Facebook CEO, Mark Zuckerberg, introduced a new Facebook version of an Android phone this past week. The theme of his introduction—the first phone to be organized around people, not apps.
While I am not going to be the first to run out and endorse this new product with any of my hard cash, I do think he got something right. Our tolerance for “app count” has probably reached its limit. As the number of apps for either Android phones or iPhones now reaches into the hundreds of thousands, I am sure that our ability to assimilate more than a half dozen apps into our daily stream of life has already been reached.
However, I am confident that the whole notion of a phone experience that is organized around “you” certainly has some “legs.” It also has some direct relevance for those of us who are designing applications for patients and customers in the social media era. Putting the individual at the center of the experience is the right place to start if our aim is to have patients engage with their care plans and prioritize the actions that we ask of them.
So where do we start, assuming we don’t have the multi-million dollar marketing budget that Mr. Zuckerberg has at his disposal. First, we need to remember that the patient world is largely centered around the doctor and the healthcare provider that works on his/her behalf. All of our applications must incorporate information from the EMR systems that record doctor plans and prescriptions for care. Health applications that do not integrate with available information won’t cut it with our customers who will quickly understand that your information is irrelevant.
Incorporating information from remote monitoring solutions is another big step. The current generation of listening devices put the patient at the center of the care process in a very literal way. Monitoring collects information in a near real-time basis and uses it to communicate to a health care organization which can use the information for better care. It also lets patients know that their body is communicating directly to a system that is putting that data to use on their behalf.
The Facebook Home concept also challenges those of us in the mHealth space to remember the social nature of the individuals who use our engagement solutions. Facebook users spend an average of over 6 hours a month tapped into the world’s most popular social network. While patient’s will never engage in our applications with the same fervor, we certainly can use the incredible drive of individuals to be social on our own behalf. Encouraging individuals to connect with their family and other connections to reinforce the regularity of care can be a major force on our behalf.
The just completed ACC (American College of Cardiology) conference in San Francisco provided insight into many new and exciting treatments for a wide variety of cardiac diseases. Because of our interest at Preventice in diseases relating to heart rhythm, several studies on drugs that treat this disease (or at least the symptoms of the disease) were particularly interesting.
Representatives from Boeringer-Ingelheim discussed results of a major study that showed that Pradaxa was significantly better at reducing the risk of ischemic stroke while avoiding any meaningful increase in hemorrhagic stroke when compared to warfarin. Pradaxa has been on the market for several years and it continues toestablish itself as a market leader. Another new drug for Afib, Eliqus, was just released to market by Bristol Meyer Squibb. Eliqus promises to reduce symptoms and actual occurrence of heart arrhythmias.
But one other study caught my attention—and not because it talked about something new, but because of what it had to say about something quite old—heart disease in ancient Egyptians. A study by xyz used a CT scan to examine 137 mummies that were believed to have dated back to about 5,000 years before the present time. They found that individuals, whether they came from privilege or from common folk, contained extensive evidence of cardiovascular disease.
So the ultimate question is whether or not new drugs, devices, and emerging technologies such as remote monitoring can begin to cure diseases that have plagued the human race prior to the onset of civilization. In some way, we struggle simply to keep up with the negative consequences of technology and affluence. New treatments must overcome the impact of modern society on our heart and health in general.
But I remain optimistic that we are winning the race and that patients will benefit from the emerging technologies that were in fulldisplay at ACC
The Mobile World Congress is purportedly the second largest technology conference in the world. It certainly appears to be the most bullish about the future of a connected human race.
It’s a blur of technologies and acronyms. Trying to sort out the relevance of LTE, NFC, IP Backhaul and a handful of other new standards is a challenge to industry veterans. One thing is certain- the mobile industry is prepared to move data more places, faster and with a higher level of security than it did last year.
But a couple of human statistics really stood out. First, 400 million more people have access to a mobile phone than they do to electricity. Second, we expect to connect another billion humans to the mobile cloud in the next 3 years. I am sure that the gap between access to electricity and the phone network will only widen.
The human side of mobile health is equally apparent here as well. Much of our focus at Preventice is on the industrialized world where people can already afford a high level of health care. Remote monitoring solutions will further increase their quality of life and provide peace of mind that, should something happen; a doctor will know that immediate action is required.
