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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 First or Voice And? Dispatches from Voice Summit

The inaugural Voice Summit was held last week in New Jersey, with the hashtag #voicefirst. At Wellpepper, we’re actually in the “Voice and” camp. We love voice interfaces for their convenience, promotion of empathy and connection, and their natural engagement. However, there are times when voice isn’t the best interface for the task or others when voice plus other interfaces are even better, which is reflected in some of our work with the Alexa Diabetes Challenge, which I spoke about at the conference.

People can only remember 5 things at a time, which is a challenge for delivery of complex instructions, education, or information through voice. Add this to the fact that voice is a “headless” navigation. That is, there are often no cues to figure out where you are going. Most of us are visual creatures, and visual cues together with voice or text often provide a richer experience. And believe it or not, the many of the sessions at this inaugural voice conference also seemed to reinforce this idea, in particular many of the consumer sessions, in addition to the healthcare sessions.

Talks by two very different consumer organizations, Comcast and Lego both showed how early we are in voice design, and how when voice is more seamless and ubiquitous we may see the promise of “voice first” but also how “voice and” is possibly the better path forward.

While when you think of giants of voice, you many immediately think of Amazon and Google, did you know that Comcast processed over 6B voice queries last year? My first thought on attending this session was that it was going to be about using interactive voice response trees before you get to a customer service agent, but Comcast has been quietly infusing voice into their entertainment experiences.

Did you know that your Comcast remote has a “voice” interface? You can talk to your TV to find programs, change the channel, or start a show. This is probably one of the best examples of “voice and.” First, voice search is actually found on a physical device. The Comcast design team had originally created a mobile app for the remote voice experience, but found that downloads were a small fraction of their entire subscriber base, so adding a “voice button” to the remote encouraged more searches. Also remember that when you use voice to search it shows you the results on your television screen. This is a “voice and” experience which wouldn’t make a lot of sense as voice standalone. Imagine searching for a movie to watch, say you’re looking for something starring Harrison Ford, and you’ve got to keep in your mind all the titles over his varied career and then choose one. First it’s a lot to remember, and second isn’t it easier to browse titles when you can see pictures and a description to jog your memory? I spoke briefly with the Comcast presenters about why they chose to put voice on the remote, versus directly in the cable box, and they said that it helped their users find the option, which was a big takeaway from the conference for me, although voice is a natural interface, the end-user still needs guidance. (A nice side benefit of the button on the remote is that it’s not always on and listening.)

Lego was another unlikely consumer company playing in the voice arena. Lego “Duplo Stories” is an Alexa skill that tells stories that children can then build using Duplo blocks. While the video was heartwarming, this session in particular highlighted both opportunities for “Voice And” using augmented reality, and also the current discovery limitations of voice.

In the video, a child playing with Duplo blocks asks his mother to start a story. The mother asks Alexa to play a Duplo story. Think about this: the skill had to be discovered and activated before any of this could take place. How would you learn about the skill without something printed on the box that the Duplo blocks came in? While it’s clever, imagine a new scenario where voice and augmented reality are built right into the blocks: a virtual Duplo minecraft. The child builds something with Duplo, and then a voice and visual interface projects the story on the child’s creation.

It’s still early days, and the potential for “Voice And” is still huge. In fact, a lot of the content at this conference reminded me of the early days of web interfaces. There was lots of talk about taxonomy of information, and “chunking” information into manageable pieces. (I used to teach a course on writing for the web, where we practiced this, which is funny as we now are so accustomed to screens that long-form journalism is making a real comeback.)

Similar to the early days of the web, there seemed to be slightly more focus on publishing than on end-user goals: what does the end-user actually want to accomplish, not what is the end-goal of the content publisher. What’s different though is that while during Web 1.0, the answer to question of whether every business needed a website, was a resounding yes, it’s not clear that everyone needs a voice skill. With 30,000 skills already available for Alexa, and new features coming online weekly, the irony is that the Alexa team sends a weekly newsletter to keep us up to date. So, even Alexa knows it’s a “Voice And” world.

