Navigating Healthcare – Patient Safety and Personal Healthcare Management

May the Fourth be With You

It’s the artificial holiday that celebrates the play on words from Star Wars movies – a rallying cry

The list of suggested actions from the Starwars site may not be to everyone’s taste and includes everything from

  • Holding movie marathons
  • Dress up as a Star Wars Character
  • Star wars food including blue milk!
  • Getting a Star Wars Tattoo

 

But this year I follow Yoda’s advice:

“Pass on what you have learned”

Specialty Pharmacy

This year I attended the Asembia Specialty Pharmacy Summit held this time each year in Vegas at the Wynn/Encore resort. This is the largest conference for specialty pharmacy but as Alex Fine noted and I agreed –

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All pharmacy is moving rapidly in the direction of specialty as we head into a world filled with precision medicine customized to the individual. On the one hand, this is an exciting proposition – at least to me. I am always reminded of the great scene in Monty Python’s Life of Brian

You are all individuals…..we are but medicine has not treated us that way. Historically the path to understanding disease was based on grouping patients, diseases, signs, and symptoms into logical groups that helped decode underlying cases of a disease.Just think of the seminal work of Louis Pasteur and Robert Koch who established the germ theory of disease and the resulting incredible advance in outcomes that derived from that block of work when Joseph Lister published in 1867 his Antiseptic Principle of the Practice of Surgery (met by substantial skepticism and took years to be widely accepted and adopted). This was just the start as we came to understand causative agents behind diseases that had vexed the profession. Treating someone with an infection with Penicillin thanks to Alexander Fleming’s work in 1928 was just one of many advances that grouped patients based on similarities of their disease. This methodology has served us well but the sequencing of the human genome- completed in Jun 2000 would have a big impact on this thinking.

Just think of the seminal work of Louis Pasteur and Robert Koch who established the germ theory of disease and the resulting incredible advance in outcomes that derived from that block of work when Joseph Lister published in 1867 his Antiseptic Principle of the Practice of Surgery (met by substantial skepticism and took years to be widely accepted and adopted).

This was just the start as we came to understand causative agents behind diseases that had vexed the profession. Treating someone with an infection with Penicillin thanks to Alexander Fleming’s work in 1928 was just one of many advances that grouped patients based on similarities of their disease. This methodology has served us well but the sequencing of the human genome- completed in Jun 2000 would have a big impact on this thinking.

From: http://sandwalk.blogspot.com/2016/02/happy-birthday-human-genome-sequence.html

Over the course of the last few years, we have seen a clear move towards the individualized understanding of patients and disease accompanied by the inclusion of patients (Patient Engagement).

Patient Engagement and Access

There was a clear theme in the messages from various presenters that offered a clear vision of the push towards the consumer and patient engagement and a clear desire to find a path to delivering access to everyone that was captured by Liz Barrett from Pfizer in her keynote presentation and summarized with her slide – The 4 Tenets for Healthcare:

Access to quality
Incentives
Long-Term Value
Competitive principles

Providing access that overcomes the current challenges but builds in incentives for everyone in the system – not just the providers and hospitals but also patients and everyone involved in healthcare. This is the principle of competition without which systems tend to decline and ultimately stop working. There are people who perceive competition and capital principles as contraindicated in healthcare that we want to provide to everyone. I think these ideals can and should co-exist – without competition motivation disappears and efficiency will decline.

To achieve this we should take a book out of Yoda’s wisdom to pass on this wisdom and my key message for this day. Benefiting from the extended community. Our ability to connect and access people and resources has never been better. The need to remember data is much reduced:

GIYF

This access goes far beyond the data and to people and resources. Can you imagine making a purchase without looking at ratings and reviews on sites – I can’t. Yet the reviews are from people I don’t know and have not met – yet I trust them. This works because of the human desire to help others (this, by the way, is the reason that social engineering as carried out by hackers is so successful – this will be the subject of a post coming up in the future). But this creates an incredible set of resources and talent available to you.

Patient Communities

Some of it is formalized like the early website entry in this area: Patients Like Me. But extends to informal interactions on social media channels like facebook and one of my favorite: Paying till it Hurts. Then there is your extended family and friends who all want to help. You will find people who have been through similar experiences, will have tips and ideas on how to deal with problems that others have faced and have conquered

I was lucky to hear Arnold Schwarzenegger present as the keynote at this recent conference – his recurring theme was that he was not a self-made man but his success was the result of all the help and support he received from others

So use the power of the Force – it is your network, your friends, family and those around you.

Derive strength from them, have them provide tips on what small changes you can make to improve your health and then help keep you on track – nothing like knowing that you are being watched to help keep you on track.

One of my most successful personal health drives was base don a weekly self-reported weigh in for myself and two colleagues. Anytime I felt I was going to make a poor choice on food or exercise I just thought of the weekly chart and where my line would be relative to my colleagues and I did not want to be the outlier.

Have you had success helping friends and family? What works and what doesn’t. Is there a special trick or insight you could share that might help someone else – share it now and help the community.

 

May the Fourth be With You was originally published on Dr Nick – The Incrementalist

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Patient Centered Systems

What will it take to move our healthcare system to a truly patient-centered system? We know based on multiple data points that engaged patients have a big impact on the successful outcome of treatment. Leonard Kish cited the phrase back in 2012

Patient Engagement is the Blockbuster Drug of the Century

Referencing a 2009 Kaiser study of coordinated cardiac care and comparing to those not enrolled in the study

“patients have an 88 percent reduced risk of dying of a cardiac-related cause when enrolled within 90 days of a heart attack, compared to those not in the program.”

