more!

We have a long list of sessions to attend and booths to visit, but below are some places you’re guaranteed to find us:

Monday, March 5th

  • Hear from Tami Deangelis on how our research partners at Boston University engaged patients outside the clinic and improved outcomes using Wellpepper care plans. She is speaking at the “Remote Patient Messaging for Adherence and Engagement” session from 4:05pm-4:25pm at the Patient Engagement & Experience Summit

Tuesday, March 6th

  • Hall G, Innovation Zone: Booth 9900-78 from 9am-6pm
  • CTO, Mike Van Snellenberg will be demonstrating our voice-powered scale and foot scanner, and integrated diabetes care plan at the Industry Showcase at BHI & BSN 2018 https://bhi-bsn.embs.org/2018/industry-showcase/

Wednesday, March 7th

  • Hall G, Innovation Zone: Booth 9900-78 from 9am-6pm
  • CEO, Anne Weiler, will be sharing the Wellpepper Vision and Mission at HIMSS VentureConnect http://www.himssconference.org/education/specialty-programs/venture-connect
  • CEO, Anne Weiler, will be joining other industry leaders to continue the conversation with CMS toward inclusion of patient engagement and outcomes tracking in the MIPS Improvement Activity for provider reimbursement

Thursday, March 8th

  • Hall G, Innovation Zone: Booth 9900-78 from 9am-4:30pm

We can’t wait to connect with friends, partners, colleagues and industry leaders to continue the journey towards an amazing patient experience. Hope to see you there!

Posted in: Healthcare Disruption, Healthcare Technology, M-health, Outcomes, patient engagement, Uncategorized

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Supporting Patient Motivation

What motivates people to improve their health and stay on the right track over time?

This question is on the mind of every practitioner, whether it’s a physician sending someone home with a wound care plan, a nutritionist giving dietary advice to help manage diabetes or a physical therapist providing exercises to get a frozen shoulder moving again. They’re thinking: “Will the patient do it?” To a great extent, the answer to this question determines how successful their treatment plans will be.

Some of this blog’s most popular posts have explored the issue of motivation because it is a major underpinning of patient engagement technology – will the patient use, and stick with, the technology that in turn helps them adhere to their care plans?

The subject of motivation usually starts with a discussion about goal-setting. This process, at least in the medical context, typically begins when the practitioner sets goals for the patient and provides a care plan that tells the patient what they need to do in order to get there. Some practitioners feel this should be motivation enough for a patient. In reality, they know it’s not.

So what is motivation? A great deal of research has gone into the subject, particularly with regard to behavior change. It is most often described as being either extrinsic (outside the individual) or intrinsic (inside the individual). With extrinsic motivation, we engage in a behavior or activity either to gain some sort of external reward or avoid a negative consequence. With intrinsic motivation, we engage in something because we find it personally fun or rewarding.

While these are the two areas most often discussed, there are other, deeper dimensions to motivation, including fear-based and development-based motivators – and these can be either extrinsic or intrinsic. Understanding the interplay among these different forms of motivation is an important element in successful health coaching and in the creation of successful, supportive technologies that assist people in reaching their health goals.

Fear-based motivation comes in two basic flavors: deficiency-based and threat-based. Deficiency-based motivations come from the sense you are lacking in some way. These can have an external, socio-cultural source (just watch any personal care product advertisement: you smell bad, your hair is the wrong color and your teeth aren’t nearly white enough) or an intrinsic source (e.g. internal pressure “shoulds,” self-imposed discipline or overcoming the deficiency of lost health). Threat-based motivations tap into fear at a deeper level. In the world of medicine, this might be a medical incident that serves as a wake-up call, and the threat of disability or death propels a person to make serious lifestyle changes.

Development-based motivation tends to come from the desire for personal growth or self-actualization. It can also be externally sourced (e.g. from positive peer health norms or positive environmental conditions like smoke-free public spaces) or intrinsic – from the satisfaction, pleasure or joy we derive from doing something.