Mobile health has the potential to bring high levels of care to billions of people that previously had no access to care. Visionary individuals talked to us about plans to use mobile technology to deliver care to tens of thousands of villages across central Africa and rural India. Rather than providing individuals with a smartphone, the plan is to provide the village with a phone that can in turn connect an entire community to high levels of care. In this model, one trained medical technician can serve a large community. When extra expertise is required, information can be sent to a doctor that might reside elsewhere in the country or somewhere else in the world.
Previous waves of technology dating back to the printing press and railroad added to the range of life experiences that were available to each individual. Mobility has begun to realize its potential as the first wave of technology that fundamentally transforms how the human race lives and works with each other. Ultimately, health care will transform itself as well.
Spending on construction for health care peaked in 2009 at just over $48 billion dollars. That number fell dramatically in 2010 to about $40 billion dollars and has remained relatively constant over the past two years. Of course this drop was largely driven by the Great Recession, which hammered capital improvements of all types. Our country has largely paused in its march to build any type of infrastructure and healthcare building is just part of the avalanche caused by decreased demand.
However, demand for all types of health care services continue to increase as people grow older and their dependence on the medical delivery system marches inexorably northward. One can only assume that at some point we will need to build more hospitals and clinics as people grow older and inevitably, more dependent on the services of the health care industry.
However, building more hospitals and clinics is not the only answer. One way that we can support increased demand for health care services is to simply convert in person care to distributed care. Clinics are showing up at Walgreens, Target, and Walmart. This type of substitution will continue to enable a shift in how and where individuals receive care.
Another option is to replace medical care with automated systems like the IBM Watson technology to reach patients with less direct medical involvement. Watson, most well known for winning a Jeopardy match against an all-star team of ex champions, has now been programmed to move into the medical sphere. Eventually, whether at a remote clinic or even over the Internet, Watson will offer highly accurate diagnostic services that may ultimately rival and perhaps even exceed the acumen of many general practitioners who likely lack deep expertise on every symptom known to mankind.
While replacing the medical professional is one way to reduce the number of hospital and clinics that have to be built, another strategy is to extend the ability of doctors to reach many more patients. In this way, technology serves as a multiplier, not a replacement for the care and expertise of a doctor. Patient engagement technology extends the ability of doctors to reach many more individuals without actually requiring one to one in person encounters.
Using patient engagement technology, doctors can create rules that align treatment to data that is gathered from the individual and processed through rules that the doctor has carefully created for a large group of patients that are under common care. In this fashion, a one to many relationship is far superior to a one to one interaction that requires far more medical personnel than we have available today.
Ultimately, this one-to-many paradigm may become the most effective way to deliver care. While it will not preclude the need for more buildings and care facilities, it may continue to “bend the curve” downward and allow many more patients to receive a higher quality of care than can be achieved with simply replacing medical professionals with stand alone technology.
This past week, I have seen a couple of research pieces on the emerging threats to our mental health brought about by our ever increasing engagement with the online world. First, a study documented the prevalence of Facebook envy amongst on-line users. While this is something I joke about with friends whenever I return from some international travel, I never thought about just how serious it can be. Apparently looking at photos of other people’s smiling kids can cause some serious mental health damage to a large part of the populace.
But researchers have now begun to understand that Facebook envy can really impact people’s lives. The investigaors looked at 600 individuals who were actively engaged with Facebook and sure enough, many of them reported that life satisfaction was significantly impacted by their social networking experience. (Maybe they own stock in Facebook as well!) Their conclusion—Facebook is an inherently stressful environment. Apparently, arguing about religion, politics, and work is not the best way to calm your nerves (either at work or at home). For anyone interested, you can read more here.
A few days later, research came out that documented the phenomenon now referred to as cyberchondria. A recent study by the Pew Research Center revealed that 59% of adults have reported going on-line to gather information about their own personal health. Of course, this is not a bad thing, but increasingly, online information can become a source of obsession and anxiety.
A recent story on CBS This Morning interviewed psychiatrist Janet Taylor who is an expert on this type of situation. She commented about the afflicted: “They look for self treatment and they don’t go in and see their doctor or they go in and see their doctor too much and the fact is, they don’t have anything diagnosable.”