“clinical care teams reduced overall mortality by 76 percent and cardiac mortality by 73 percent.”

And this study in Telemedicine and e-Health. Dec 2008; Vol.14 (10): 1118-1126 that showed impressive results for chronic disease management:

  • 19.74% reduction in hospital admissions
  • 25.31% reduction in bed days of care
  • 86% patient satisfaction
  • $1,600 average cost per patient per year, compared to $13,121 for primary care and $77,745 for nursing home care
  • 20% to 57% reduction in the need to be treated for the chronic diseases studied, including diabetes, COPD, heart failure, PTSD, and depression

 

Patient Data Ownership

I believe as do many others that the patient is at the center of everything we do and deliver in healthcare. By placing the patient and their information at the center of care and allowing them access and control we empower them and enable a model that moves away from the historical paternalistic delivery of healthcare to patient-centered and enabled care. It does come with challenges since many people contribute to that care and the current administrative and financial configuration focus the management and ownership of data with providers, healthcare systems and payors. While many patients want access to their data and some even want to own and manage it, many do not and are ill equipped to be responsible for this data. Perhaps what we need are some independent services and providers who aggregate, manage, secure and maintain patient data on behalf of patients – much as banks do with our money. There was some hope when Google and Microsoft jumped into healthcare offering Google Health and Microsoft Health Vault respectively. Microsoft’s version continues to this day – google withdrew theirs and Sergey Brin was widely quoted when he said

“Generally, health is just so heavily regulated. It’s just a painful business to be in, I think the regulatory burden in the US is so high that think it would dissuade a lot of entrepreneurs.”

But while complex, not insurmountable and as he rightly points out

“I am really excited about the possibility of data also, to improve health”

I am too and while there remain many challenges associated with securing and sharing that data the “entrance” of these alternative participants into the healthcare space – some perhaps looking at this from a simple employee perspective, is an opportunity for new ideas, insights, and people applying the collective brain power to one of our most pressing problems. I continue to hear from colleagues and friends of companies that are exploring and looking at healthcare. UPS highlighted their healthcare focus and the potential for 3-D printing in a recent tweet:

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And I heard from a friend that Dyson even has a healthcare “focus”.

Protecting Patients

There are some major concerns as these data-focused companies offer access but do so with agreements that contain so much legalese as to be unintelligible and opaque to the consumer who may well be giving up much more than his own personal data but potentially giving up his future health. The GINA act offers some protection to individuals who in sharing personal genomic data that tag them with a “pre-existing’ condition could have found themselves unable to access care. But the act did not go far enough failing to address the issue of other insurance and employers who can use this data to deny access or coverage and perhaps even employment?

We need the combined power of this patient data to create the insights into diseases but not at that personal expense. There are many technologies on the horizon that offer a potential path to help achieve this and blockchain represents an interesting innovation of decentralized secured data that offers individualized control and dynamic revocation options for access. If you are interested in learning more about Blockchain this article in HealthcareIt News is a good primer for its potential in Healthcare: How does blockchain actually work for healthcare?. It is not a panacea and the fundamental rights and ownership still need to be addressed without giving away the farm to corporations and businesses.

Interoperability

The existing healthcare system incentivizes behavior that is in opposition to a scalable nationwide vendor neutral interoperable patient-centered data. Our model has multiple groups who have a vested interest in the control and ownership of data (for example Payers, Providers, Patients and even employers). Each has their own economic and commercial drivers and in many instances, these do not coincide with open sharing of data. In a system that is driven by activity and delivering care (Fee for Service) sharing data could mean a reduction in work and income. Until our reimbursement system moves to a more holistic care model that focuses on wellness and outcomes and incentivizes behavior that delivers better health and outcomes for patients through cooperative and coordinated care and ultimately equitably rewards all the contributors to these outcomes we will remain stuck in the quagmire of limited interoperability.

The key to a patient-centered interconnected care model is the free flow of data between all the areas responsible for delivering care. We moved away from the single index card medical record held by your personal physician who was the focal point of care and care coordination to a distributed team-based model of care that encompasses multiple areas and people. In some instances, thatcher coordination may be carried out, at least in part by the patient or their family members, and they need to be included and ultimately in control of the data and its flow. The only way this team can deliver excellent care is through the frictionless flow of enhanced data and knowledge. This information flow must include the patient and all their family members that are authorized, interested and engaged in their care. Data should be shared with the patient’s consent with everyone concerned and available for as long as it is needed to deliver care but this access should be flexible enough to allow it to be revoked or removed when it is no longer needed or necessary

Welcome to the Fray

I am a big fan of learning from other industries and perspectives and spoke about this at HIMSS Conference in Orlando

The Best Exotic Marigold Hotel and I am excited to see the rush of companies and people into the healthcare space but for those stepping in and thinking about data and the ownership and control of this data, I would suggest this requires a new way of thinking. Much like security – patient access and control needs to be baked in from the start. Taking ownership and rights away from patients will stall progress and anger your constituents and community. As ePatient Dave would say or better yet sing:

Give me My Damn Data

Here’s hoping that these new players see the value of the engaged patient and include some of these principles in their march towards our common goal of better more cost effective healthcare. For the large organizations thinking about the data, remember you and your family members are patients too. The following thoughts are offered as some basic guiding principles on data stewardship:

  • Patients want control of their own data,
  • Patients want to be able to share safely and securely share their data with all their care providers and participants (this will include family members and friends)
  • Patients want granular control of some elements of the data limiting individual access to certain elements and areas
  • Patients requires a full audit capability tracking who has access and has accessed their data
  • Patients want to be able to easily and dynamically revoke access
  • Patients will share their data for research and benefit of others but their contributions need to be recognized and accounted for
  • Data cannot be used against Patients to deny coverage or increase their costs

 

What have I missed – what controls or limits would you place on your data that would make you more willing to share your data. What would stop you from sharing your data and why?