Research has shown that while fear can be a great motivator for getting people started on something, the positive, development-based motivators tend to be more powerful in keeping people engaged and active in behavior change over the longer term.

I believe one of the reasons the Wellpepper patient engagement platform is so successful at driving patient engagement with care plans (70% engagement compared to an average of 20% engagement with portals) is because the Wellpepper team understands this complex motivation dynamic very well and they have incorporated some of the most successful elements from it into their platform. They call it the “3rd approach” and here’s why I think it works.

Wellpepper takes a very obvious extrinsic motivator – the practitioner’s care plan – and turns it into an application that incorporates both intrinsic and extrinsic development-based motivators that keep people engaged over time. There are many layers we could explore here, but we’ll start with a few of the big ones.

Setting aspirational goals: In addition to the functional goals set by the practitioner, Wellpepper provides the ability for patients to set their own personally meaningful, aspirational goals that can support and reinforce their motivation to heal. For example, someone recovering from a total joint replacement operation might set a future vision of wanting to hike to their favorite fishing spot with a grandchild. They can use Wellpepper to set interim goals that lead them toward that vision and can rate their own progress on a Likert scale.

Research in positive psychology has shown that this kind of personal vision and goal setting is highly successful at sustaining motivation over time. In this case the patient is more likely to complete their prescribed exercises because it leads them toward goals that are personally meaningful about their own healing and about doing something special with someone they love.

Personalized experience: Wellpepper also provides a personalized experience for the patient. Using the same joint replacement example, instead of getting a piece of paper with a series of exercise diagrams or a generic video, the practitioner can record the patient doing their own exercises. Seeing yourself, and hearing the personal comments of the physician or physical therapist as you do it, is not only easier to follow, it feels personal. And, as you begin to improve, when you watch yourself then and now, seeing your own progress can be very satisfying (a powerful development-based motivator).

Adaptive notification: Wellpepper’s patented adaptive notification system means the patient doesn’t get the same generic reminder every day – it changes the notification based on the patient’s progress and level of engagement, keeping the extrinsic motivator relevant, fresh and focused on personal development.

Tracking progress: By enabling people to track progress on their goals and sharing that information with their practitioners, patients tap into positive, extrinsic motivation. Also tracking progress on personal, aspirational goals helps people feel a greater sense of accomplishment and direction over their own developmental outcomes.

While motivation for any one individual can be elusive, the way Wellpepper weaves together the positive extrinsic and intrinsic development-based motivators may be the key to its success in helping patients stay motivated and helping practitioners answer the age-old question: “Will the patient do it?”

If they’re using Wellpepper, chances are, they will.

Jennifer Allen Newton is Wellpepper’s PR lead, and also a Functional Medicine Certified Health Coach. 

Posted in: Adherence, Healthcare motivation, Healthcare Technology, Healthcare transformation, patient engagement, Physical Therapy

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The Secrets of Strong CIO and CMIO Relationships

What’s the secret of a strong CIO and CMIO relationship? Many things including the ability to be adaptable, understand organizational priorities, and deadlines, but most importantly to align on shared goals and purpose.

These were some of the takeaways from the insights shared by CIOs and CMIOs of Confluence Health, and EvergreenHealth at the annual Washington State HIMSS Executive dinner. While the conversation was split between how to foster innovation, and how to manage the demands of an EMR rollout (including the resulting backlog of other IT requests), where the relationship really shone was in the implementation of tools for a shared purpose, in this case tracking and control of opioids to help curb the epidemic we’re seeing in this country.

In particular a project at EvergreenHealth to implement e-prescribing of controlled substances, showed the need for strong CMIO and CIO collaboration. The program is designed to decrease fraud and misuse of controlled substances, but it can also improve patient care. Since it involves both technology implementation and clinical guidelines it’s a perfect example of medical and technology collaboration. In Washington State, where we’re based, the Bree Collaborative also has recommended guidelines for prescribing opioids, that while optional are widely adopted across the state.

