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Trends That Survive Healthcare Reform

While many aspects of the Affordable Care Act drove significant new opportunities, innovation and change in healthcare, this recent article from Harvard Business Review points out that there are trends that are not dependent on the system. In particular they identify three trends that are not dependent on the act in its current form:

  1. Aging population
  2. Technology adoption
  3. Discoveries in life sciences

However, we think there are at least three more that will mean that the momentum in technology innovation and a patient-centered approach will continue.

  1. Consumer focus: High deductibles are driving two types of behavior. Patients are acting more like consumers and are shopping with their healthcare dollars. Healthcare organizations are trying to attract patients and better understand their experiences and pathways through the organization. The expectation of good and real-time service is high.
  2. People are getting less healthy: While we would like to see this change on its own, through diet and exercise, the fact is that people are not eating well or active enough, and the rates of diabetes and pre-diabetes are increasing. By 2030, it’s estimated that over 470M people world-wide will have pre-diabetes.
    Leading causes of death

    Leading Causes of Death from http://www.independent.co.uk/news/health/the-things-most-likely-to-kill-you-in-one-infographic-a7747386.html

  3. Value stays top of mind: Our healthcare costs cannot keep rising indefinitely, and experiments in value-based payments have shown to work. Payer/provider organizations are looking to deliver better outcomes at lower costs, and patient self-management and self activation can help with that.

While patient engagement is not the only solution, we believe activated people and patients are an under-utilized source of positive health outcomes. Regardless in of changes in the healthcare act, that will remain true.

Patient engagement has been a mantra for those seeking to reform health care, as it’s widely accepted that patients who are engaged in their own health care have better outcomes. Frank Baitman & Kenneth Karpay

 

Posted in: Healthcare Policy, Healthcare transformation, Outcomes, patient engagement, Uncategorized

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Falls Challenge

How might we enable older adults to live their best possible life by preventing falls? We have entered a challenge with AARP and IDEO to bring our proven falls solutions to the masses. Along side our partners at Harvard and Boston University, we believe that using mobile technology to enhance and scale a proven falls prevention program will lead to better life by increasing access to care and decreasing costs.

The challenge started with over 220 submissions and recently weeded down to the top 40. We’re thrilled to have made the first cut. Our method is proven and we invite you to participate in the next round to refine our idea and help achieve greater impact.

Click here to check out our entry!

 

 

Posted in: Aging, Clinical Research, Healthcare Technology, Outcomes, Physical Therapy, Research, Uncategorized

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Wellpepper attends Episodes of Care Summit at Cambia Grove

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

Horizon BCBS of New Jersey is an episodes of care pioneer

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

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

Community involvement is imperative

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

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

Memorable quotes from breakout sessions:

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

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

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Using AWS with HIPAA-Protected Data – A Practical Primer

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

It’s Not Rocket Science

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

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

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

Stay Up To Date

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

Take Responsibility

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

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

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

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

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

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

Share the Responsibility

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

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

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

Draw a Bright Line Around Your ePHI

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

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

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

Secure at Rest and Over the Wire

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

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

Good guidance in this area is easy to find:

Logging and Auditing

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

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

Authentication

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

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

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

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

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

Conclusion

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

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

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Wellpepper Receives Seattle Business Magazine’s 2017 Leaders in Healthcare Gold Award for Achievement in Digital Health

We are honored to have been named the Gold Award winner for outstanding achievement in digital health from Seattle Business Magazine’s 2017 Leaders in Health Care!

Thank you to our amazing team and partners!

 

Posted in: Healthcare Technology, Healthcare transformation, M-health, patient engagement, Press Release, Seattle, Uncategorized

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Finding Change and Honesty at Mayo Transform Conference 2016

mayo-clinic-logoAlthough the theme of this year’s Mayo Transform conference was “Change,” it might as well have been dubbed “Honesty.”

From keynotes to breakout sessions, there was a raw sense of honesty and acceptance of the fact that change is hard, and we’ve reached a point where the evolution in healthcare doesn’t seem to be happening fast enough.

When you’re as successful as Mayo, it might be easy to brush failure under the rug – which made this session, “We Made This Thing, But It Didn’t Go as Planned. Now What?” unique. Now that some of the initial hype for digital health has died down, we are in a phase of realistic optimism where sharing both wins and misses represents a realistic way forward.

This interactive session in three parts by Steve Ommen, MD, Kelli Walvatne, and Amy Wicks unfolded a bit like a mystery. Questions were posed to the audience at each phase for our input on what might have gone right and wrong. Not surprisingly, the attentive audience proved as capable as the presenters, and some of the most valuable insights came from the audience questions.

The case study in this session was a three-year process to develop a new interface and workflow for the cardiology clinic. Dr. Ommen and the other presenters did not tip their hands to whether the project was successful or not, and we had to tease out the wins and losses that occurred during each phase.

The presenters shared stories, but did not show any artifacts of the process such as flow diagrams, screenshots, or personas. This methodology was effective because, instead of getting bogged down in critique of particular elements, we were able to see the bigger picture of challenges that could apply to any innovation or clinical change.