 

 

Patient Centered Systems was originally published on Dr Nick – The Incrementalist

Digital Health Summit

This is Australia’s premier health innovation convention on the technologies that are revolutionizing healthcare and the implementation of ehealth initiatives and I was honored to be asked to give a keynote presentation at the Digital Health Summit taking place in Melbourne 29-30 March 2017. The bonus was listening to so many great presentations throughout the day from some great speakers.

The Perfect Storm for Healthcare

The opening session that set the tone for the future came from Alfred Poor, Editor for Health Tech Insider who eloquently described the perfect storm of The Internet, wireless communications and the pervasive smartphones that last year shipped 1.5 Billion – enough to provide one for every 5 people on the planet. Innovation that can take off the shelf technology and create accessible telehealth programs that reduce readmissions from 20% to 6%.

Everything from wearables devices to non-invasive sensors and monitoring to allow the capture of data on patients, improve care and treatment options and allow the elderly to safely stay in their home. Innovations that address the major challenges around the world in the society that needs to adapt and focus on wellness:

2009 Continua Health Alliance Brigitte Piniewski, MD

 

Stuart Smith took us through the potential for Gamification: exploring the magic of video games in health and rehabilitation providing repeated examples where implementing Gamification to engage with patients was seen as some kind of Voodoo by his colleagues who were amazed at the incredible success and high utilization by patients

He showed examples of rehabilitation patients using Sony Play Station with Microsoft Kinect that made the rehab program a positive experience and even had the audience dancing along with Dance Dance Revolution explaining how they had adapted this to elderly patients and using Glenn Miller and Big band music

With the explosion of data comes increasing risks to the security and privacy of data and Nathan Steiner Veeam Software detailed the expanding risk and the staggering incidence of data breaches that extend well beyond healthcare which remains the top target for hackers. No surprise and notably the FBI highlighted the hacking community that is targeting vulnerable FTP servers.

Julian Bright and Adrian Medhurst from Amelie AI took the audience on an interactive journey with an Artificial Agent focused on mental health issues and braved the Live Demo gremlins as captured on this Periscope:

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Personalized Medicine

 

Dr Robert McLeay, Founder, DoseMe highlighted the changing nature of medicine that improves on the old style model of guess work on drug choice and dosage and builds individual models to reduce the side effects and maximize the selection of the right drug for patients first time round – practical personalized medicine available for your patients today

Professor Phil Robinson, Head, Cell Signalling Unit, Children’s Medical Research Institute (CMRI), co-lead of The Australian Cancer Research Foundation International Centre for the Proteome of Cancer (ProCan) shared the exciting international progress being made in fighting cancer with industrial scale proteomic system that they have set up in the Children’s Medical Research Unit that was Announced by Vice-President Joe Biden on 17 July 2016 in Melbourne as part of the Cancer Moon shot that has rapidly grown to include 10 Nations, 18 Institutions. They are now producing huge amounts of proteomic data and creating Digital Proteme Maps that has been committed to the public domain indefinitely to facilitate ou sharing and learning and will be providing new options for targeting cancer. You can see more about their project here.

Digital Health Innovations from the Front Line

 

We heard from 2 clinicians from the US Aenor J Sawyer, MD, MS Director, UCSF Skeletal Health Health Innovation &Tech in Ortho University California, San Francisco and Dr Megan Ranney, Associate Professor of Emergency Medicine; Director, Emergency Digital Health Innovation program, Brown University. They shared the experiences from UCSF and Brown University of applying digital technology in the clinical setting offering insights into the use of sensors, Virtual reality and how to evaluate the technology in the context of a busy hospital and Emergency room.

 

After lunch, the panel session on the future of aging was hosted by The Hon Bronwyn Pike, former Victorian Minister for Housing, Aged Care, Community Services, Health, Education, Skills and Workforce Participation focusing on the innovations in place and how the sector can benefit from the data and analytics increasingly available from the digital transformation taking place. and then a detailed review of the great Victorian Stroke Telemedicine Program that has been rolled out with great success by Prof. Christopher Bladin, Program Lead – Victorian Stroke Telemedicine Project, The Florey Institute of Neuroscience & Mental Health with a proven protocol that is statewide and heading nationwide

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Social Media in Healthcare

 

Professor Enrico Coiera, Director, Centre for Health Informatics, Australian Institute of Health Innovation offered some tantalizing insights into the way that social media is changing the way we think about health. Not only does Social Media offer a means of reaching and engaging with patients it is also a potential avenue for treatment. The social propagation of obesity as detailed in this New England Journal of Medicine article: Network Medicine — From Obesity to the “Diseasome” and these complex networks are of direct relevance

He left us wondering of social media can treat social disease (his BMJ article Social networks, social media, and social diseases talked about this concept)

Modeling of Data

 

James McCaw, Associate Professor in Mathematical Biology, The University of Melbourne shared insights into the modeling for influenza forecasting and pointed out that despite how much progress we have made in medicine the influenza pandemic of 1918/9 (Spanish Flu) would have a similar effect on the population today

The models for prediction have improved but he likened them to weather forecasting capabilities from the 1970’s

 

It was a great day filled with insights from a wide selection of experts covering a huge range of areas. All the talks were engaging with practical tips and wisdom that the attendees could take back and use.