We’ve written about this problem before in pain management for total joint replacement. Sadly, an unintended consequence of the pain management question on the HCAHPS survey, is sometimes an overprescribing of prescription pain medication. According to one speaker at the event, 30mg of oxycontin over 7 days is enough to trigger an addiction, and yet often post-surgery up to 30 days of pills are prescribed. We talked to one patient (not a Wellpepper user) who reported taking all of her prescribed pain medication, not because she needed it but because it was prescribed. The first step to solving this problem is with the prescription, and EvergreenHealth’s e-prescription program, combined with locked cabinets in the operating room (the idea is that if you don’t need it immediately, you don’t actually need it), alerts on over prescribing, and programs to substitute suboxone, coupled with behavior health management can all help. As well behavior change happens with the physicians, and a powerful image was the story of a pharmacist who put a bag of unused opioid prescriptions on the table to show that even if they didn’t think so, some physicians may have been over-prescribing.

However there are ways to take it a step further: tracking what the patient actually took outside the clinic, which is why we include a pain medication usage task in many care plans. This activity asks patients some simple questions about their over-the-counter and prescribed pain medication usage, and alerts if the numbers or the length of time is over certain thresholds. It’s in use in care plans that include general pain management, surgical, and neurology (headache management), and provides a view into usage, and the opportunity to reach out and help patients outside the clinic before usage becomes a problem.

We’re strong believers in the ability for patients to record their own outcomes and experiences, and the value of combining this with prescribing and clinical data to close the loop on delivering better care. If you’re interested in learning more, get in touch.

Posted in: Adherence, Behavior Change, Healthcare Legislation, HIPAA, Opioids, Outcomes, patient engagement

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Your Cupcakes Are Not My Goals

This year Google Maps tried out a short-lived motivational technique of showing how many cupcakes you would burn off or ostensibly could eat if you chose to walk to your destination. Not surprisingly this backfired, and they quickly retracted the feature. The reasons ranged from users expressing feelings of shame for not walking, to those with eating disorders saying it would encourage more obsessive behavior. Beyond that, many questioned how Google was even calculating both caloric expenditure and the actual calories in the cupcakes.

Regardless of the myriad of criticisms the experiment illustrated a key point: motivation and goal setting is best left to the individual, and understanding someone’s personal context is extremely important if you want to help them set goals.

One of our most read blog posts of 2017 was a 2015 post on whether setting SMART or MEANINGFUL goals was most effective for patients. I’m not sure why this bubbled to the top this year but the post provides an overview of two thoughtful frameworks for helping patients set goals.

At Wellpepper, we’d like to propose a third methodology: let people figure out what’s important to them. This year we expanded a capability we’ve had since V.1 that enables patients to set their own goals. This is a free-form, 140 character text box where patients write about what’s important to them. Over the years, we’ve had some clinicians express concern about whether patients could set their own goals. Functional goals are best left to the experts, but these are life goals, things that are important to people and why they are even bothering to use this app which helps them through healthcare activities to manage chronic diseases or recover from acute events.

Since we already knew that setting patient-generated goals is motivating, we also got to wondering whether you could track progress in a generic way based on patient-generated goals. After analyzing thousands of patient-generated goals, we figured out that asking a question about the patient’s perception progress on a Likert scale would work, and so this year we expanded the patient goal task type to include tracking.

It looks like this.

In case you’re skeptical that this works, here are a few examples of patient-generated goals.

Spend more time with family.

Get outside more frequently.

Walk more.

Be ready for vacation.

Now ask the question. See, it’s entirely possible for patients to set their own goals, unaided, and track progress against those goals. We’re pretty excited about the possibilities of this for improving motivation, and also for further analysis of patient adherence and outcomes. If you’d like to know more, or see a demo, we’d love to hear from you.