At the end of the session, the presenters summarized their top takeaways as:

  • Not having enough credibility and evidence

Much of the Transformation team were experts in design, but not necessarily the clinical experience for this service line. There were some misunderstandings between what could work in theory and in practice, although the team did identify areas of workflow improvement that saved time regardless of whether the technology was implemented.

  • Change fatigue (or “Agile shouldn’t be rigid”)

The team tried to use a lean or agile methodology with two-week product sprints: iterating on the design and introducing new features as well as interface changes biweekly. This pace was more than what the clinical users – especially the physicians – could handle, but the design aimed to stay true to the agile process. In this situation, the process was not flexible to the needs of the end users and possibly exacerbated the first point of lack of credibility.

  • Cultural resistance

The team lost champions because of the process. It also seemed like they may have spent too much effort convincing skeptics rather than listening to their champions. One physician in the audience wondered aloud whether the way physicians were included in the process had an outsized impact on the feedback the team received about what was working and wasn’t working. From his own experience, he noticed that a physician’s authority is often a barrier to collaboration and brainstorming.

From audience observations, it seemed like there may have been some other challenges such as:

  • Scope/Success Definition

There wasn’t a clear definition of success for the project. While the problem was identified that the current process was clunky and the technology was not adaptive and usable, not all parties had a clear understanding of what constituted success for the project.

Looking back, Dr. Ommen suggested that rather than trying to build a solution that addressed all co-morbidities, they should have chosen one that worked for the most common or “happy path” scenario. The too-broad scope and lack of alignment on goals made it challenging to conclude success.

  • Getting EPIC’ed

When the project started, the team was largely solving for usability problems created by having two instances of Cerner and one of GE used in the clinical workflow. During the course of this three-year project, Mayo made the decision to ink a deal with Epic, rendering the current problem they were solving for obsolete.

Going for a smaller win early on might have delivered value to end users before this massive shift in the underlying medical records software.

So what happened?

You can probably tell from the recap that the project was shelved. However, the team did have some wins, certainly in their understanding of how to better run a project like this in the future as well as in helping the clinical team optimize their workflow.

What should you take away?

Know your users, iterate, and move quickly to deploy quick wins – but not so quickly as to alienate your stakeholders.

Finally, ask your peers: we’re facing similar problems and can learn together.

Posted in: Clinical Research, Healthcare motivation, Healthcare Research, Healthcare transformation, Outcomes, Research, Uncategorized

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Cardiac rehab is effective, but patient-centered care needs to actually be patient-centered

With CMS’s new Cardiac Bundle, cardiac care (especially post-acute care), is the next service line to go under the microscope. As with total joint, variations in outcomes and costs are often seen in post-acute care so looking at how that care is delivered is key. For any bundle to be successful, engaging patients and ensuring their participation in follow up is a driver of success.

I have to admit, I haven’t read the bundle specs yet, just the news on the bundle. According to Becker’s Hospital Review’s “10 things to know about CMS’ new mandatory cardiac bundle”, the bundle includes provisions to test cardiac rehabilitation services, with 36 sessions available over 36 weeks. However, according to this article from NPR, although cardiac rehabilitation is proven to be effective, most people don’t participate. If you read through the comments on the NPR article (ignoring the trolls of course), you’ll start to see the reasons: cardiac rehabilitation care is built around the needs of the people providing the rehabilitation, not the patients.

From our experiences delivering post-acute care plans, as well as talking to payers and providers we’ve learned a few reasons why patients don’t follow up with their outpatient care:

  • Distance: In cardiac cases, patients are taken to the closest hospital, but this may not be the closest to their home or work. In other post-acute scenarios, they may have gone to a center of excellence that is also at distance.
  • Time commitment: These programs often require multiple days of treatment a week. Not everyone has the flexibility to take off work.
  • Timing: Programs are usually offered during 9 to 5, to accommodate the needs of the providers. Patients might prefer evening or weekend programs. We talked to one provider that focuses on lower income patients. People in hourly wage jobs don’t get to choose when they take breaks and their breaks are usually 15 minutes, and maybe 30 minutes for lunch. It’s next to impossible for them to attend in-person sessions.
Francis Ying/Kaiser Health News

Francis Ying/Kaiser Health News

The NPR article keyed in on these within the one example of Kathryn Shiflett (a healthcare worker herself!) whose distance and work hours (4:30 AM – 3:00 PM) pose a significant barrier: “She lives an hour away and is about to start a new job. Cardiac rehab classes happen Mondays, Wednesdays and Fridays, with sessions at 8 a.m., 10 a.m. and 3 p.m.”

While the bundles are definitely driving the right behavior in focusing on patient outcomes rather than procedures, they need to go further to promote patient-centered care. In this case, that should be testing new models like mobile health or community-based rehab programs that are adaptable to the unique needs of different patient groups.

Posted in: Adherence, Healthcare Disruption, Healthcare Legislation, Healthcare motivation, Healthcare transformation, Occupational Therapy, patient engagement, Patient Satisfaction, Rehabilitation Business, Uncategorized

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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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Wellpepper goes to Vegas for HIMSS16!