Posted in: Behavior Change, 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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Digital Transformation in Pharma: Digital Pharma West

Like the rest of the healthcare industry, the pharma industry is also grappling with lots of data, disconnects from end-users, and shifting to a digital-first experience while grappling with ongoing regulatory and privacy challenges. Actually it’s pretty much what every industry is grappling with, so the good news is that no one is getting left behind in this digital revolution.

In pharma though, the division between commercial and R&D creates both delays and lags in implementing new technology and the regulatory challenges cause specific issues in communication with both providers and patients.

Last week, I was invited to speak at Digital Pharma West about our work in voice-enabling care plans for people with Type 2 diabetes, and also how our participation in the Alexa Diabetes Challenge enabled us to engage with pharma. It was my first ‘pharma-only’ conference, so it was interesting to contrast with the provider and healthcare IT world.

If you think that there are a lot of constituents who care about digital health in provider organizations, pharma rivals that. For example, there was a discussion about the value of patient-facing digital tools in clinical trials. While everyone agreed there could be real value in both efficiencies of collecting data, and engaging patients and keeping them enrolled in trials, a couple of real barriers came up.

First the question of the impact of the digital tools on the trial. Would they create an intended impact on the outcomes, for example a placebo effect? Depending on how the “usual care condition” is delivered in a control group, it might not even be possible to use digital tools in both cohorts, which could definitely impact outcomes.

Another challenge with digital technology in randomized control trials is that technology and interfaces can change much faster than drug clinical trials. Considering that elapsed time between Phase 1 and Phase 3 trials can be years, also consider that the technology that accompanies the drug could change dramatically during that period. Even technology companies that are not “moving fast and breaking things” may do hundreds of updates in that period.

Another challenge is that technology may advance or come on the market after the initial IRB is approved, and while the technology may be a perfect fit for the study, principle investigators are hesitant to mess with study design after IRB approval.

Interestingly, while in the patient-provider world the number of channels of communication are increasing significantly with mobile, texting, web, and voice options, the number of touch points in pharma is decreasing. Pharma’s touchpoints with providers are decreasing 10% per year. While some may say that this is good due to past overreach, it does make it difficult to reach one of their constituents.

At the same time, regulations on approved content for both providers and patients means that when content has had regulatory approval, like what you might find in brochures, on websites, and in commercials, the easiest thing to do is reuse this content. However, new delivery channels like chatbots and voice don’t lend themselves well to static marketing or information content. The costs of developing new experiences may be high but the costs of delivering content that is not context or end-user aware can be even higher.

At the same time, these real-time interactive experiences create new risks and responsibilities for adverse event reporting for organizations. Interestingly, as we talk with pharma companies about delivering interactive content through the new Wellpepper Marketplace, these concerns surface, and yet at the same time, when we ask the difference between a patient calling a 1-800 line with a problem and texting with a problem there doesn’t seem to be a difference. The only possible difference is a potential increase in adverse event reporting due to ease of reporting, which could cause problems in the short term, but in the long term seems both inevitable and like a win. Many of the discussions and sessions at the conference were about social media listening programs for both patient and provider feedback, so there is definitely a desire to get and make sense of more information.

Like everyone in healthcare, digital pharma also seems to be at an inflection point, and creativity thinking about audiences, channels, and how to meet people where they are and when you need them is key.

Posted in: Adherence, Clinical Research, Data Protection, Health Regulations, Healthcare Disruption, Healthcare Policy, Healthcare Research, Healthcare Social Media, Healthcare Technology, HIPAA, M-health, Outcomes, pharma, Voice

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The Challenge of Challenges: Determining When To Participate

There’s an explosion of innovation in healthcare and with that comes a plethora of incubators, accelerators, pitches, challenges, prizes, awards, and competitions. Trying to sort through which ones are worth paying attention to can be a full-time job. At Wellpepper we’ve tried to be selective about which ones we enter. A recent post by Sara Holoubeck, CEO and founder of Luminary Labs about the outcomes of challenges got me thinking about the cost/benefit analysis of entering challenges. Both costs and benefits come in hard and soft varieties.