Posted in: Behavior Change, Healthcare motivation, Healthcare Technology, Healthcare transformation, patient engagement, patient-generated data

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May You Live In Interesting Times: Wellpepper’s Most Interesting Blog Posts of 2017

Who would have predicted 2017? As soon as the election results were in, we knew there would be trouble for the Affordable Care Act no one could have predicted the path through repeal with no replacement to claw backs in a tax bill that no one has read. It’s been a crazy ride in healthcare and otherwise. As we look ahead to 2018, we’ve found that a good place to start is by looking back at what was popular in 2017.

Looking back over the past year’s top blog posts, we also believe trends that started in 2017, but will even stronger in 2018. These four themes bubbled up to the top in our most-read blog posts of 2017:

Shift to the cloud

We’ve noticed a much wider spread acceptance of cloud technologies in healthcare, and the big cloud platform vendors have definitely taken an interest in the space. Wellpepper CTO Mike Van Snellenberg’s comprehensive primer on using AWS with HIPAA protected data was one of our most read posts. Since he wrote it, even more AWS services have become HIPAA-eligible.

Using AWS with HIPAA-Protected Data – A Practical Primer

Consumerization of healthcare

Consumer expectations for efficient online interactions have been driven by high-deductible plans and an expectation from consumer technology and industries like retail and banking that customer service should be personalized, interactive, and real-time. These two posts about the consumerization of healthcare were among the most popular.

The Disneyfication or Consumerization of Healthcare

Consumerization Is Not A Bad Word

Value of patient-generated data

In 2017 we saw a real acceptance of patient-generated data. Our customers started asking about putting certain data in the EMR, and our analysis of the data we collect showed interesting trends in patient adherence and predictors of readmission. This was reflected in the large readership of these two blog posts focused on the clinical and business value of collecting and analyzing patient-generated data.

In Defense of Patient-Generated Data

Realizing Value In Patient Engagement

Power of voice technology

Voice technology definitely had a moment this year. Okay Google, and Alexa were asked to play music, turn on lights, and more importantly questions about healthcare. As winners of the Alexa Diabetes Challenge, we saw the power of voice firsthand when testing voice with people newly diagnosed with Type 2 diabetes. The emotional connection to voice is stronger than mobile, and it’s such a natural interaction in people-powered healthcare. Our blog posts on the Alexa Diabetes Challenge, and developing a voice solution were definitely in the top 10 most read.

Introducing Sugarpod by Wellpepper, a comprehensive diabetes care plan

Building a Voice Experience for People with Type 2 Diabetes

Ready When You Are: Voice Interfaces for Patient Engagement

Since these themes are still evolving we think 2018 will present a shift from investigation to action, from consideration to deployment and possibly insights. Machine-learning and AI will probably remain high in the hype cycle, and certainly the trends of horizontal and vertical healthcare mergers will continue. We also expect a big move from one of the large technology companies who have all been increasing their focus in healthcare, which in turn will accelerate the shift to a consumer-focus in healthcare.

There’s a saying “may you live in interesting times.” We expect 2018 to be at least as interesting as 2017. Onwards!

Note: There was one additional post that hit the most popular list. Interestingly, it was a post from 2014 on whether SMART or MEANINGFUL goals are better for patients. We’re not sure why it resurfaced, but based on analysis we’ve done of patient-directed goals, we think there’s a third approach.

Posted in: Behavior Change, Healthcare Disruption, Healthcare motivation, Healthcare Research, Healthcare Technology, Healthcare transformation, HIPAA, patient engagement, patient-generated data, Voice

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Healthcare + A.I. Northwest

The Xconomy Healthcare + A.I. Northwest Conference at Cambia Grove featured speakers and panels discussing the opportunities and prospects for applying machine learning and artificial intelligence to find solutions for health care. The consensus was that we are no longer held back by a lack of technological understanding and ability. A.I. and M.L. models can be learned at a large scale by harnessing the power of the cloud and advances in data science. According to the panelists, today’s challenges to incorporating A.I. into healthcare include abundant, but inadequate data and resistance from health systems and providers.