Screen Shot 2016-02-24 at 4.03.54 PM

 

Sunny and 70’s all week,Vegas here we come! We will try to bring some sun back with us.Vegas Weather HIMSS Blog

We will be in booth #5 @ the HX360. Let us know if you’ll be attending HIMSS16 by sending us a tweet @wellpepper.

Contact us, to set up a meeting with Anne Weiler CEO or Robin VP of Business Development 

The annual HIMSS conference is almost here! A few tips.  Wear comfortable shoes and your Fitbit, you will be walking miles. With over 43K in attendance at HIMSS15, the lines for coffee and food were long.  Bring a few snacks and get your morning coffee before you get to the conference!

So many interesting and inspiring education sessions, so little time! Between walking and navigating the crowds, it can take up to 10-15 minutes to get where you are going so take some time to plan out your education sessions. Get to the sessions early if you want a seat, many sessions end up being standing room only. 

Stop by to see Wellpepper CEO Anne Weiler on this panel which is part of the HX360 Innovation Leaders Program

Date: Monday, February 29, 2016: [Time: 2:30 PM – 3:15 PM]

Session Title: Flexible Care to Fit the Second Half of Life: from Independent Aging to Acute & Long Term Care

Session Description:  How can technology support flexible, high quality, cost-efficient care delivery that meets patients’ needs in the second half of life? Where are the most egregious gaps in care for older patients? These are the questions that will be explored by our panel, covering topics ranging from aging independently to rehabilitation, home care support, family caregiving and honoring end-of-life wishes.

Here are some of our  education session picks.

Connected Health

March 1, 2016 — 08:45AM – 09:45AM : Trends & Resources in Connected Health: Harnessing the power of mobile for research 

Clinical and Business Intelligence                                                                

March 1, 2016 — 10:00AM – 11:00AM: Actionable Analytics: From Predictive Modeling to Workflows

March 3, 2016 — 02:30PM – 03:00PM: Getting to Big Data Insights in Healthcare

Consumer and Patient Engagement

March 2, 2016 — 10:00AM – 11:00AM: Patient Engagement – The Next Chapter

March 4, 2016 — 12:00PM – 01:00PM: Patient Engagement Beyond Patient Portal-Strategic Approach

Care Coordination and Population Health

March 1, 2016 — 10:00AM – 11:00AM: Too Many Patient Portals – What Can You Do About It?

March 1, 2016 — 01:00PM – 02:00PM: Coordinated Health: The Experience You Should Expect

March 1, 2016 — 03:15PM – 03:45PM: mHealth solution for remote patient engagement

March 1, 2016 — 04:45PM – 05:15PM: Rethinking patient engagement and provider workflow

Clinical Informatics and Clinician Engagement

March 1, 2016 — 04:00PM – 05:00PM: Enhancing Patient Outcomes with Big Data: Two Case Studies

March 2, 2016 — 10:00AM – 11:00AM: Taking Plans of Care from Clinician to Patient-Centric

March 2, 2016 — 01:00PM – 02:00PM: Seven Essentials in Clinical Information Technology Adoption

 

Posted in: Healthcare Research, Healthcare Technology, Healthcare transformation, M-health, Outcomes, Patient Satisfaction, Uncategorized

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The Tide of Change is Coming…….

I have been in healthcare my entire career and have seen lots of change in some form or fashion for this industry. But, as many will attest to, BIG change is fast approaching when it comes to reimbursement. That was very evident at a recent conference I attended – The American Association of Hip and Knee Surgeons – AAHKS. Change in reimbursement was the common theme and the ones shouting it from the roof tops were the industry expects, the surgeons in the trenches, and us – the vendors. Although many are getting ready for this tidal wave, there are still the ones, very few, that are digging their heels in hoping to ride out the wave. I think they’ll likely crash head first.

In January 2016, bundled payments will be here for total joints via the Comprehensive Care for Total Joints mandates from CMS.  The sessions I attended at AAHKS made it loud and clear: surgeons need to be prepared for this change. What they need to be prepared for could be anywhere from working collaboratively with their hospitals partners to really understanding the data for process improvement, results and patient engagement. All of these efforts are needed to drive value for their practices, partners and ultimately the patient. No longer are the days where practices, departments or hospitals can stand alone in this journey.

Dr. Thomas Vail from UCSF suggested in order to attract patients that still have a choice, physician practices and health systems must work together to drive value and make that the centerpiece to improve outcomes. Furthermore, instilling competition among the care teams will instinctively drive better behavior and thus, have shown to improve patient satisfaction stats in those departments.

Every department at UCSF will be effected by change in reimbursement. They use the data to drive a strategy of quality, safety, efficiency and financial performance to help mitigate the risk fact that goes along with this change in reimbursement. The data will show trends to drive change verses just looking at individual metrics. Their focus is on the goals that focus on the measurements.

During a panel discussion on Patient Reported Outcomes – This is Your Reality, it was all about engaging the patient. Dr. Kevin J. Bozic from Dell Medical School at UT Austin, PROs are the “holy grail” for measuring quality. Physicians should understand patient outcomes are based on the patient’s expectations and the cost it takes to get to that outcome.