Digital Health Summit was originally published on Dr Nick – The Incrementalist

Joining the MedicAlert Board

MedicAlert

I am excited to be elected to the MedicAlert Board joining Jessica Federer, head of digital development at Bayer. As Barton Tretheway, CAE, chair of the MedicAlert Foundation Board pointed out

Their collective experience aligns with our priorities and will be immeasurable to us as we look to leverage the power of new technology to expand the mission of MedicAlert Foundation, which is designed to help save lives

Which succinctly captures my feelings around this additional role. I personally experienced the value of the MedicAlert solution, brand and promise when I practiced as an Emergency Room physician in the United Kingdom. It was part of the standard procedure for any patient who arrived unconscious or confused to look for the signature bracelet

Traditional Medical Alert Bracelet

 

With its iconic Caduceus (similar but different to the Rod of Asclepius) which was the traditional sign of the God Hermes and became established as the symbol of medicine in the United States in the late  19th Century.

History of MedicAlert

The Original MedicalAlert User – Linda Collins

The history of MedicAlert dates back to the Early 1950’s developed by parents of Linda Collins who had an who had an anaphylactic reaction to tetanus anti toxin (which in her instance she only received a small scratch test as was the practice in 1953) and had a severe reaction. She survive but her parents Dr Marion Collins and his wife Chrissie realized that she was at risk and made a paper bracelet and note that was attached to her coat detailing her severe allergy.

 

 

 

 

 

In fact the original MedicAlert Bracelet is now in the permanent collection of the Smithsonian Institution in Washington, D.C. Today

The Original Bracelet stored in the Smithsonian in Washington DC
The Original Bracelet stored in the Smithsonian in Washington DC

From these modest beginnings things have developed with early recognition by “Peace Officers”. The California Peace Officers magazine even ran an article back in January 1957 highlighting the MedicAlert bracelet to their members. In the era before mobile phones and always on communication it was a reliable way of identifying individuals and providing immediate access to a 24- hour phone line linked to critical and life saving information for that individual. This function continues today with a live 24/7 Emergency Response Service

I worked on one of these switchboards as a Medical Student many years ago

 

 

with full health and personal information including your personal health record and emergency contacts information and available in other countries including Australia, the UK, Canada and South Africa to mention a few through affiliates and partnered with many groups including AAFP, Alzheimer’s Association, ACEP, Autism Association, Philips LifeLine, National Alliance of Mental Illness, Food Allergy Initiative – to mention but a few

The age of computing brought new innovations and the ability to more readily store and retrieve more information for members and track and follow membership and presidential recognition dating back as far as April 9-16, 1978 when then President Jimmy Carter commemorated the occasion of MedicAlert and their contribution to Medic Alert week in April. Even Hollywood got in on the act with appearances of the MedicAlert in everything from the Today Show and Good Morning America to CHiPs

and Columbo

Peter Falk in Columbo

 

Moving into the Digital Age

The organization is moving into the digital age with solutions around stored medical records, moving to digital mobile formats and storage solutions and even exploring the potential for RFID enabled solutions and in partnership with the American Medical Association has a joint venture on advanced directives.

Back in 1956 Dr Marion Collins commented that

“I think I can save more lives with MedicAlert that I’ll ever save with my scalpel”

Which is much like my own perception of medicine and the opportunity of Digital Health that I saw 30 years ago and continues to be the case. It’s this combination of a storied brand and concept from MedicAlert as a foundation and the opportunity to update for the new Digital world we live in that presents such an exciting opportunity. We are facing a Silver Tsunami of people who struggle to age in their homes and technology and solutions that help them do so, safely and with the support of their relatives and the health system will be in high demand.

I’m looking forward to working with my fellow board members and the MedicAlert team to continue the tradition and build on the brand with a Digital update and twist

 

 

 

 

 

 

Joining the MedicAlert Board was originally published on Dr Nick van Terheyden, MD

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What 2016 will Bring for Healthcare Technology

Posted in Africa, Disruptive, Innovation, Patient Engagement, Technology by drnic on March 25, 2016

2015 was an incredible year in technology and healthcare; from new consumer technology and personalized devices coming to market to the introduction of new supercomputers that reduce the time and cost of healthcare data analysis. It’s been great to see how innovation continues to penetrate the medical profession, improving patient services and care. As we look to 2016, there are some areas that we can expect technology to further impact.

Dance like no one watching Encrypt - Security

Growing patient concern over security

Security is a major concern for consumers and the healthcare industry, and the threat of it is only rising. While technology and data provides patients with the precise, personalized medicine that they want, individuals have not forgotten the security breaches that occurred this past year, which had heightened their concern, particularly with the type of personal information in medical records. Implementing stronger, more reliable and transparent security practices will be a critical objective for medical practitioners, but equally important will be reestablishing trust with their patients and consumers.