As an evangelist for mHealth and remote monitoring technologies, I always think of increased engagement as a good thing. But do we run a risk of creating an entire generation of cyberchondriacs? Could it be that having a device attached to your chest or wrist will cause patients to take significant risks that they should not take? Hopefully not, but the laws of unintended consequences should always be considered. Will remote patient monitoring be the final tipping point in our obsession about our own health.
It is highly unlikely that patients who wear some type of monitoring device will ever become the subject of device envy. More likely, increased usage of these devices will become routine and accepted. Just this past week I talked with a co-worker who had been prescribed a cardiac monitoring device because of a stroke that he had had last month.
Having said that, cyberchondria does seem like a legimate concern. We must always remember that monitoring devices and engagement solutions are extensions of the doctor’s conversation with the patient. They should never replace that interaction. By always having that central principle in front of us, we will not go wrong in how we interact with patients.
Data Privacy and mHealth are not naturally coexistent. Data Privacy in general, refers to the collection; storage and usage of data, often personally identifiable, such that if used improperly could cause financial or reputational harm to an individual. The sheer amount of data that can be collected from a device or application is mind-boggling. Much of this data can be extremely useful in determining a patient's behavior and compliance to their care plan, monitoring for disease related trigger events, trending for possible disease states, prevention and above all, life saving. The data can actually provide a doctor with a view into the patient's behavior and the possible stimuli that may produce an event, thus bridging the gap between the truth and the patient's comments to the doctor. Data can help paint a clearer picture of a patient's condition when utilized properly.
mHealth medical devices and applications can provide millions of pieces of data very quickly. Application developers often see data as point of purchase type collection of raw data that can be shared and used with just about anyone. Unfortunately, healthcare data is different from other types of data collected like purchases at the grocery store, driving habits and history, claims data from property insurers, etc. Healthcare data must be kept private and secure during its entire lifecycle. It must be controlled, validated, secured and made available to a patient upon request. Plus, the "holder" of the data must be able to prove that they have policies and procedures in place, and that they are following them in order to maintain the privacy and security of the data in their possession and that they share. This is where HIPAA comes in. Under HIPAA providers must regularly disclose privacy practices to patients, and parties must also disclose information to the Department of Health and Human Services if they’re under investigation. In addition, it gives patients the rights to their records, and that has always been the most important aspect.
The patient is the driver of how their health care data, known as Protected Health Information (PHI), is shared, used and disclosed for any purpose other than for their treatment, payment to the provider or other specific uses in healthcare operations (aka TPO). Protected health information (PHI) is defined as individually identifiable health information transmitted or maintained by a covered entity or its business associates in any form or medium (45 CFR 160.103). PHI can be a confusing concept for some. For example, a name or address by itself is not considered PHI; but, when it is combined with a visit, a diagnosis code, a medical device serial number, claims data or other piece of information, it becomes PHI and falls under the protection of the HIPAA and HITECH Privacy and Security regulations, among other Country specific, federal and state regulations.
If data is to be used for anything other than the standard purposes of "TPO", or other reason for which the patient has given clear consent in writing, then the data must be must be completely de-identified by removing 18 defined pieces of information before sharing. New guidance under HIPAA was just issued last week and can be found here.
Entities sharing healthcare data must be able to account for the disclosures and the subject of the data has a right to request a log accounting for the disclosures. Time frames for maintaining the accounting were adjusted under the HITECH act. If an entity uses an electronic medical record, the accounting must be for 3 years.
Of particular note under the HITECH Act is the new Breach Disclosure Rule. The regulations, developed by OCR, require health care providers and other HIPAA covered entities to promptly notify affected individuals of a breach, as well as the HHS Secretary and the media in cases where a breach affects more than 500 individuals. Breaches affecting fewer than 500 individuals should be reported to the HHS Secretary on an annual basis. The regulations also require business associates of covered entities to notify the covered entity of breaches at or by the business associate. There are specific time frames and methodologies in the handling of a breach of unprotected PHI depending on the number of data subjects possible, involved. A clear understanding of responsibility is necessary to provide the correct response. Everyone involved in the use, processing, storing, collection or sharing of healthcare information bears responsibility. Extreme fines have been issued for noncompliance. Data breaches can now cost companies up to $250,000 or more in some cases.