Orthopedic society groups such as AAHKS, AAOS and AJRR are taking it upon themselves to bring the PROs up to today’s reality by working together to modify the surveys to make them more patient friendly – thus getting the patient more engaged. (These recommendations are awaiting CMS approval.) Also, there is a big push to ensure there is a “risk adjustment” factor taken into consideration in order to make it a level playing field given the diversity of total joint surgery and the different levels of complexity. However, regardless of any update or approval by CMS, the panel agreed that obtaining RPOs will be the cost of doing business. Last, which I believe supports the need for patient engagement technologies, Dr. Bozic closed with……“It (PRO) will be a nice to have to a need to have”.

The Tide of Change provides a tremendous opportunity to all of us who look to make a difference in the way technology can improve the delivery of healthcare but most importantly, provide the patient with a better experience.

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The (Little) Things That Matter To Patients

Outcome measurement is top of mind for all of us in healthcare these days, and there’s been a lot of talk about whether measures drive the right behavior, with some examples of how patient satisfaction measures can create a “Disneyfication” of the healthcare system, which at its worst, results in animatronic nurses reciting scripts and patients demanding the amenities of a 5-star hotel. When managing towards patient satisfaction in the extreme results in a “patient is always right” mentality and additional or unnecessary procedures are performed on demand we need to question whether “patient satisfaction” or outcomes should be the goal. However, the patient experience with and in a healthcare setting impacts their desire and ability to recover, and therefore can impact outcomes.

Small and not so small things that focus on the patient experience, not in trying to win at patient satisfaction measures, but in really thinking about what will make patients comfortable and cared for to help them heal. At a recent talk at Seattle’s Cambia Grove, a physician who had recently joined Iora Health described their clinics as “places you could actually get better.” Compare how spas are designed to inspire you to health versus your average doctor’s office. A lot of healthcare offices feel like places you could get sick, and they often are.

In their annual report on patient outcomes, Hoag Orthopedics offers patient stories. I was struck by how fondly these patients recalled their hip replacement experiences. There is no way a hip replacement can be pleasant, but Hoag delivers such a high quality of care and for these patients, the hip replacement provided a release from constant pain and function back. As a result, the entire experience was positive.

That got me thinking about my own experiences as a patient and those of my loved ones, and which ones felt that way and which didn’t.

Similar to the Hoag patients, I had a really positive experience when I had an appendectomy, in Russia no less! A few things stand out for me about the quality of the experience:

  • The hospital was extremely quiet and in a city of 13 million this was no small feat. Noise in hospitals is often cited as the number one complaint for patients impacting satisfaction scores, and has recently become a top priority for hospital administrators. Compare the noises of a spa to the noises of a hospital and consider which one you’d want to recover in.

    Luxury hotel or private hospital, the European Medical Center in Moscow

  • As I regained consciousness in the recovery room, hot air was pumped into my bed—general anesthesia lowers the body temperature, but my first sensation on regaining consciousness was of being in a warm cocoon, this continued to my hospital bed which had a duvet on it. This may not seem like much but for someone who is always cold it made a big impression.
  • I wasn’t able to eat anything but my roommate said that the food was incredible (and in Russia no less)
  • The cost for all this value, including not having a burst appendix or other complications: 2 nights was less than $5000!

Contrast this to my mom’s experience during 6 months in a rehabilitation hospital recovering from a rare auto-immune disease. Blankets were flimsy at best and we supplemented them and the pillows to make her more comfortable—granted this was a long stay and adding comfort and personal items was important. While my mom was in the hospital she started losing her thick and still almost black hair. The physicians looked into whether it was side effects of any of the drugs she was taking. However, when she left the hospital it started to grow back. Her family physician diagnosed the problem: poor nutrition. The food in the hospital was of such poor quality that she lost her hair! Although this hospital had a nutritionist that reviewed patient’s diets, to save money they no longer had food preparation on staff and an institutional caterer brought in food. How did this lack of nutrition impact her recovery? Could she have regained strength and function faster with better food?

Two vastly different experiences with things that may seem tangential to care, but are they really? Think back to when you were a child and were sick. What did you want? Comforting nutritious food, and a cozy blanket. While what was most important in both experiences was treating the original problem: a duvet wouldn’t have helped me much if my appendix had burst or surgery was botched, however, the experience of being warm, comfortable, and cared for definitely helped my recovery. I raved about the experience to a friend who thought I was crazy until she had surgery at the same hospital: she didn’t want to leave either.

The way we are cared for impacts our own recovery, and often our desire for recovery. Patients need to feel confident and cared for and with this, they can take responsibility for their own health.

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Telemedicine Requires Optimism and Patience: Dispatches from American Telemedicine 2015

The 21st annual American Telemedicine Conference wrapped up last week in Los Angeles. While there were amazing patient success stories, and a group of people dedicated to the success of telemedicine, it was slightly depressing that after 20 years, there are still people questioning the value and calling for more data as well as no consistent reimbursement except in rural settings. Considering that we can order just about everything at 3am from the couch in our pjs, it’s amazing that we still require sick (and possibly infectious people) to find their way to the doctor rather than offering at-home options.