The consumerization of healthcare

Consumers have grown to expect personal and custom experiences from technology.  The consumerization of healthcare will gather greater momentum and the healthcare industry will see the first effects of this trend on individual behavior in 2016. By treating patients and individuals seeking healthier lifestyles as consumers, the healthcare and related technology developed becomes more and more applicable to serving their needs and meeting them where they are. This is a great thing. As an example, imagine telehealth kiosks now allow patients to engage in a face-to-face video consult with their doctor, or have their vitals taken and receive a diagnosis – without setting foot in their doctor office.  Pilot programs for these “pods” are being tested in Rite Aid and the Cleveland Clinic.

The latest innovations will further fuel the moment around treating patients as consumers and developing relevant technology that make it easier for them to monitor their health and seek treatment, driving more adoption and healthier populations.

IoT - We have to go out for Dinner - Fridge not Talking to Stove

Embracing the Internet of Things toward patient engagement

The Internet of Things (IoT) connects billions of objects around the world, and in 2016, the healthcare industry will take the first steps in tapping IoT’s full potential through passive monitoring. Leveraging wearables and connected devices, healthcare organizations, with the consent of patients will be able to passively monitor the wellness of patients and personalize their experience. For example, for those with chronic diseases, such as diabetes or heart disease, these devices can monitor all aspects of the patient’s  daily life to provide insight to the patient and the healthcare providers, into how different activities, such as eating, sleeping or watching TV, affects his or her body. Connected devices equipped with real-time feedback can provide subtle alerts that prompt, caution or encourage patients to stick with or avoid certain behaviors.  These devices can also help them to comply with a treatment or regimen. In 2016, we’ll see the industry understand that subtle patient engagement through passive monitoring can have positive, long-term effects on behavioral change.

 

The potential of ICD-10

While the rollout of ICD-10 was reluctantly undertaken by some in 2015, the healthcare industry will begin to realize its actual potential in 2016. As a result of ICD-10, healthcare organizations will receive a higher level of granularity in the clinical data that has been collected including patient information and clinical data.  Utilizing this data will enable new insights and deeper analysis.  This will be the first step in turning descriptive healthcare analytics to predictive and prescriptive insights enabling results like reducing readmission and improving population health management. However, as we see potential benefits being realized, discussions will center on the interoperability of systems that is limiting analysis and holding back potential insights.

Africa-Kids-iPad

More democratized, globalized healthcare

While diseases such as AIDS and malaria are now considered chronic or curable with the proper treatment, there are still geographical, technological and societal barriers that pose great challenges when trying to treat the demographics that are most commonly affected. In the third world and emerging countries, healthcare organizations are leveraging technology, including simple mobile devices, to provide patients with faster, more effective care. In 2016, we will see more companies create technology that democratizes healthcare with innovations that help to lower the cost of healthcare, enhance patient engagement and improve overall worldwide population health.

Not only is it exciting to imagine how we’ll see technology continue to evolve and change everyday life, but also fascinating to see the impact and opportunities for enabling healthcare providers. These trends will manifest in some exciting and innovative changes in 2016 that will have a tremendous impact and further improvements in patient care.

 

This post originally appeared in HealthIT Outcomes

 

Original

 

 

What 2016 will Bring for Healthcare Technology was originally published on Dr Nick van Terheyden, MD

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Digital Health for the Undeserved

A recent report published by Jane Sarsohn-Kahn for the California Health Foundation: Digitizing the Safety Net Health Tech Opportunities for the Undeserved offers some deep insights into reaching the population most in need of help but often left out in the discussions of the latest and greatest technology to break into the news cycle.

As pointed out low-income households have access to mobile technology with 8 out of 10 sending and receiving text messages – in fact mobile phone usage and ownership mirrors the experience in Africa where many of the communities have little choice given the paucity of existing infrastructure and have bypassed the traditional communications systems in favor of mobile networks
Adults who own a cell phone, Africa

and gave rise to a whole innovation of mobile banking that originated that pre-dated, is more flexible and is more widely used than anything developed in the west (The M-Pesa system) – servicing the unbanked people of Africa without requirements to have a smart phone nor to use an app. I’ve written about the opportunity we have of learning from our African friends in the past)
In the case of the undeserved here in the US many of these people mirror these experiences and providing easy access using simple tools is effective not just from a cost standpoint (as Healthcrowd showed $1 for mobile messaging vs $34 for paper mailing) – and that’s even before you consider the engagement/response rate we find with mobile applications and interactions…think about it, when you want to reach your children do you send them an email or text them

Textpectation

 

Take the time to read about the multiple projects that are reaping big benefits and doing so cost effectively. These are real working projects with a range of technology that has demonstrable impacts and could be applied to many more groups and environments. The extensive piece takes you on a journey from everything as simple as text messaging from Healthcrowd to the medication adherence and tracking concepts of Proteus Digital Health of digestible sensors that track your pill from manufacture to ingestion.

There are a few guiding principles to help steer you to success

  • Meet people where they are – widely varied and none are typical
  • Build Trust – under promise, over deliver; everything is fragile for this community and failure can be far more catastrophic for them than “average” users
  • Address social determinants of health – just providing a ride to get to the clinic could mean the difference between success and failure and an Uber Ride is a lot more cost effective than an ambulance required for the crisis that could have been averted
  • Consider the cost of data service – data is expensive on many plans treat it like memory used to be in the days of 640K
  • Recognize the many layers of health literacy – not just comprehension but basic literacy and even language
  • Speak in the Vernacular – and make it culturally sensitive too

As Aman Bhandari said

“The new sexy is scaling what can work”

Proven solutions that have been effective provide great opportunities for those looking to make that impact on their own area.