Many researchers have found insufficient data to be an unexpected challenge. As keynote speaker Peter Lee of Microsoft Research pointed out, the more data we have, the better our machine learned models can be. He used an analogy to a speech identifier trained on multiple languages such that the model predicted English better after learning French to illustrate that improvements can be made with large sets of unstructured data. Unfortunately, because we are not capturing enough of the right kind of data for researchers, much patient data is getting lost in the “health data funnel” due to PHI and quality concerns. Lee called for more data sharing and data transparency at every level.

Physician researchers on multiple panels were concerned about a lack of suitable data. Soheil Meshinchi, a pediatric oncologist from Fred Hutchinson Cancer Research Center, is engaged in collecting data specific to children. He discussed his research on Acute Myeloid Leukemia on the panel titled, ‘Will A.I. Help Discover and Personalize the Next Breakthrough Therapy?’. While there is a large body of research on AML in adults, he has found that the disease behaves much differently at a genomic level in children. He also expressed distrust in some published research because studies are rarely reproduced and often a researcher who presents results contrary to existing research faces headwinds at journals who are reticent to publish “negative data”. His focus at this point is gathering as much data as he can.

Matthew Thompson, a physician researcher at the University of Washington School of Medicine, argued on the “Innovations for the Over-Worked Physician” panel that technology has made patient interaction demonstrably worse, but that these problems can and should be solved innovatively with artificial intelligence. His specific complaints include both inputting and extracting data from health system EHRs, as well as an overall glut of raw patient data, often generated by the patient himself, and far too much published research for clinicians to digest.

Both keynote speakers, Microsoft’s Lee and Oren Etzioni of the Allen Institute for Artificial Intelligence, referenced the large numbers of research papers published every year. According to Etzioni, the number of scientific papers published has doubled every nine years since World War II. Lee referenced a statistic that 4000 studies on precision cancer treatments are published each year. They are both relying on innovative machine reading techniques to analyze and categorize research papers to make them more available to physicians (and other scientists). Dr. Etzioni’s team has developed SemanticScholar.org to combat the common challenges facing those who look for research papers. He aims to reduce the number of citations they must follow while also identifying the most relevant and up-to-date research available. One of the advantages of taking this approach to patient data

is that scientific texts have no PHI concerns. Lee’s team is marrying patient data and machine reading to match potential research subjects with appropriate NIH studies.

Dr. Thompson was concerned that too much data is presented to the medical staff and very few of the “predictive rules” used by ER personnel are both ‘accurate and safe’. When reviewing patient outcomes and observations to predict the severity of an infection, he found that patients or their caregivers would provide ample information, but often clinicians would disregard certain details as noise because they were atypical symptoms. The amount of data that providers have to observe for a patient is massive, but machine learned models may be utilized to distill that data into the most relevant and actionable signals.

Before data is gathered and interpreted, it must be collected. Like Dr. Thompson, Harjinder Sandhu of Saykara sees ponderous, physician-driven data entry via EHR as significant barrier to efficient data collection. Sandhu notes that healthcare is the only industry where the highest-paid teammember is performing this onerous task and his company is using artificial intelligence to ease that burden on the physician.

Once patient data has been aggregated and processed into models, the challenge is getting the information in front of providers. This requires buy-in from the health system, physician, and, occasionally, the patient and his caregivers. Mary Haggard of Providence Health and Services spoke on the “Tech Entrepreneurs Journey into Healthcare” panel and stated that the biggest problem for entrepreneurs is defining the correct problem to solve. During the “Investment Perspective” panel, Matt Holman of Echo Health Ventures recommended tech startups emphasize an understanding of the context of the problem within a health system.