Here are a few high-level impressions of the event:

  • The exhibit hall was smaller this year. A number of people commented on this, and there seemed to be two reasons. First, there was an impression that this conference was too close to HIMSS for the big companies to get a booth shipped between the two conferences. This is partially good news though: telemedicine has gone mainstream into the biggest health IT conference.

The second reason might have been that some vendors are struggling or have left the market. This is purely based on my observation but I didn’t see as many “all-in-one” hardware and software vendors, which makes sense when video conferencing is available on every computer and every mobile device. As well, vendors that sold “equipment” for telemedicine, like specialty carts were also absent. Vendor consolidation may also have accounted for some of this as well.

So while a smaller tradeshow floor may have indicated a problem at first glance, it also points to market maturation.

  • The reasons for implementing telehealth are changing from purely rural access and access to specialists to consumer preference. However, reimbursement has not caught up with this and most consumer-facing applications are cash-pay by the consumers. Lack of reimbursement despite the evidence supporting telemedicine remains a sticking point. Although I didn’t attend any policy specific sessions, reimbursement came up in every session I did attend.
  • Tuesday morning’s plenary featured a lively debate about consistency in telemedicine. One camp held the position that without consistency of care we could not judge the validity of telemedicine, while the other asked why we would hold telemedicine to higher standards than the current system. While there is something to be said for not making the same mistakes in a new model, it did seem like some of the people in the consistency camp were using this as a reason to stall implementation.

Consistency in Telemedicine

  • A new consumer-facing program by Southwest Medical Associates showed that telemedicine was no-less consistent than in-person, pointing out that antibiotic prescribing rate were identical for UTIs treated via telemedicine or in person. They also discovered that 70% of their telemedicine patients were women, which is not surprising given that women still bear primary childcare responsibilities, and getting to a doctor with kids in tow is not easy.
  • In many cases, telemedicine was not seen to replace rather to augment existing care, especially for chronic disease patients where additional check-ins help them manage care and stay healthy. However, there were other examples of using telemedicine, especially after hours, to treat and triage issues to keep people out of the ER so that the ER could focus on the people who really needed to be there.

We create a nine-to-five system

  • In addition to providing access to specialists and specialty care telemedicine can provide basic access to care. Proponents pointed out that there are many areas of the country, where there is no access to primary care physicians, for example there are 30 counties within Texas with no PCPs. Of course this brings up another sticking point for telemedicine, which is licensure. Without an easy way for healthcare professionals to practice cross-state, it’s hard to solve this problem. In the consumer scenarios this is even more ridiculous, as many consumer-facing telemedicine solutions required that the first check for the patient be which state they resided in. Personally, I’d like to think that if someone has qualified to practice medicine in one state in this country they are competent in another.
  • One of the most touching uses of telemedicine was for pediatric palliative care. There are very few palliative care centers for children, and they are also more comfortable at home. UC Davis Medical Center with the George Mark Children’s House used telemedicine to give families access to nurses remotely. Nurses at first expressed skepticism but were astonished at how much compassion they could share through a video call.
  • Telemedicine decreases no-show rates. Not surprisingly The Cleveland Clinic saw 100% show rates with patients when they did a video follow-up from surgery rather than being asked to drive 100 miles to a visit.
  • Overcoming internal skepticism was often the biggest barrier. Marshfield Clinic physicians didn’t offer telemedicine to their older patients initially because they thought that they wouldn’t want it. Again, not surprisingly they did as older people often have greater challenges getting to the office, especially if they have had surgery or are no longer able drive. The idea that older people don’t want or can’t use telemedicine is another myth that needs to be dispelled for wider adoption.

Looking forward to 2016, let’s hope that the sessions show fewer pilots and more system-wide implementations of telemedicine, an increased focus on patient preference for telemedicine, and a decrease in the regulatory barriers. The best sessions I attended featured real patient stories, while HIPAA is a concern, patients who had positive experiences were more than willing to have their stories told. Let’s hope more of those move us all forward.

For a selection of our live tweets from sessions, see our Twitter feed.

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This Month [March] in Telemedicine

March 31, 2015
American Telemedicine Association
Presenters:
Gary Capistrant, Chief Policy Officer, American Telemedicine Association
Latoya Thomas, Director, State Policy Resource Center
Jordana Bernard, Chief Program Officer

I admit this is only my second ATA ‘This Month in Telemedicine’ webcast I have listened to and whereas the federal and state legislative ‘lingo’ isn’t as intimidating anymore, I still have a headache from going into information overload. Luckily it isn’t my full time job to be on top of legislative telemedicine on goings, but ATA’s. To me it was clear with each passing minute that ATA’s mission to achieve “Educating and engaging government, payers and the public about telemedicine” is steadfast, and kudos to their small staff to keep on top of legislative issues and make telehealth materialize for us all.