 

 

 

Digital Health for the Undeserved was originally published on Dr Nick van Terheyden, MD

Healthy Living Starts with You

Human capital – the stock of knowledge, habits, social and personality attributes embodied in the ability to perform labor so as to produce economic value.

When reading the above definition of human capital, a particular word jumps out… habits. I am passionate about habits because poor lifestyle choices—or bad habits—are the number one driver of today’s health crisis. Chronic illnesses—such as heart disease, stroke, asthma, diabetes, and obesity—are responsible for 7 of 10 deaths each year, and treatment of chronic diseases accounts for 86% of U.S. healthcare costs. However, while they are among the most common and costly of health problems, chronic diseases are also the most preventable and manageable, because they often result from choices we make in our daily lives. To conquer chronic illness, we have to change our bad habits. And that’s not easy.

If I had to prescribe one medication to cure bad habits, it would be patient engagement. When we are effective at engaging patients to participate in their care, they begin to take more responsibility for their own health and adopt healthier habits. Effective engagement of chronic disease patients can lead to reductions in hospital visits, decreased morbidity and mortality and improvements in treatment adherence and quality of life.

To truly influence positive behavior changes, health goals must fit meaningfully in patients’ everyday lives. People must be surrounded by opportunities to embrace healthy lifestyles, and that requires the involvement of the entire community – care providers, governments, businesses, and of course, the people living there.

It’s no surprise that 7 of the top 10 Future-Ready cities overlap with the American Fitness Index’s list of healthiest U.S. cities. These developed cities are arguably some of the most connected and most educated, and they have infrastructure that supports recreational activity. But health is not only an outcome of development, it is a prerequisite for it, and never before have communities had such an incredible tool to engage people in making healthy lifestyle changes… technology.

Just as technology is giving providers more ways to care for and engage their patients in more places, it’s also providing the means for governments to reach constituents, businesses to tailor wellness programs for their workforce, and people to take charge of their own health.

Care providers

Technology gives caregivers unprecedented opportunity to engage patients and provide excellent care, anywhere, while also giving both patients and doctors a valuable feedback loop. Telehealth, remote biometric monitoring, and technology-assisted health coaching are powerful tools in the fight to improve chronic care outcomes because they provide in-the-moment support to patients struggling with diet, exercise habits, and medication routines.

BlueStarDiabetesAppFor example, an FDA-cleared mobile app that delivers real-time motivational messages, behavioral coaching and educational content right to the mobile devices of patients with Type II diabetes has demonstrated significant drops in their A1C levels.

Even simple text message programs can make a difference. Text2Breathe, a program of the Children’s National Medical Center, sends care information and reminders to parents of children with asthma and has helped help reduce emergency room visits.

State and local government

State and local government agencies have immense power to use technology to spearhead healthy lifestyle and disease prevention programs. For example, in response to Philadelphia’s high rates of chronic disease, city officials recently launched PhillyPowered, a multi-media campaign designed to encourage Philadelphians to become more physically active. The campaign features a mobile-friendly website, which lists free or low-cost places to get fit in the city, provides educational information, and includes a social media component that enables Philadelphians to share tips on how to fit exercise into their busy lives.

Portland University, in conjunction with the Oregon Department of Transportation, is piloting a smartphone app called ORcycle

designed to collect data and feedback about bicycle routes, infrastructure and accidents in order to improve infrastructure suitability for bicycling in Oregon.

Businesses suffer from the impact of chronic illness through absenteeism and retention problems, yet they are uniquely positioned to promote healthy lifestyles for workers and their families. Employers can work with their health plans to identify need for wellness programs and services such as preventive screenings, tailored to lowering both health risks and costs.

 

 

Companies are increasingly integrating technology into their wellness programs. For example, Dell’s Well at Dell program includes a virtual wellness portal that imports numbers from onsite health screenings and provides employees with an action plan, educational information, and email and text reminders to stay on track. Some companies are adopting wearable technology as part of their wellness programs to incent employees to get fit. It is worth noting that data security and privacy is paramount to protect employee health information and need to be designed in as part of all of these initiatives to maintain the trust that is essential for an effective healthcare system.

Technology today gives communities in all geographies the means to invest in the health of human capital and very real opportunities to shape the future of healthcare… now.

 

This article previously appeared on Future Ready Economies site

Healthy Living Starts with You was originally published on DrNic1

Patient engagement lessons from Africa

Posted in #mHealth, Africa, education, HealthIT, Patient Engagement, Technology, Telemedicine by drnic on September 29, 2015

I was raised in Gabon on the equatorial west coast of Africa

and though I’ve never practiced there, I consider myself African and continue to be interested in the delivery of healthcare on the continent. Though health resources are scarce, my colleagues there have made creative use of the tools available. In Gabon, and indeed across much of the rest of Africa, text messages are routinely used to provide timely health messages about medications, clinic appointments, health risks and general health information. They are way ahead of the U.S. in proactive use of mobile technology for health improvement.