If you want to be scientific, you can assign a score to each of the costs and the benefits, and use it to decide whether to throw your hat in the ring. (For the purposes of this blog post, we’ll use the term “challenge” to refer broadly to all of these opportunities.)

Costs

  • Time: How many hours will your team need to put into this challenge? How much of your team needs to be involved?
  • Focus: Does the focus on this challenge distract your team from core customer or revenue priorities?
  • Financial: Is there an entry fee to participate? What other costs, like travel, may you need to incur to deliver on the challenge?
  • Strategy: Is this challenge aligned with your
  • IP: Do you have to give up intellectual property rights as part of this challenge? Do you have to give away any confidential information that you are not yet ready to share publically?

Benefits

  • Financial: Is there prize money? Does it cover your expected costs? Could you actually profit from entering? If winner receives funding who decides the terms? Is this an organization that would be beneficial to have on your cap table?
  • Focus: Does this challenge provide the team with a forcing function to deliver innovation in an area that is aligned with your overall strategy?
  • Innovation: Does this challenge take your team in stretch direction or enable you to demonstrate a direction on your roadmap that you may otherwise not immediately approach due to market issues?
  • Publicity: Where will the winner be announced? Is there a PR strategy for the entire process or just the winner? Does it help your organization to be aligned with the content or sponsors of this challenge?
  • Introductions: Who will this challenge help you meet that can further your business goals?

It’s up to you to consider the cost/benefit analysis. Both may not have to be high, but when they are the opportunity can be high if you have the ability to put in the effort. You may also consider your chances of winning if it’s defined as a competition, and whether there is any drawback to losing, or if just participating provides enough benefit.

Here are a few examples from our own history that may help illustrate the tradeoffs.

Low cost/medium benefit

We entered a local pitch event for a national organization. The effort to pitch was minimal: we had case studies and examples that fit the thesis directly. The event was nearby and there was no cost to enter. The pitch was short. We won this pitch and got some local awareness and leads. However, when we were offered to go to the national conference and pitch for an even shorter period in a showcase heHIMSS Venture+ Winnersld simultaneously with other conference activities and with no actual competition, we declined as the cost/benefit was not there.

Medium cost/medium benefit

Each year HIMSS has a venture competition at the annual conference. We won this event in 2015, and received PR as well as in-kind benefits at HIMSS conferences including booth space. The effort to prepare was medium: any startup should be prepared for an onstage venture pitch, and the audience was exactly right. As a follow on from this event we’ve been involved in panels showcasing our progress.

High cost/migh benefit

Both the Mayo Clinic ThinkBIG challenge, and the Alexa Diabetes Challenge had a relatively high effort and opportunity cost to participate and high rewards, but both were aligned with directions our company had already embarked on, and both resulted in deeper connections for us with the sponsoring organizations, positive press, validation of our company and solution, and financial support.

In the case of the Mayo Clinic ThinkBIG challenge, we received investment on our convertible note for winning, and the challenge afforded us introductions to important clinical and IT contacts at Mayo Clinic. We were also able to showcase our solution to other potential customers live at the annual Transform event.

Our team put in a tremendous effort on our winning entry for the Alexa Diabetes Challenge but the pay-off was worth it in a number of ways. Certainly the prize money and publicity was welcome, but more importantly, we have created new IP and also come to a whole new understanding of how people can move through their daily lives with technology to support them in managing chronic conditions.

Both of these challenges have afforded us ongoing opportunities for engagement and awareness as a result our participation, and our positive outcomes.