One of the most important and difficult hurdles for health technology companies is working into clinical workflow. Mike McSherry from Xealth has found that physician champions who know how they want to use technology help with integrating into a health system or physicians group. Lynn McGrath of Eigen Healthcare believes physicians want their data to be defined, quick to assess, condensed, and actionable, while Shelly Fitz points out that providers are not used to all the data they are receiving and they don’t yet know how to use it all. These are all issues that can and will be solved as healthcare technology continues to become more intelligent.

As Wellpepper’s CTO, Mike Van Snellenberg pointed out, health systems and doctors are resistant to “shiny new things”, for good reason. When approaching a health system, in addition to engaging the administration, clinicians need to understand why the machine learned model is recommending a given course of treatment. After integration, patients will also want to understand why a given course of treatment is being recommended. Applying artificial intelligence solutions to medicine must take into account the human element, as well.

The exciting possibilities of artificial intelligence and machine learning are hindered more by human constraints in health systems and data collection than by available technology. “Patients are throwing off all kinds of data when they’re not in the clinic,” according to our CTO. Wellpepper’s tools for capturing patient-generated data provide a pathway for providers to access actionable analysis.

Posted in: Healthcare Disruption, Healthcare Technology, patient engagement

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Meet Wellpepper At Connected Health

We’re gearing up for a great week at Connected Health. See Wellpepper, and our Alexa Diabetes Challenge Grand Prize winning entry Sugarpod in Boston next week. Contact sales@wellpepper.com to schedule a demo, drop by Booth 84 in the Innovation Zone.

 

Wednesday October 25
Natural Language Pre-Conference, we’ll be talking about the Alexa Diabetes Challenge, Sugarpod, and voice

Thursday October 26

Voice Technologies In Healthcare Applications

  • Room: Harborview 2/3
  • Session Number:R0240D
  • 2:40 PM – 3:30 PM

U.S. Department of Health and Human Services Town Hall with Bruce Greenstein, Entrepreneur Panel and Q&A (Invite-only)

Friday October 27

The Power of Patient-Generated Data

Exhibition Showcase 11:00 AM – 11:10 AM

 

 

Posted in: patient engagement, Voice

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Wellpepper Wins $125K Grand Prize in Alexa Diabetes Challenge

NEW YORK: Today, the Challenge judges awarded Wellpepper the $125,000 grand prize in the Alexa Diabetes Challenge. Wellpepper is the team behind Sugarpod, a concept for a multimodal diabetes care plan solution using voice interactions.

The multi-stage Challenge is sponsored by Merck & Co., Inc., Kenilworth, New Jersey, U.S.A., supported by Amazon Web Services (AWS), and powered by Luminary Labs. In April, the competition launched with an open call for concepts that demonstrate the future potential of voice technologies and supporting Amazon Web Services to improve the experience of those who have been newly diagnosed with type 2 diabetes.

“Technology advances are creating digital health opportunities to improve support for people managing life with a chronic disease,” said Tony Alvarez, president, Primary Care Business Line and Customer Strategy at Merck & Co., Inc. “One purpose of the Alexa Diabetes Challenge was to identify new ways to use the technology already present in a patient’s daily routine. The winner of the Challenge did just that.”

Sugarpod is a concept for an interactive diabetes care plan solution that provides tailored tasks based on patient preferences. It delivers patient experiences via SMS, email, web, and a native mobile application – and one day, through voice interfaces as well. Since much of diabetes management occurs in the home, the Wellpepper team recognized that integrating voice was the natural next step to make the platform more convenient where patients are using it most. During the Challenge, Wellpepper also prototyped an Alexa-enabled scale and foot scanner that alerts patients about potential foot problems, a common diabetes complication.

“Sugarpod helps newly diagnosed people with type 2 diabetes integrate new information and routines into the fabric of their daily lives to self-manage, connect to care, and avoid complications. The Challenge showed us the appeal of voice solutions for patients and clinical value of early detection with home-based solutions,” said Anne Weiler, co-founder and CEO of Wellpepper.