A new round of regulation known as the Omnibus Rule should be released soon. It gets complicated but it is safe to say that the bar on Privacy and Security in general will be raised. With the implementation of electronic medical records, mHealth, personal health records, new devices and applications, and the subsequent sharing of data electronically using new tools and E-reports, technology has exceeded the grasp of the regulations in a very short time. The new regulations will be a start in defining and regulating the data as we move forward.
Its quite ironic that the things that are good for our health are most often the things that are of least interest to us,or in some cases, require that extra bit of effort that a lot of us don’t have the time or motivation for. For example-- medicine is never sweet, but it is there to help you recover. Similarly, staying fit and exercising takes a lot of push and effort, but it proves to be worthwhile in the long run. This begs the question: can technology help bridge this motivational gap?
Over the past few years, we have seen how mHealth technology has become an integral part of the health care ecosystem. Even sports giants like Nike and Adidas have jumped into this mix with remote devices programmed to track everything from the speed, distance, time, heart rate and water levels. Most people would call this a Brand extension, simply another offering for their loyal customers. However, the underlying picture in this, is the fact that the Nike’s and Adidas of the world are realizing what Healthcare companies have been focusing on for a long time now. They have realized that the most important thing is to keep people engaged and healthy and help them lead healthier lives and prevent illness, sports professionals or not. At the end of the day all businesses are here to make profits, that’s not something we can deny, but that does not mean that we cannot do so while promoting a better lifestyle for our customers. Call it a win-win situation if you will, for both sides.
I've had the opportunity to work on a variety of health programs that are intended to change health behavior. It is interesting to see first hand the impact that coupling behavioral science and motivational factors with the right delivery technologies could have on the problem.
Organizations and individuals have come to understand just how effectively goal setting can drive major behavioral change. Most of the goals we set don’t materialize because we don’t give it enough shape. This is where a concept like SMART can help provide us with meaningful direction. SMART is an acronym for Specific, Measurable, Attainable, Realistic and Timely goals. While technology is generally used to drive efficiency, it can also guide individuals through a process:
- Specific – Goals should have very discrete and attainable outcomes. A generic goal like “I want to lose weight” doesn’t do a lot to bring about the desired change. A goal like “I want to lose say 20 Pounds”, is more specific and actionable.
- Measureable – Every goal must be capable of being measured. Weight can be easily measured using a weight scale and running can be measured using distance and speed, which is now possible with smart phones. More sophisticated devices such as ECG monitors can help a participant be more specific.
Now, I’m going to break the order of SMART and explain Realistic goals and Timely goals before explaining Attainable goals.
- Realistic – Goals must be achievable with the available resources. A patient or consumer must choose goals accordingly to their own limitations.
- Timely –Goals need to be achieved according to a specific schedule. Incremental approaches work particularly well. A good approach would be to decide to lose say 1 or 2 pounds every week for a 10-week period as opposed to 20 pounds in 3 months. Setting clear start and end points are important. Linking these discrete time periods together is also important. Having the next set of goals after the first are achieved is also important.
- Attainable - This is one area that could completely affect the accomplishment of goals over and above the rest, which is why we dedicate this paragraph to it. Motivation is a huge factor when it comes to achieving set goals, especially if it requires consumers to break out of their cycle and push themselves to a better tomorrow. The key word here is rewards. Rewards give people an added incentive to work for something.Careful thought into the research around intrinsic rewards verses extrinsic rewards is important and perhaps worthy of a future blog post. Extrinsic-rewards can serve an important role and provide for a short-term boost. Though research has shown intrinsic rewards tend to lead to longer-term, ongoing results and technology has the opportunity to formalize a person’s individualized reward system. The combination of the two becomes real interesting.
If we can help patients and consumers choose a SMART goal, we can facilitate powerful behavioral change.The inclusion of all this is the key to getting people to lead the path to a better lifestyle and stay changed and motivated to maintain that lifestyle for a better tomorrow. And the icing on the cake is the fact that we have the power to do all of this, at the palm of our hands.
I would like to know what you, the readers, think about this. If you have any comments, view points or suggestions, please feel free to drop a comment in the section below.