The biggest Telemedicine conference in the world: The annual ATA Annual Telemedicine Meeting and Trade show is next month, May 2-5 in LA and they are busy in preparation for this event that is over 2500 miles from their headquarters in Washington, D.C. Jordana Bernard, ATA Chief Program Officer, believes the conference highlights will be the pre-meeting courses (continuing education credits offered), State Telemedicine Gaps Analysis awards and the keynote speakers, Emmy-award winning chief medical correspondent for CNN, Sanjay Gupta and Patrick Soon-Shiong, Chairman and CEO, NantHealth. Early bird registration ends tomorrow, so hurry!

Additional up-to-date ATA highlights addressed by Jordana:

  • There will be a survey arriving shortly in your email about how and if your organization is using telehealth in primary and urgent care practices when addressing mental conditions.
  • Accreditation initiative: There are five ATA Accredited Telemedicine training programs with a new online patient consultation accreditation program launched in December 2014. –This newly developed training program could be useful for Therapists utilizing Wellpepper.
  • Practice guideline initiatives: There are fourteen completed online documents under development such as the General Pediatric group, Pediatric mental workgroup, Teledermatology (revised guidelines from 2007), Telestroke guideline and an initial draft of remote burns and assessment treatment is forthcoming.

*Blue enacted, Orange introduced and Grey no status.

State license compacts are still being discussed as I mentioned in my last ‘This month in Telehealth’ blog. Latoya Thomas (a truly remarkable intelligent lady and my hero this week), Director of State Policy Resource center at ATA, summarized the current state of things (no punt intended!). There are 11 states that have introduced bills to legislation on how they would like to tackle this issue and sadly, my state, Washington, hasn’t introduced any bill! Legislation has decided that once physicians enter into a compact they will be issued expedited licenses in order to facilitate interstate licensure practices. Interesting Louisiana, Montana and Tennessee are looking at unique telemedicine licensing. There is a state policy webinar April 23rd that ATA will be hosting that might clarify and will undeniably go into more detail.

Last, but most definitely not least, an important CMS event happened on March 20th when “proposed rulemaking for electronic health record incentive program (meaningful use) stage 3 [1] to begin by 2018. This proposal is open for public comment until May 29.” Also this month CMS announced a new payment model “The Next Generation ACO” (as I referred to in a post) which also contained ATA’s request to Expand Telehealth coverage. Gary Capistrant brushed upon the FCC’s Net Neutrality Rules (brushed because it is a heavily loaded topic). I personally have been avoiding it because it’s 400 pages long… and well I already have a headache.

For full audio/video of this webinar please visit here.

Next “This month in Telemedicine” is 4/26.

 

 

 

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Will 2015 Be the Breakout Year for M-Health?

While on the one hand, many are proclaiming 2015 to be the year that M-Health finally becomes mainstream (and certainly CMS’s announcement that they will pay $42 per month for remote care for chronic diseases helps with that), the opening day keynote at  the M-Health Summit last week at the Gaylord National Harbor Convention center, seemed to suggest we are in the trough of disillusionment.

In particular Walgreens Chief Medical Officer Harry Lieder and Partner’s Center for Connected Health Director Joseph Kvedar were pragmatic to almost pessimistic about how mobile health would be adopted by consumers, healthcare systems, and payers. While being realistic about how mobile health can help, who can benefit, and who will actually pay for it is a conversation we all need to be having, the tone of the opening day keynote was not so much about celebrating successes but shoring up the audience to continue the good fight.

Walgreens CMO, Lieder outlined four areas where he thought that M-Health could have an impact across the care continuum:

  • Health, fitness, and well-being
  • Self-diagnosis
  • Acute care
  • Chronic care

Source: M-Health Summit

He then went on to debunk the myths of the quantified-self, that is that consumers will take their health in their own hands if presented with information. He also talked about why wellness is not popular with insurers and employers: the impact of wellness programs is generally only in the long-term, for example 10-20 years, and most employers and insurers hope that any individual won’t be their problem for that long. Taking the short term approach, Lieder said there were really only two ways to have a successful m-health startup today: enable people to bill for an existing CPT code or show significant cost savings to the healthcare system in 12-18 months. This is the current reality of the healthcare system, but certainly not how we’re going to drive change. CPT codes are backward looking not about new ways of delivering care, and while ROI needs to be forthcoming, managing patients over their lives needs to be the goal of the healthcare system.

So with this grounding in the somewhat depressing realities of today’s situation, Lieder then announced that Walgreens has partnered with MDLive to offer in-store telemedicine visits. Their recognition that consumer health alone doesn’t change behavior and that patients need support prompted the introduction of this new service, Lieder said “We need people available behind the device to change behavior.” If you can’t fix the system, reinvent it! One speaker called pharmacy the “last mile” that is, the patient loses connection to the health system at the pharmacy so brining the health system to the pharmacy might be the solution.

Joseph Kvedar of Partners.org asked if 2015 would be m-health’s coming out party but said that until applications hit certain key criteria we won’t see widespread adoption. He asked that application builders make m-health apps usable, social, personalized, and with relevance to everyday life. From a patient’s perspective applications should know the patient, engage the patient on his or her terms, and empower the patient. Kvedar did not seem to think that applications had nailed these things yet, especially in the area of usability and that we don’t get this right (and soon) m-health will “go down as another tech bubble.”