The Challenge received 96 submissions from a variety of innovators, including research institutions, software companies, startups, and healthcare providers. The panel of judges, independent from Merck, narrowed the field down to Wellpepper and four other finalists, who each received $25,000 and $10,000 in AWS promotional credits and advanced to the Virtual Accelerator. During this phase of the competition, the finalists received expert mentorship as they iterated their solutions in preparation for Demo Day. At Demo Day on September 25, 2017, the five finalists presented their solutions to the judges and a live audience of industry leaders at the AWS Pop-up Loft in New York to compete for the grand prize.

“The Alexa Diabetes Challenge has been a great experiment to re-think what a consumer, patient, and caregiver experience could be like and how voice can become a frictionless interface for these interactions. We can imagine a future where technological innovations, like those provided by Amazon and AWS, are supporting those who need them most,” said Oxana Pickeral, Global Segment Leader in Healthcare and Life Sciences at Amazon Web Services.

Learn more at alexadiabeteschallenge.com and follow the Challenge at @ADchallenge.                                                                   

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Contact: Emily Hallquist

(425) 785-4531 or emily@luminary-labs.com

Posted in: Healthcare Technology, Healthcare transformation, patient engagement, Press Release

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Ready When You Are: Voice Interfaces for Patient Engagement

We started experimenting with voice as a patient interface early this year, and showed a solution with a voice-enabled total-joint care plan to a select group of customers and partners at HIMSS 2017. Recently we were finalists in the Merck-sponsored Alexa Diabetes Challenge, where we built a voice-enabled IOT scale and diabetic foot scanner, and also a voice-powered interactive care plan.

Over the course of the challenge we tested the voice experience with people with Type 2 diabetes. We also installed the scale and scanner in a clinic, and we found that clinicians also wanted to engage with voice. Voice is a natural in the clinical setting: there’s no screen to get in the way of interactions, and people are used to answering questions. Voice is also great in the home.

However, voice isn’t always the best interface which is why we think multimodal care plans including voice, text, mobile, and web can deliver a more comprehensive solution. Since it’s easier for someone to overhear a conversation than look at your smartphone or even computer screen, mobile or web are often better interfaces depending on the person’s location (for example taking public transit), or the task they need to do (for example, reporting status of a bowel movement). We do think that voice has many great healthcare applications, and benefits for certain interactions and populations.

In our testing, we found that both patients and providers really enjoyed the voice interactions and wanted to continue the conversation. They felt very natural, and people used language that they would use with a human. For example, when asked to let the voice-powered scale know when he was ready to have his foot scan, one person responded with:

“Ready when you are.”

This natural user interface presents challenges for developers. It’s hard to model all the possible responses and utterances that a person would use. Our application, would answer to ready, sure, yes, and okay, but the “when you are” caused her some confusion.

Possibly the most important facet of voice is the connection people have with voice is extremely strong, and unlike mobile voice is not yet associated with the need to follow up, check email, or other alerts. (Notifications on voice devices could change this.)

“Voice gives the feeling someone cares. Nudges you in the right direction”

Creating a persona for voice is important, and relying on the personas created by the experts like the Alexa team, is probably the best way for beginners to start.

“Instructions and voice were very calm, and clear, and easy to understand”

Calm is the operative word here. Visual user interfaces can be described as clean, but calm is definitely a personification of the experience.

Voice is often seen as a more ubiquitous experience, possibly because using fewer words, and constantly checking for the correct meaning are best practices, for example “You want me to buy two tickets for Aladdin at 7:00 pm. Is this correct?” We often hear pushback on mobile apps for seniors, but haven’t heard the same for voice. However, during our testing, a senior who was hard-of-hearing told us she couldn’t understand Alexa, and thought that she talked too quickly. While developers can put pauses to set the speed of prompts and responses in conversation, this would mean that the same speed would have used for all users of the skill, which might be too slow for some or two fast for others. Rather than needing to build different skills based on hearing and comprehension speed it would be great if end-users could define this setting so that we can build usable interfaces for everyone.