Human civilization faces an enormous challenge of dealing with the cost of Health care. Brought on by changing demographics and high risk lifestyles, the problem looms like a giant fireball on the not so distant future.
At the just completed mHealth Conference, one of the keynote speakers, Mark Bartoloni, the CEO of Aetna, spoke about the enormity of the challenge and the opportunities to address the issue.
We all know some of the key statistics in this battle. And the war plays out every day this month as we confront the need to “bend the cost curve” or face major changes to our lives in the future. Perhaps for the first time, the reality of the need to cut entitlements while still having to provide for basic health care services, is coming into focus for us.
Of course, everyone knows that the ideal solution is to avoid major cuts and finding ways to cut waste is definitely the preferred path forward. And there is hope and opportunity. Mr Bartoloni pointed out that 75% of our national debt is now directly attributable to health care. As a result, small changes in health care efficiency can make an enormous impact on our fiscal challenges. The elimination of waste could effectively eliminate the battle over the fiscal cliff, another “waste” that we would be better off without. Over the long term, savings gained from improved health care efficiency could equal half of what is proposed in the Simpson Bowles deficit reduction plan. This is something that, surely both political parties could agree to.
The other major opportunity relates to waists and the numbers here are perhaps even more astounding. We are now at a point where half of the cost of health care in the developed world relate to medical situations associated with weight and exercise. While the bell weather marker of weight control is Type 2 diabetes, nearly all of the top ten most costly medical conditions are made worse due to poor weight management. Fortunately companies are realizing this opportunity and we can now see a dozen or more mobile applications out in the market that help people keep track of their weight, their calorie intake, what to eat, what not to eat or even the number of calories burnt by doing indoor and outdoor daily activities. Some of the the more well known applications out of these are Noom Weight Loss, My Net Diary, Fooducate and Noom Cardio Trainer.
Mobile health is a potential answer to dealing with both waste and waists. Today, one in three individuals have access to a mobile phone. For better or worse, more people have access to their phone than clean water and a variety of other necessities. By comparison, patients outnumber doctors in the developing world by250,000 to 1. Already 1 of every 3 individuals who has a phone, has used it to solve a health care need. Given the number of emerging technologies that were showcased at the mHealth conference, the opportunities for patients and consumers to use their phones will skyrocket in the years ahead.
All of us in mHealth are learning about how to change and mold consumer behavior. mHealth applications are now connecting to provider EMR systems and payer databases that dramatically improve the quality and effectiveness of the experience delivered to the user. A new generation of devices such as the Preventice BodyGuardian™ remote monitoring solution will allow patients to go about their lives, where previously they may well have spent days in the hospital and at the same time it will also help cut costs. Given that 5% of patients account for nearly 50% of health care costs (and many of the 5% were put in that position by lifestyle decisions), the opportunity to make a big impact is enormous.
As always, I'd like to read what you have to say. Please feel free to leave your comments and view points in the comment section below.
As usual, the annual Medica event in Dusseldorf Germany served up the world’s largest aggregation of medical technology, products, and services. While rapidly growing in size and influence, digital health still represents a small portion of this illustrious event.
As a pioneer in this new movement, we see our success predicated upon bridging the digital divide between the world of medicine and the world of digital systems. On the medical side of the divide we must adhere to regulations (on a country or regional basis), execute clinical trials that establish the ability of our products to deliver a measurable clinical outcome, and encourage doctor's acceptance of our products. This is because, ultimately, our success relies on a physician or health care specialist to prescribe our solution.
On the digital side of the divide, we must still live and execute according to the physics of digital systems. Our products must protect data and privacy, they must function in a highly reliable fashion, and they must integrate with the core systems such as EMRs, care management, and pharmacy databases.
People on both sides of this divide have different backgrounds, different experience bases, and even speak different languages. Digital “folks” are comfortable talking about cloud technology, HL7, HIPAA compliance and services oriented architecture. While all of these concepts and terms are table steaks at a discussion amongst digital professionals, they are foreign and even annoying to those who practice medicine.
But in spite of these cultural and professional barriers, the closing of this divide is necessary for the digital movement to succeed. Here are some of the keys for the world of digital health, mHealth, and remote patient monitoring to move to the mainstream -
- First, medicine represents the “home team” in this coming together. While we may attend a mHealth conference and delude ourselves into thinking that this is all about us, it is not. Two hours at the Medica conference will give any digital health executive a good lesson on the relative importance of mobile technology in the world of medicine. It is therefore incumbent upon us to learn the norms of the buyers of health care products and services.