One thing to note, none of these challenges I mention had an entry fee. Sometimes nominal entry fees are used to deter casual entries, but for the most part if a challenge is seeking to fund itself by charging the startups to participate, it’s the wrong model.

While you don’t have to be this explicit when making your decisions about entering a challenge, consideration of the costs and opportunity cost of either participating or not, can help you sort through the ever increasing number of grand challenges.

Posted in: Healthcare Disruption, Healthcare Technology, Healthcare transformation, Uncategorized, Voice

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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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Sidelined by mindlines?

Evidence-based medicine (EBM), a movement that emerged roughly 30 years ago, advocates for the use of current best evidence from high quality research studies in healthcare decision making. This logical and straightforward way of delivering healthcare often fails in modern day practice. One simple reason that clinicians cannot execute point of care decision making with EBM is due to the overwhelming volume of scientific evidence that is ever changing and available within severe time constraints. A more pervasive reason is found in the way clinicians practice and incorporate knowledge into their daily work – they tend to follow what ethnographers Gabbay and Le May have coined as mindlines: collectively reinforced, iterative, internalized, and tacit guidelines. Clinicians’ practice is primarily influenced by trusted colleagues, mediated by cultural and organizational features of their practices, and is constantly refined as knowledge-in-practice-in-context.

Through my own wandering through various clinical settings, I have often heard phrases from respected clinicians including “there is evidence…and then there is actual practice.” The five part concept of EBM appears intuitively important in a science-based profession – define the problem, search for sources of information, critically evaluate that information, apply the information to the patient encounter, and evaluate the efficacy of the application of that information for that specific patient. It seems that an exciting opportunity would be data analytics enhanced by artificial intelligence that could search high volume clinical research and identify patient-matching criteria in order to assist clinician judgment on relevant treatment protocols.

How much of this is naïve rationalism? Upon evaluating a typical clinical scenario, what I used to think was a clear set of facts in a one-dimensional reality is now more like an interaction of temporary realities of patients, clinicians, researchers, and guideline/policy makers. Mindlines are therefore:

  • More than intuition.
    Mindlines that clinicians abide by undergo a validation process despite being mainly tacit. They are built off of shared sense-making in the local settings of patient care, which leads to coherence and negotiation with real-time environmental influences. They provide for more accuracy than the reductionist tools and beliefs of EBM.
  • More patient centered.
    Mindlines allow for incorporation of valid knowledge to occur from the patient’s perspective, as opposed to the paternalistic model of clinician knowing all and only being able to derive more information from EBM.
  • Meaningful and effective.
    Mindlines are not very far off from the way typical high performers solve problems – they consciously and unconsciously adjust their frameworks through contextual experience, colleagues, and the physical world. EBM can negotiate with these frameworks, but likely can never replace them.

The paradigm of mindlines offers insight into the way clinicians practice and how western medicine operationally works in an environment with varying expectations from the patient and the overall industry where innovative work is being attempted. The secular trend for the future hopefully will be the risk-adjusted incorporation of EBM with assistance from artificial intelligence into the tacit world of clinical medicine.

Posted in: big data, Clinical Research, Research

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Dispatches from the Canadian E-Health Conference: The same but different

Bear statue in VancouverThe annual Canadian E-Health Conference was held in Vancouver, BC last week. I had the opportunity to speak about the work we’re doing at Wellpepper in applying machine learning to patient-generated data, and in particular the insights we’ve found from analyzing patient messages, and then applying a machine-learned classifier to alert clinicians when a patient message might indicate an adverse event. Our goal with the application of machine-learning to patient generated data is to help to scale care. Clinicians don’t need to be alerted every time a patient sends a message; however, we don’t want them to miss out if something is really important. If you’d like to learn more about our approach, get in touch.

My session was part of a broader session focused on ‘newer’ technologies like machine-learning and blockchain, and some of the other presenters and topics definitely highlighted key differences between the US and Canadian systems.

