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

Wise Up to Hidden Healthcare Fees

It’s perverse but the healthcare system in the United States is making you sick. Don’t believe me – then maybe you have a high-end plan with no deductible and full access and no ceiling. But there are not many of those and for the rest of us, I imagine your interaction with the system is as frustrating and stressful as mine – probably on a spectrum depending on your plan (High deductible plan or the more traditional Preferred Provider Organization (PPO) and co-payments.

 

Fee for Service Healthcare

The cynical view might be this is deliberate since our system remains firmly stuck in a fee for service model – healthcare providers are paid to do something…anything. From its original development, this made sense – our capacity to treat conditions was limited and the cost of these treatments in line with our ability to pay for them. But along this journey science and in particular the incredible progress of medical research got involved and we have been on a veritable tear of progress and innovation, or as the Exponential Medicine group would say Exponential progress.

Original from Foundation Teaching Economics

There is a continued push towards a more robust and accountable model – Accountable Care Organizations have been set up and these models of total care and coverage and responsibility tested for effectiveness and economic effect. There is lots of disagreement on the success or failure of ACO’s and it is fair to say that the jury is still out. But intuitively we know that taking care of the complete picture and being responsible for the total care of patients health is better for the patient and for outcomes. I have seen it time and again where individual mandates or focus induce unwanted/unexpected/unintended consequences elsewhere in the whole system.

Discharging Patients Early – Unintended Consequences

Discharging patients from the hospital early typically results in better outcomes. Early programs that incentivized this behavior and rewarded programs that got patients out of the hospital early were deemed successful but failed to take account of the downstream impact of readmissions resulting from too early a discharge and subsequent complications for that patient that could have been avoided.

Fixing a Broken System

The recent book “American Sickness” by Dr Elisabeth Rosenthal “An American Sickness” takes on the existing system and is filled with strategies for patients faced with mounting medical bills, an intractable and aggressive healthcare system that is unflinching in seeking payment and by many estimates the leading cause of personal financial crisis and insolvency. While the figures remain under debate my own personal reality living with a High Deductible Plan that has found me

  • Self-treating Fractures
  • Becoming my own compounding pharmacy and
  • Spending months and many hours fighting multiple bills

 

In the case of one screening procedure, that under the current regulations are fully covered but thanks to either mistaken coding or perhaps even deliberate coding, remains outstanding and in two of the three cases, the billing organizations despite my attempts at regular communications, response and protests were handed over to debt collection agencies.

So I am with Dr. Rosenthal and “breaking down the monolithic business”.

The situation is far worse than we think, and it has become like that much more recently than we realize. Hospitals, which are managed by business executives, behave like predatory lenders, hounding patients and seizing their homes. Research charities are in bed with big pharmaceutical companies, which surreptitiously profit from the donations made by working people. Americans are dying from routine medical conditions when affordable and straightforward solutions exist.

Employer Sponsored Insurance

Central to the challenges is the arcane concept that you access to healthcare and health insurance should be linked to your employment. As one friend of mine commented, “There are some who believe this is a deliberate policy on the part of employers to lock in employees to jobs they may not want but have to take because they need the health insurance and can’t afford the challenge or cost of changing (health insurance”. I don’t quite go down that rabbit hole and think Dan Munro’s explanation in his great book “Casino Healthcare

that detailed the history linked to the war effort and the need to find other incentives after they introduced: “An Act to further the national defense and security by checking speculative and excessive price rises, price dislocations, and inflationary tendencies, and for other purposes.” (EPCA) in 1942 – wages were frozen to stop inflation but as is so often the case left the door open for unintended consequences that found employers looking for ways to compete for a shortage of labor. And as they say what follows is history – Employer Sponsored Insurance (ESI) was born.

History of the NHS

It is interesting to note that the NHS model was also a product of the war that found the wounded servicemen and women in need of healthcare. A need that was serviced by the “Emergency Hospital Service” (aka Emergency Medical Service) that provided a model and experience to the country that became the model for what is now the NHS established in 1946.

But whatever the history, reasons, and background – this remains a millstone around American’s. It can add to job reductions and General Motors have stated that their employee healthcare costs add $1,500 – 2,000 to the price of every car they produce. It makes us less competitive internationally and crippling many with overheads that add to the cost of goods sold. It also puts employers at the table on healthcare decision making for their employers that present potential conflicts of interest given their need to service their share holders and remain profitable.

Finding a pathway to resolving this big intractable healthcare mess is going to take some major re-thinking and compromise on all sides. In the meantime, I suggest focusing on individual incremental approaches locally.