- Second, successful and well-executed clinical trials are the key to crossing the digital divide. Of course, trials document the clinical effectiveness of the technologies that we bring to market. But they also represent the single best opportunity to understand how new cures fit into the clinical workflow of doctors, nurses, and other practitioners. If digital solutions impose significant new work demands on these professionals, they are likely to face significant user adoption challenges, even if they improve patient outcomes and reduce costs. Small refinements can make dramatic improvements in the fit of digital technology into a workflow.
While digital health solutions will make continued inroads into the health care landscape in the years ahead, leaders must understand the realities of making these products part of the main stream. While much effort continues to be made on the effectiveness of the technology, equal effort must be made to merge into the mainstream of the core practice of medicine. Digital technology will transform medicine in the same way that it has changed photography, communications, and payments. Strong leadership can make this happen much sooner rather than later.
This is the final blog entry in a five-part series associated to a recent Preventice webinar focused on helping Accountable Care Organizations (ACO’s) overcome some of their key challenges through the use of effective mobile health solutions. If you didn’t get a chance to attend, you can view the on-demand webinar here, or you can read the most recent blog entry for this series here. This entry covers the last strategy discussed on the webinar of how ACO’s can overcome their primary challenges through mobile health solutions.
As humans, we have an innate need for community and the exchange of information and knowledge with others. For patients dealing with chronic disease or persistent health issues, these basic needs often become even stronger. It is through both family and social networks that these needs can be met.
While some healthcare providers realize the importance of involving a patient’s family and social circles as active participants with that patient’s care, many supposedly “patient-focused” solutions fail to foster those connections.
Mobile health solutions are in a prime position to change that. In a world where even Grandma is using an iPhone or signing up for a Facebook account to keep track of her grandkids, the family and social connections of a given patient are more “wired” than ever before.
This enables two primary scenarios we’ll cover in more detail:
- Connecting patients to their care team, family, and social networks
- Enabling real-time coaching and feedback
Connecting Patients to Their Care team, Family, and Social Networks
Mobile health solutions represent a great opportunity to involve a community of individuals to participate with and encourage a patient through their care plan or recovery. That could be anyone from the family doctor to the patient’s children to the neighbor across the street.
Mobile health solutions are a natural medium for helping patients connect to these individuals. Consider for example,
- The large number of consumer mobile devices (many with high resolution cameras and video chat capabilities) that are in the market today
- The plethora of burgeoning social networks that many individuals already participate in
- The numerous ways which people can communicate today from SMS to email to instant messaging and more
Mobile health solutions have the ability to incorporate ALL of these trends within the context of a patient’s care plan, enabling them to connect, collaborate, and communicate with others around their health in engaging and effective ways.
Enabling Real-time Coaching and Feedback
With mobile health solutions and remote sensors that can track essentially any detail about a patient’s health and behaviors, it is entirely possible to provide others with secure, role-based access to information that may help them keep the patient healthy and engaged.
With options from personalized alerts to custom reminders for example, individuals are empowered to provide real-time coaching or feedback to patients as soon as a troubling sign or trend appears.
Mobile health solutions can facilitate coaching or feedback to patients from family or social networks where applicable, they can be directed by and funneled through the healthcare professional, or in some cases the coaching and feedback may even be automated based on the implementation of a workflow rules engine and proven clinical protocols (something previously discussed in this blog entry).
Connecting to patients is a two-way street of course. Giving patients tools that help them communicate with those in their care community is equally important. For example, providing a simple interface for a patient to submit a non-critical question to his or her care team can increase the patient’s understanding while fostering a stronger relationship between provider and patient.
Likewise, connecting a heart disease patient to an established social community full of other patients suffering from the same disease can help that individual feel less isolated and enable them to give or receive support and feedback from a broader yet related audience.
Through the intelligent integration of social features into mobile health applications, providers can better arm patients to deal with their care through the additional support of the community that surrounds them. This helps engage patients with their care plan process, a key ingredient to help solve the big challenges of improving outcomes while reducing costs.