Below are a few examples of the remarkable achievements they’ve made with cell phones and text messages. Most of the examples were compiled by IRIN, a news service that focuses on humanitarian news and analysis, plus a few others that I’ve added to the list:

Health check-up by text message

  • A recent study published in The Lancet noted that Kenyan patients who received weekly text message check-ups were 12 percent more likely than a control group to have an undetectable level of HIV virus a year after starting life-prolonging antiretroviral (ARV) treatment.
  • In the south-central Ghanaian village of Bonsaaso, using mobile phones to contact health workers has lowered the maternal death rate.
  • TxtAlert, a product of the Praekelt Foundation, is a mobile tool that sends unique, automated SMS reminders to patients on chronic medication. This reminds them to take their medication or perform other necessary tasks. A special tool, called “Please Call Me” allows patients to call their doctors even if they don’t have any airtime available by pinging their doctor who then calls back.
  • A pilot project in Cape Town, South Africa, used text messages to improve adherence to tuberculosis regimens.
  • Medic Mobile allows patients to get home-based care even if they can’t be physically visited by a caregiver. The organization launched a pilot program in Malawi, where more than 100 patients received treatment for TB after their symptoms were noticed by the community and reported by text message.

Health information

Health literacy is often low in Africa, and text messages have proven an effective way to increase knowledge

  • In Tanzania, text messages are sent to pregnant women based on their due dates, providing important information that is relevant to each stage of their pregnancy.
  • On Valentine’s Day 2008, a Dutch NGO started an eight-week campaign in Uganda’s southwestern district of Mbarara with the slogan, “Don’t guess the answers, learn the truth about HIV.” The campaign led to a 100 percent increase in visits to the voluntary counseling and testing center run by the NGO’s health partner. This year, the same NGO used a text message quiz to test malaria knowledge in a fishing village in eastern Uganda.
  • In Ethiopia, people can call a confidential hotline anonymously with HIV-related queries.
  • On a 24-hour toll-free medical hotline in the Republic of Congo, set up by the government, the UN Children’s Fund (UNICEF) and a mobile telephone network operator, health professionals respond to queries about pediatric emergencies.

I could go on, and on and on, listing successful use of cell phones and text messages. The bottom line is that African health workers are using this technology in useful and creative ways to provide communication with patients.

Many U.S. medical professionals have been reluctant to use text messages and other mobile technology, and lag far behind their African colleagues in this area.

So what’s behind this disparity? Two factors, both related to infrastructure, have boosted use in Africa and delayed use in the U.S. First, because there is no significant landline infrastructure in much of Africa, cell phones account for 90% of all phones on the continent. In the cities, adoption has been near universal. (Pre-paid cell minutes are now used as a form of currency, as an alternative to sometimes volatile official currencies.) In many remote locations, where even clean water and electricity are scarce, you can get a cell signal and power a cell phone with a small solar charger to gain access to voice calls, text messages and the Internet. Cell phones have become a vital link for the continent.

With scarce health infrastructure and near-universal adoption of cell phones, health care workers were quick to see the usefulness of text messages, which only cost about 2 cents each.

Conversely, in the U.S., we have highly advanced medical infrastructure that has been in place for decades. A large proportion of primary care physician practices were established long before cell phones became widely used, and they still depend largely on the landline infrastructure they’ve always used. Same for most hospitals and outpatient clinics. Changing protocols, workflows and thinking patterns for these organizations isn’t easy, particularly if there is no urgent incentive to do so.

Many healthcare organizations also are concerned about HIPAA compliance and security in mobile patient communications; while those are valid considerations, there is a host of information that can be exchanged through mobile devices that wouldn’t violate the patient privacy regulations. And with a secure patient portal that can be accessed via smartphone, physicians can use mobile technology to share even protected information.

So why should physicians and hospitals change the way they work? Three reasons: meaningful use attestation, better outcomes and market competition.

While texting is not a part meaningful use attestation, it is a tool that could help you meet the criteria for getting patients to log in and view their health records. A text message with a link to your portal could prompt many to take a look just out of curiosity. And chances are, they’ll use their smartphone, not a PC to access your portal. Just this year, the number of users who access the internet with a mobile device exceeded the number who use a PC to gain access. So you’d better be sure your portal is mobile-friendly.

Perhaps the most immediate value of texting and other patient engagement strategies is improved care and better outcomes. Currently, we are not doing a good job of patient communication and education, despite putting time, energy and staff resources on the task.

Often, physicians, nurses and health educators are talking to patients who are too scared, too stunned by a new diagnosis, or just too intimidated by the healthcare system to be mentally and emotionally available to learn. Much of what we tell them is forgotten by the time they are out the door. And even those who don’t completely forget instructions often miss medication doses and appointments due to the forgetfulness that plagues all of us. And they often have trouble taking the advice we give and putting it to use in the real world.

Text message reminders could be used to remedy many of these problems. If the texts are scheduled to automatically send at the time that is most useful to a patient, the immediacy of the information would help patients follow through on treatment and be more engaged in their care.

The third reason that we should start using text messages is that the population under 40, and especially those under 30, use text messages as a primary communication tool. I have kids in that under 30 group, and they never answer the phone when I call or reply to emails (I doubt they even open emails). But a text message gets their attention. In fact, the average teenager sends 3,339 text messages each month. That’s more than 100 texts per day.

Granted, adults don’t text nearly that much, but those age 25-44 send texts more often than they call. And email is declining for many users, because they hate sorting through all the ads. Instead of emails and phone calls, they text and use Facebook and other social media to communicate with friends. Even business use of texts are on the increase, because it offers immediacy without the intrusion of a voice call.