Joseph Kvedar

Source: MHealth Summit

M-health has had a lot of hype, and while this keynote provided some grounding in the reality of the market today, it seemed that this might have been a better keynote for the second or third day. Day one, it would have been nice to hear some success stories. After this keynote, I attended a session where one medical researcher spent most of the time explaining how she knew better on how to build good software than anything out there. We m-health entrepreneurs definitely need to get better at telling our success stories. It seems the press to date has been too much hype and not enough clinical substance and ROI to make our case.

At Wellpepper, we predict that if m-health companies can show real clinical evidence, tell real patient stories, and find partners in the ACOs and other organizations that are passionately trying to change healthcare in this country, then 2015 really will be the breakout year for M-Health, and next year’s keynote will see us out of the trough of disillusionment and firmly into real value.

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10 Reasons Why Running a Relay Race is Like Running a Startup 

This weekend was Ragnar Northwest Passage, a 196-mile relay race here in the beautiful Pacific Northwest. It’s painful, it’s exhausting, and it’s great fun. Kind of like founding a startup. Here are 10 similarities:

1. You don’t get much sleep

sleeping under the steps

Team member Todd catches an hour of quality shut-eye in the dirt with the rats after running the second of three legs.

 

2. It’s a small team. Each person is critical. And they smell bad.

honey buckets in a row

It ain’t all honey

 

3. You push hard to reach the goal, and then someone faster overtakes you

Runner getting passed.

Getting passed in the last hundred yards sucks. Unless you catch them back. He did.

 

4. You meet a lot of great people along the way

The CRAWLERS at the finish line

Team CRAWLERS. Our finish time was 29:16:55.

 

5. Vanity Metrics

Road kill tally chalked on van window.

Our BI system for tracking how many runners we passed.

 

6. It’s not a straight route to the end of the race

indirect route on a map

At least with a relay race, you have a map.

 

7. You’re a volunteer

Mike wearing a volunteer shirt

Unpaid labor. The backbone of startups and relay races.

 

8. Print marketing is hard.

Car door: "We Suck"

There’s a reason PR and marketing firms charge big bucks.

 

9. You can’t do it without an understanding spouse at home

Mom getting tackled by 3 year old

She has a harder job than I do, whether I’m building patient engagement software, or running grueling races.

 

10. You take a beating, and keep coming back for more

Ragnar finishing medals

Perseverance produces results. In this case, bottle opener medals.

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Big Distances Make the Case for Telemedicine: Recap from the Canadian E-Health Conference

Vancouver Convention CentreJust back from the American Telemedicine Conference, and we took a short trip over the border (and back to the motherland), to the Canadian E-Health Conference in Vancouver, BC. Due to the short timeframe between conferences, it’s hard not to compare and contrast the two, although the healthcare systems between Canada and the US could not be more different. The E-health conference had a broader scope than the ATA conference, with telehealth as a sub-topic and electronic records management featured more broadly, in fact, all the major EMR vendors were there, with the exception of Epic.

Know Me in Powerchart

Know Me in Powerchart

In a session sponsored by Cerner, Island Health CMIO and Acting Executive Medical Director, Dr. Mary-Lyn Fyfe shared their patient-centered approach to EMR implementation called “Know Me.” Island Health Authority has been a Cerner customer for 5 years, and have a robust implementation with plans to extend to patient recorded profiles. Dr. Fyfe talked about how what is most important to patients is not always evident or even apparent to healthcare providers, for example, a patient admitted for heart issues but who is more concerned about who will care for his spouse at home with dementia rather than his own condition. Only by treating the whole patient does Dr. Fyfe believe that healthcare providers can have real impact.

Although telehealth was not more advanced in Canada than what we’ve observed in the US, Canada has real financial incentives for telehealth. Vast distances and sparse populations make delivering a high-level of care in many parts of Canada very expensive. The more that can be done remotely, the better. One group covering First Nations groups boasted that they had delivered nine telebabies, that is babies delivered with the help of a doctor over telemedicine. Another doctor talked about how his being able to coach a medical assistant onsite through a video call prevented a $10,000 emergency helicopter flight. Others talked about the environmental benefits of thousands of car trips of 3-4 hours that were avoided by using telemedicine, not to mention the quality of life improvements for patients. Another benefit of telemedicine that we hadn’t seen cited before was doctor education, this is in the scenario where a local primary care physician calls a specialist and together they meet with a patient. In an in-person specialist care scenario the patient would not see these two physicians at the same time. Having both in the same patient visit enables knowledge sharing between the doctors, for the specialist more context on the patient, and for the primary care physician education about the specialist’s area of expertise and the patient’s condition. You could call this collaborative telemedicine.Hackathon

While telemedicine is well established in Northern Canada, it seemed that the benefits in parts of Canada closer to the US border where most of the population lives were not as well established, and a surprising number of telemedicine initiatives were still in pilot mode. Similarly there seemed to be a great disparity in electronic records management with some health authorities still entirely on paper.