 

Incremental Steps to Coping With Healthcare

The list of 6 Questions to ask your doctor before your appointment and 5 questions to ask before you stay in a hospital are excellent resources from Dr. Elisabeth Rosenthal, that are featured in the book and on the website. So in the spirit of the incremental approach, I offer up two credit card size templates containing the

  • 5 Questions to Ask During Your Hospital Stay
  • 6 Questions to Ask Before Every Doctor’s Appointment

 

Formatted in a handy Avery 5371 White Business Card Template that can be printed – double sided and put in your wallet: Questions When Using Healthcare Avery Template 5371

Do you have any tips or suggestions in dealing with the healthcare system? Disagree with any of this – feel free to leave your comments or reach out.

Wise Up to Hidden Healthcare Fees 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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Men’s Health Week

Posted in Aging, Blood Pressure, Cancer, Personal Health, Suicide by drnic on June 29, 2016
Having a “Y” is No Excuse

It was Men’s Health week Jun 13 – 19 and I had the pleasure of talking to the Talk Ten Tuesday host Chuck Buck last week (Tuesday Jun 21)  to offer some thoughts and insights for their listeners and in particular for women thinking about any men in their lives

 

Most women know about their own health but not so much about men yet most women have men in their lives – sons, brothers, fathers, partners. Here are some of the highlights of the challenges in men’s Health

More men are born than women but that lead disappears quickly – in 1920 women outlived men by 1 year that’s now up to 5 years women outlive men. Having a “Y” Chromosome is not the reason for the poorer health of men.
Men “lead” in the top 15 causes death with the exception of Alzheimer’s (and that’s because men don’t live as long and as a result experience less Alzheimer’s).

Mars and Venus

This is the Mars vs Venus Gender gap in health. Men, like women have some diseases that are specific to them – prostate disease for example, but despite 1 in 6 being diagnosed with prostate cancer only 1 in 35 die from the disease. But most diseases are a shared problems – they strike both men and women. The leading issues for both gender’s are:

Heart Disease

  • Cardiovascular – men lead in heart un healthiness – but ladies are catching up
  • Heart disease and stroke – leading cause of death
  • Men develop atherosclerosis ~5 years earlier than women
  • Diet, Exercise, and fitness – don’t forget sleep
  • Cholesterol, blood pressure

If you want to explore the gender differences and causes of death head over to World Life Expectancy

Cancer

Lung cancer remains a threat – tobacco causes 90% of lung cancer and is causing ~158,000 deaths each year but there are gender differences; ~85,000 in men and ~72,000 in women (that’s more than enough to fill the Superdome every year)

Mental Health

But when it comes to Mental Health, Depression and Suicide we thought this affected men more than women but this may just be that men hide their feelings better and men also tend to seek help less for depression and while women attempt suicide more than men, more men die of suicide as they are more “successful”:

That’s about 100 people per day who commit suicide

Diabetes

“The high sugar of diabetes is anything but sweet”

The sugar is a slow poison inducing:

  • Heart attacks
  • strokes
  • blindness
  • kidney failure, and
  • amputations

If you were born after the year 2000 as a boy your chances of developing Diabetes is 1 in 3

“The combination of diabetes and obesity may be erasing some of the reductions in heart disease risk we’ve had over the last few decades”

So what should women do – as they should for themselves, encourage exercise (30 minutes per day reduces the chances of diabetes by 50% for men)  and a balanced and healthy diet. Not ignoring problems and focusing on prevention helping men seek medical help, but above all give them a hug and help them share and talk about their feelings

 

 

Men’s Health Week was originally published on Dr Nick van Terheyden, MD

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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

Memorial Weekend – Be Happy

Posted in Inspiration, Personal Health by drnic on May 23, 2015

This memorial day is a good time to reflect and give thanks – in fact this visual gives a great sense of the sacrifices of so many for our freedoms and life today

BloodofourVeterans

Original from Facebook

Here’s one for the SHARE button. A truly powerful image that tells it like it is.

Posted by Madison Rising on Thursday, October 30, 2014  

So while thinking about how lucky we are we should try hard to be happy as Bobby McFerrin suggested: “Don’t Worry, Be Happy” So in the spirit of focusing on happiness which is well proven to improve your life this piece in Time Magazine: Happy Thoughts: Here Are the Things Proven To Make You Happier choked full of great ideas and principles – starting with Gratitude which

Showing gratitude for the good things you have is the most powerful happiness boosting activity there is….which seemed a perfect match for today. But there are many other elements starting with

Doing what you are good at – no matter what that might be as often as possible – Starving Artists are happier with their jobs which goes a long way to explain the power of Regina Holliday and her amazing presence and power in medical advocacy (She’s just a published her first book “The Writing on the Wall” which should be required reading and would definitely be on Oprah’s book list if that were still thing)

As for you time – spend it with the people you like – the happiest people are social with strong relationships and that describes much of the online community around Healthcare and Patient advocacy that i consider myself very lucky to be part of. There have been some studies that suggest a causation between happy social networks influencing others and helping them to be happier (I know could just as easily be correlation but either way Happiness is infectious)

Money can help but is not essential to happiness and it is not good to focus on money or the desire for it.