So if you want to remind a patient about an appointment, odds are that a text message is a more reliable vehicle than either a phone call (which usually ends up as a voice mail that is never heard) or an email (which is likely to be missed among all the ads, if the person even bothers to check the inbox). If you send a text reminder at the time that a patient should be taking medication, chances go way up that the dose won’t be missed.

If you have a robust, mobile-friendly patient portal, you can use text messages to alert your patients to information they need on the portal – like their health records, useful research information and links to lifestyle advice like healthy recipes and exercise tips. With a secure portal, you can exchange even the most sensitive data with patients, even from a mobile device.

As this under-30 cohort becomes an increasingly larger portion of your patient population, they will expect your organization to communicate with them in ways that make sense to them, not you. Call only during office hours and wait on hold? I don’t think so. They will expect to use their smartphones to schedule appointments through your portal and receive information and ask questions through your portal, with text alerts to let them know when to check back for answers.

And if your organization can’t do that, they will find another one that will. Because the more future-ready, forward-thinking organizations have already made a move in that direction.

This piece originally appeared in MedCity News

Patient engagement lessons from Africa was originally published on DrNic1

Personal Healthcare Management

This piece by Aaron Carroll detailing his personal experiences with the healthcare system for what should be an easy and simple activity represents the frustration and challenges everyone faces on a daily basis including myself

I have the exactly the same challenges with renewal of what is a long standing formulation

I know this is not good for anyone and as pointed out it is not good for personal health – in my case as my wife and family will attest it definitely raises my blood pressure as I spend countless hours on the phone fighting with systems.

Everyone’s story will be different and in my case I don’t love the drug company who have taken long standing medication mixed them in a standard way and patented this to make it extraordinarily expensive for a formulation that contains one over the counter medication (OTC) and one generic prescription medication. And because of the artificial limits placed on supplies (90 days supplies with a maximum 1 year) behavior is modified attempting to reduce unnecessary costs. Ultimately everyone is behaving in the way the system incents.

Imagine that experience in the store – CostCo refusing to allow you to buy your supplies in bulk limiting your purchase to 3 months supply of toilet paper

and having to keep going back to an external party to require approval for purchasing when CostCo offers a special deal to purchase 12 units that might cover you for a year. Costco want you to purchase more and if you have the space and storage and will use it you want to buy in volume because it saves you money and the manufacturer wants purchasing their product. Costco is focused on making the process and cost as efficient as possible.

Before the deluge of complaints that buying drugs is not the same as buying toilet paper – true but take many maintenance drugs with excellent efficacy and safety. Even if it does require regular blood tests forcing the workflow to link the two in an sequence that tortures everyone in the process makes no sense. Engaged patients want an efficient process, will follow sensible and safe treatment guidelines and don’t need to be squeezed into a sequential process that includes steps that are linked for clinical reasons but remain disconnected in real life and difficult and expensive to follow for everyone concerned

As the costs shift to the individual the frustrations rise with the process and the necessary costs and waste – expect a rising voice of complaints and frustrations that might hopefully start to effect change

Personal Healthcare Management was originally published on DrNic1

Dunkirk Spirit: How physicians support patients overcoming adversity

One in eight U.S. women will develop invasive breast cancer over the course of her lifetime.  In 2014 alone, an estimated 295,000 new cases of invasive breast cancer are expected to be diagnosed.  That’s approximately 808 cases per day.

That’s ~640 cases per day or a little over 1 case per hour (26 per day)1

But these statistics don’t matter.  Whether it’s one-in-eight or one-in-3 million, the impact of the illness is what matters—not the numbers.  It immediately becomes a reality to you.  We can never forget that healthcare is personal, something my colleague, Melissa Dirth, articulated beautifully in her recent post “When 1 in 8” was no longer just a statistic to me.”

As a physician, sharing unfavorable findings and test results is always a sobering moment, no matter how many times you’ve done it before.  We all struggle to find the right words, and look for ways to be supportive as you allow your patient to handle the shock that accompanies such news.  We all have different viewpoints and our perspective on the disease is colored by our own life experiences and the individual circumstances.

What never ceases to amaze me, however, is the strength of the human spirit.  Despite the hard road stretching before them, so many of our patients face breast cancer with what the British would term “Dunkirk Spirit,” that inner strength that helps patients and their families overcome tremendous adversity.

Dunkirk Spirit

It is, in my opinion, one of the reasons that make cancer sufferers and survivors such an important and compelling tableau of courage.

Unfortunately, one of the essential elements that quickly becomes lost in the morass of technology is the Art of Medicine, and our ability as doctors to spend the time focused on our patient and their relatives.  As clinicians, we intuitively know the statistics associated with the disease and can interpret them to understand the impact the diagnosis we have just communicated with the patient is likely to have, but there is so much more to providing care.  We don’t just treat the condition, the physical body—we are caregivers and healers, and we seek to help the whole patient.

Technology can help in healthcare, but it is not the goal nor should it ever be the focus.  Yet, in some cases, it has detracted from our ability to provide care and compassion.  To deliver on the promise of great healthcare we have to return to the Art of Medicine and enable, not disable, our clinicians with the technology we develop.

To learn more about the role technology plays in the Art of Medicine, read: “There’s no room in technology in end-of-life care decisions

 

This article originally appeared on WhatsNext: Healthcare