Kicking off the Canadian Telehealth Forum, which was a pre-conference session and also an annual event, Joseph Cafazzo of the Center for Global E-Health Innovation showed examples of home monitoring technology that did not take into account the users, who are primarily seniors, and called on the audience to consider empathy in the design of products. One of the key reasons for this is that the only person capable of managing a chronic illness is the patient themselves, and yet many don’t want to identify with their illness or be reminded that they have it. Empathy to the patients experience can help in designing products that make it less intrusive for patients to manage their health. The Juvenile Diabetes Foundation has been putting pressure on manufacturers for this as teens in particular don’t want to take their blood sugar readings although it’s crucial to their health. The Center for E-Health developed an application that identified the times that teens really don’t want to take readings (at lunch when they are at school for example), and offered rewards like iTunes giftcards for doing so, a great example of a carrot that is attuned to the patient’s preferences.

Mobile health seemed in the same place as in the US: a lot of very interesting, patient-centered applications like the 30-day stroke assessment from the Center for E-Health and the Heart & Stroke Foundation of Canada, which used AirMiles rewards to entice a high-risk group of men to download and complete the assessment. Engagement was 12% across all groups, including seniors. One of they keys to the app was that it focused on a short-timeframe, although this does bring up the question of how to keep patients engaged over the long-run.

Not surprisingly a number of solutions were based on lowering costs of population health management. Because healthcare is government funded, unlike the US there are real incentives for decreasing costs as well as keeping the population out of long-term care. While many solutions addressing issues such as CHF and COPD are in early stages, we heard lofty goals of increasing the number of outpatients managed by one nurse to over 200, and also using wellness coaches to scale further.

Considering that unlike the US, all the economic and patient incentives are aligned for e-health, it was a bit surprising that so many of the solutions and presentations were about pilots rather than completely implemented systems. However, that might be a tradeoff of having government run programs. Regardless, the conference featured many passionate speakers who are using innovative solutions to both improve patient outcomes and experience while being cost-effective.

Posted in: Behavior Change, Health Regulations, Healthcare Disruption, Healthcare motivation, Healthcare Technology, M-health, Telemedicine, Uncategorized

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Customized Seating, A Dream Come True

Last month, I was asked if I would be a ‘model’ for a custom seating session at the 30th International Seating Symposium held in Vancouver, BC. I replied yes without a moment‘s hesitation and I am glad I did.

The international symposium offered a number of lectures and demonstrations presenting current and future developments in the areas of seating, positioning and mobility for the disabled. The session for which I modeled was titled “I’m Not Straight, So Please Don’t Make Me… Custom Seating Do’s and Don’ts”. The session was lead by Sheila Buck, an occupational therapist, speaker and author specializing in seating and mobility.

Pressure sores have been the bane of my existence—their appearance always causing immense frustration, materializing at most awkward times, and forever interfering with my life! No matter the number of skin grafts, the preventative measures or off-the shelf cushions, those ugly ulcers would mysteriously develop on my right buttock. Doctors always recommended staying off my rear end. Do you know how long an open wound takes to heal on an area of skin that has endured previous incursions? I would have had to spend years lying down!

The advent of the ‘customized cushion’ was my singular liberation from these miseries.  Once assessed, mapped, measured and ordered, the day that cushion arrived was the first day of freedom from that overriding burden of anxiety and it has lasted to this day.

Sheila’s thought-provoking introduction covered topics such as the choosing “off-the-shelf’ or customized seating, assessing a client’s seating requirements as well as techniques and measurements that can be used when creating contoured seating. She then asked me to come up front for a real-life demonstration for the audience of therapists and other medical practitioners.

Custom chair technology from PRM Rehab

Custom chair technology from PRM Rehab

In front of us was a molding frame supporting 2 bean bags not unlike a new-age easy chair. Sheila said that she would be molding this cushion to customize the shape to support my body. The bean bags were covered with a 4 way stretch pliable material marked with repeating pattern, filled with small bean-like plastic pellets and was attached to a vacuum. She explained that as she molded the cushion, she would use the vacuum to extract air from the bean bag to compact the pellets or blow air in to loosen them. She also mentioned that when the mold was finished, the company manufacturing the cushion would take photographs of the molded bag using the 3D image to design a mold to achieve the desired shape to support the client’s body.

Before I transferred to this molding chair, she asked the audience to help identify my seating issues. (It didn’t take much prompting to come up with a list.) Once I was comfortably seated in the chair, she then began kneading and forming the cushion, pressing on my shoulders, hips and thighs, and pushing the pellets in the molding bag to the left and right to form the shape that best supported my body the way it wanted to while addressing my posture issues. As I recall it was an iterative process, first forming the basic shape, assessing the effect, and returning to provide the additional off-loading and additional reinforcement my body required. As she did this my body slowly started to relax to use the support the cushion provided.

At the end of the demonstration, I wanted to take the cushion mold home with me! It was sooo comfortable! I would have used in on my next airplane flight. (I am not looking forward to sitting in a seat designed for a normal able-bodied person!) But even more important was the fact that those in the audience left with an awareness of the knowledge and expertise required to provide customized seating for suitable clients.

For more information on the seating technology, visit PRM Rehab.

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