Aside from the obvious difference of Canada having universal healthcare, there were subtle differences at this conference as well. While the same words were used, for the most part: interoperability, usability, big data, and of course blockchain and AI, the applications were different and often the approach.

Interoperability: Universal doesn’t mean one

Each province has their own system, and they are not able to share data across provinces. Unlike the UK which has a universal patient identifier, your health records in Canada are specific to the province you live in. As well, apparently data location for health records is sometimes not just required to be in Canada, but in the actual province where you reside and receive care. As for interoperability, last we heard, British Columbia was doing a broad roll out of Cerner while large systems in Alberta were heading towards EPIC, so Canada may see the same interoperability challenges we see here if people move between provinces.

Privacy: The government is okay, the US is not

What’s interesting is as a US company, is that whenever we talk to health systems in Canada they bring up this requirement, but as soon as you mention that the PIPEDA requirements enable patients and consumers to give an okay for out of Canada data location they agree that it’s possible. Regardless, everyone would rather see the data in Canada.

What was possibly the most striking example of a difference in privacy was from one of my co-presenters in the future technologies session, who presented on a study of homeless people’s acceptance of iris scanning for identification. 190 out of 200 people asked were willing to have their irises scanned as a means of identification. This identification would help them access social services, and healthcare in particular. The presenter, Cheryl Forchuk from the Lawson Health Research Institute said that the people who participated didn’t like to carry wallets as it was a theft target, that they associated fingerprinting with the criminal justice system, and that facial identification was often inaccurate due to changes that diet and other street conditions can make. When I tweeted the 95% acceptance rate stat there were a few incredulous responses, but at the same time, when you understand some of the justifications, it makes sense. Plus, in general Canadians have a favorable view of the government. The presenter did note that a few people thought the iris scan would also be a free eye exam, so there may have been some confusion about the purpose. Regardless, I’m not sure this type of identification would play out the same way in the US.

Reimbursement: It happens, just don’t talk about it

The word you didn’t hear very much was reimbursement or when you did, from a US speaker the audience looked a bit uncomfortable. The funny thing is though, that physicians have billing codes in Canada as well. It’s just that they are less concerned about maximizing billing versus being paid for the treatment provided and sometimes even dissuading people from over-using the system. Budgets were discussed though, and the sad truth that money is not always smartly applied in the system, and in a budget-based system, saving money may decrease someone’s future budget.

Blockchain: It’s not about currency

Probably the biggest difference with respect to Blockchain was the application, and that it was being touted by an academic researcher not a vendor. Edward Brown, PhD from Memorial University suggested that Blockchain (but not ethereum based as it’s too expensive) would be a good way to determine consent to a patient’s record. In many US conferences this is also a topic, but the most common application is on sharing payer coverage information. Not surprisingly this example didn’t come up at all. If you consider that even though it is a distributed ledger, a wide scale rollout of Blockchain capabilities for either identification or access might be more likely to come from a system with a single payer. (That said, remember that Canada does not have a single payer, each province has its own system, even if there is federal funding for healthcare.)

“E” HR

Physician use of portalFor many of the session the “E” in e-health stood for EHR, which while also true in the US, the rollout of wide scale EHRs is still not as advanced. Cerner and EPIC in particular have only just started to make inroads in Canada, where the a telecommunications company is actually the largest EHR vendor. In one session I attended, the presenter had done analysis of physician usage of a portal that provided access to patient labs and records, but they had not rolled out, what he was calling a “transactional” EHR system. Physicians mostly accessed patient history and labs, and felt that if the portal had prescribing information it would be perfect. Interesting to see this level of access and usage, but the claim that they didn’t have an EHR. What was also interesting about this study is that it was conducted by a physician within a health system rather than an academic researcher. It seemed like there was more appetite and funding for this type of work within systems themselves.

Other Voices: Patients!