While this was our first foray into testing voice with care plans, we see a lot of potential to drive a more emotional connection with the care plan, and to better integrate into someone’s day.

People need to manage interactions throughout their day, and integrating into the best experience based on what they need to do and where they are provides a great opportunity to do that, whether that’s voice, SMS, email, web, or mobile. While these consumer voice applications are not yet HIPAA-compliant, like our tester patient said we’ll be “ready when you are.”

Posted in: Behavior Change, Healthcare Technology, Healthcare transformation, patient engagement

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What Motivates You, May Not Motivate Me

At Wellpepper our goal is to empower people to be able to follow their care plans and possibly change their behavior, so we think a lot about how to motivate people. Early on when working with Terry Ellis, Director of the Boston University Center for Neurorehabilitation, wanted to make sure that our messages to patients that may struggle with adherence were positive. She works with people who have Parkinson’s disease, and stressed that while they may improve symptoms they would not “get better.”

Last week I had a similar conversation with an endocrinologist about diabetes care plans. People with chronic diseases are often overwhelmed and may take a defeatist attitude to their health. Feedback and tools need to be non-judgmental and encouraging. Ideas like “compliance” and “adherence” may not be the way to look at it. Sometimes the approach should be “something is better than nothing.” And humans, not just algorithms need to decide what “good” is.

Am I good or great?

Here’s an example, non-healthcare related of algorithmic evaluation gone wrong. Rather than applauding me for being in the top tier of energy efficient homes, the City of Seattle, says I’m merely “good.” There’s no context on my “excellent” neighbors, for example are they in a newly built home compared to my 112 year old one, and no suggestions on what I might want to do to become “excellent. (Is it the 30-year old fridge?) I’m left with a feeling of hopelessness, rather than a resolve to try to get rid of that extra 2KW. Also, what does that even mean? Is 2KW a big deal?

Now imagine you’re struggling with a chronic disease. You’ve done your best, but a poorly tuned algorithm says you’re merely good, not excellent. Well, maybe what you’ve done is your excellent. This is why we enable people to set their own goals and track progress against them, and why care plans need to be personalized for each patient. It’s also why we don’t publish stats on overall adherence. Adherence for me might be 3 out of 5 days. For someone else it might be 7 days a week. It might depend on the care plan or the person.

As part of every care plan in Wellpepper, patients can set their own goals. Sometimes clinicians worry about the patient’s ability to do this. These are not functional goals, they represent what’s important to patients, like family time or events, enjoying life, and so on. We did an analysis of thousands of these patient-entered goals, and determined that it’s possible to track progress against these goals, so we rolled out a new feature that enables patients to do this.

Patient progress against patient-defined goal

Success should be defined by the patient, and outcome goals by clinicians. Motivation and measures need to be appropriate to what the patient is being treated for and their abilities. Personalization, customization, and a patient-centered approach can achieve this. To learn more, get in touch.

Posted in: Behavior Change, chronic disease, Healthcare motivation, Healthcare Technology, Healthcare transformation, Outcomes, patient engagement, patient-generated data

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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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Meeting Consumer Expectations in Healthcare

We could talk about this all day, and we do! We’re glad to see healthcare executives start to take ownership of the digital experience, and understand that consumer and patient engagement is key to outcome success.

Consumer expectations are indeed hitting healthcare – hard. Patients are no longer shy about telling physicians and payers what they want and how much they’re willing to pay for it. While these expectations can seem overwhelming to those insiders who have long become accustomed to healthcare’s glacial pace, we shouldn’t be discouraged. These greater expectations can indeed be met, provided we take the time to develop and offer physicians and patients tools that meet their needs and fit their workflows.

Here’s the latest take on this topic from HISTalk

 

Posted in: Healthcare transformation, patient engagement, Patient Satisfaction

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