Patients on the mainstageDuring the interlude between the presentations and judging for the well-attended Hacking Health finals, and on the main stage, presenters interviewed two advocate patients. While they said this was the first time they’d done it, both patients had been at the conference for years. So while the mainstage was new, patient presence was not, and patient advocate and blogger Annette McKinnon pushed attendees to go further when seeking out engaged patients. Noting that retirees are more likely to have the time to participate in events she asked that they make sure to seek out opinions for more than 60 year old white women.

There was also an entire track dedicated to First Nations Healthcare. Think of the First Nations Health authority as a VA for the indigenous people of Canada, which incorporates cultural differences and traditional practices of the First Nations people. The track started and concluded with an Elder song and prayer.

Manels

Speaking of diversity, I didn’t witness any manels.

Best Quote

 

Posted in: big data, Clinical Research, Health Regulations, Healthcare Disruption, Healthcare Research, Healthcare Technology, Healthcare transformation, Interoperability, M-health, patient-generated data

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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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Wellpepper now an Amazon Partner Network Advanced Technology Partner

Wellpepper is pleased to announce that we are now an AWS Advanced Technology partner!

When we started Wellpepper in 2012, we evaluated a list of hosting options. We looked at availability and durability guarantees, the breadth of service offerings, how deeply the provider was investing in their cloud offerings, and their expertise and compliance with healthcare requirements.

AWS was clearly at the head of the pack in their cloud investment, and had the most believable availability and durability guarantees. Over the last 5 years, this has proven true – AWS has been a rock solid platform for us. But what’s really been incredible is to watch how fast AWS has broadened their service offerings (many new useful platform-as-a-service tools), and pulled many of these under the HIPAA-eligible service umbrella.

Our software architecture has evolved over time. We have always relied heavily on EC2 instances and S3 for bulk object storage, and we still do. We have also started using services like Lambda for some of the newer parts of our platform. We also rely heavily on AWS services like CloudWatch for monitoring and logging, CloudTrail for auditing, and CodeDeploy to deploy services automatically. We did a little video about our architecture with the AWS Startups team last year if you want to know more.

As Advanced Tier partners, we’re looking forward to delivering the Wellpepper patient engagement platform through the AWS marketplace, in addition to selling directly.

Posted in: Healthcare Technology

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

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

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

“You’re late to the party.”

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

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

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

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

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

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

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

Until next year’s party, cheers!

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

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

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Mayo Clinic Care Plans to be available on the Wellpepper patient engagement platform

PR Newswire release

Las Vegas, Nevada, March 5, 2018 – Mayo Clinic Global Business Solutions and Wellpepper, Inc. announced today that Mayo Clinic will be providing best practices for interactive care plans on the Wellpepper platform. Wellpepper is a clinically-validated patient engagement platform used by major health systems to improve outcomes and lower costs of care.

Wellpepper customers who use any electronic health record will be able to use Mayo Clinic care plan protocols to help patients follow their physicians’ instructions outside the clinic to self-manage and improve their outcomes.

Mayo Clinic Care Plans will be available through Wellpepper Marketplace, which launches later in the second quarter of 2018. Mayo Clinic Care Plans initially will be available to cardiac rehabilitation, headache and sports medicine patients. The care plans eventually will encompass hundreds of patient interventions showcasing the breadth of Mayo Clinic expertise.

“Wellpepper and Mayo Clinic share a continuous commitment to providing care that ultimately benefits patients,” says Steve Ommen, M.D., interim medical director of  Mayo Clinic Global Business Solutions. “We look forward to the opportunity to share our best practices with other health systems through the Wellpepper platform.”

Wellpepper’s interactive care plans are based on a framework of building blocks that support creating any type of patient instructions. Wellpepper patients are more than 70 percent engaged in their care plans, and control trials conducted by researchers at Boston University and Harvard University show clinically meaningful patient outcomes for patients using the Wellpepper platform.

“We are thrilled to launch the Wellpepper Marketplace starting with one of the leading academic medical centers in the world,” said Wellpepper CEO Anne Weiler. “Our customers and their patients will benefit immensely from access to Mayo Clinic best practices. Analysis of patient experience and outcomes from these care plans will enable continual improvement and new insights to deliver better care.”

The Wellpepper Marketplace will offer health systems the choice of best practice care plan templates from leading health systems and Wellpepper’s out-of-the-box care plan templates. These turnkey solutions will enable quick deployment of evidence-based and clinically-validated care plans to improve patient outcomes.

About Wellpepper 
Wellpepper is a health care technology company with an award-winning and clinically-validated patient engagement platform used by major health systems to improve outcomes and lower costs of care. Wellpepper treatment plans can be customized for each health system’s own protocols and best practices, and personalized for each patient. Wellpepper’s patented adaptive notification system helps drive over 70 percent patient engagement with treatment plans. Wellpepper was founded in 2012 to help healthcare organizations lower costs, improve outcomes and improve patient satisfaction. The company is headquartered in Seattle, Washington.

Media contacts:

Jennifer Allen Newton, Wellpepper, (503)-805-7540, jennifer@bluehousecg.com

Rhoda Madson, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

Posted in: Press Release

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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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Alexa, Get Well Soon

The unofficial winner of the Super Bowl ad race this year was “Alexa Loses Her Voice”, an ad that shows celebrities subbing for Alexa when she (anthropomorphic being that she is, comes down with a cold). Both USA Today and YouTube are calling it the most watched ad.

Alexa, who won USA TODAY’s 30th Ad Meter?

“Well, um – me.”

Jeff Bezos looks skeptical that his team can replace Alexa as he should be, since their solution of Gordon Ramsay, CardiB, Rebel Wilson, and Anthony Hopkins is both extremely expensive, (Wellppper CTO Mike Van Snellenberg did the math), and breaks the key trust relationship that people have with Alexa.

Voice is a natural interface, and empathy can be quickly established by the types of utterances and engagement. By default, Alexa apologizes when she doesn’t understand something and it feels genuine. Compare that to Gordon Ramsay insulting his poor hapless user—all the guy wants is a bit of help making some comfort food. What he gets is abuse.

Or, the woman who wants Alexa’s help while she’s in her boudoir presumably getting ready for a date with her love. Instead, Anthony Hopkins insinuates that something horrific has happened to her beau possibly involving a pet peacock.

Cardi B insults a young man’s interest in Mars. Let’s hope she has not squashed his spirit of discovery and his desire to ask questions.

Since this is an all-ages blog, we won’t even mention the response Rebel Wilson gives from her bubble bath to the poor gentleman who asked Alexa to set the mood for a party. He and everyone at his party were fully traumatized.

We get it, Alexa is just better at delivering what people are asking for than real people. Especially real people with attitude like these celebrities.

As we found in our research with people with type 2 diabetes, Alexa has a natural ability that these celebrity Alexa impersonators do not. You can see it in this feedback we received from real people trying to manage Type 2 diabetes.

  • “Voice gives the feeling someone cares. Nudges you in the right direction”
  • “Instructions and voice were very calm, and clear, and easy to understand”

Voice is a natural fit to deliver empathy and care. However, since each one of these people is expecting Alexa, and has no visual indicator that anything has changed, the negative experiences will reflect on Alexa and she’ll have to win back their trust.

While the implied message of the ad spot is that Alexa does a better job of delivering on your needs than any of these celebrity experts we’re still feeling a bit traumatized by the abuse they hurled. For the sequel to this commercial, we’d expect to see Jeff firing the team that replaced Alexa with celebrities, and Alexa as a therapist working through the trust issues that her replacements created. She can do it. We believe in her.

Posted in: Behavior Change, Healthcare Disruption, Healthcare Technology, Voice

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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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