Well known that giving is better for happiness than receiving – notable during the holiday that the giving of gifts is more satisfying than receiving. Interestingly striving for ambitious goals has a positive effect and being optimistic (even bordering on delusional) has positive effects but it is this list of “big life regrets” that is worth highlighting

  • I wish I’d had the courage to live a life true to myself, not the life others expected of me.
  • I wish I didn’t work so hard.
  • I wish I’d had the courage to express my feelings.
  • I wish I had stayed in touch with my friends.
  • I wish that I had let myself be happier.

and as someone pointed out – no one says as they near death – I wish I had worked much harder and spent more time at work.

 

Relish the time off, enjoy your life, family and friends, savor the positive experiences and do so frequently even in small doses.

 

 

 

 

 

 

 

 

 

 

 

 

 

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Wearable Technology – An Exploding Segment

Posted in #mHealth, bigdata, Healthcare Technology, HealthIT, Personal Health by drnic on October 1, 2014

I attended a Wearble Technology conference today in Pasadena California: Wearable Tech LA

There was a wide range of technologies and innovations – everything from the mind monitoring by IntraXon’sMuse headband. Here’s their online demo video

One of the more interesting concepts takes the challenge we have all faced mastering the mechanics of walking, exercise, running and in some cases rehabilitation by placing sensors in the sole of shoes – Plantiga who have taken force analysis for our feet to a whole new level

The technology takes the static Force Plate sensor and turns into a continuous assessment 3-D tool offering an opportunity to apply this in specific sports and to help rehabilitate people who have been injured or have mechanical challenges (the side effect of capturing all this data is actually creating more comfortable shoes as they now have built in suspension and springs).

Better than this concept!

It might take a while to arrive in healthcare but in the meantime may well show up as another input device for the X-box or PS3 for a more realistic interface.

There was sensors to be placed all over the body for respiration, heart rate, muscle movement, acceleration/deceleration and even some to be ingested

A major challenge highlighted by several speakers facing all of the wearables genre was the issue of battery life

(and ironically it was the same problem I faced as I tried to capture and post social media)

The opening keynote was from Nadeem Kassam – CEO of BioBeats (Founder of Basis which is now an Intel company). His journey was one of classic rise from poor neighborhood in South Africa where he started his entrepreneur sporty selling oranges

He focused on three lessons – the first an essential learning point for everyone especially those facing healthcare challenges

Nothing is stronger than habit

He also suggested that those looking to succeed with innovation should:

  • Look for innovation outside of your industry, and
  • Don’t throw a big team or money at innovation

His story behind this was a classic one of engineers told to build a product who came back with his wearable watch that was a huge device that weighed down his arm and had a velcro battery pack under the arm!

He ended up finding his greatest engineers on Craigslist who’s references and Resume was a cardboard box full of devices that he had built.

The new concept of “Adaptive Media” which is bridging the divide between human emotion, data and the media we consume and should adapt to our mood based on our emotion. His new company has done some interesting research programs including an experiment with machines designed to allow people to hear their own heartbeat and have it set to music in Australia. When people heard their heartbeat for the first time it created a deeply emotional experience and many were moved to share very personal life stories.

They took this a step further and worked to gather heartbeats worldwide – a clever BIGData gathering exercise that amassed large quantities of rate, rhythm and details of millions of people around the world.

His overriding point was

We have to make health fun and engaging – merging it with entertainment to help people achieve what we all want – long tail of healthy life
 

There was a fascinating blend of the Entertainment industry and Hollywood and a slew of companies taking different approaches to these devices:

Epihany Eyewear tries to make wearables fashionable as well as functional (I’d say it not so much as fashion but blending into society)

Optivent with  powerful wearable glass – but no mention of the interface They probably had the most fun concept video

Les lunettes d’Optinvent voient plus grand que les Google glass from Rennes, Ville et Métropole on Vimeo.

Enlightened design had the most impressive on stage display with a jacket that had lapels that constantly changing color

Janet Hansen – Founder & Chief Fashion Engineer, Enlightened Designs

Sporting her jacket with lapels that constantly changed color

Sports and Wearable

Given the excitement over the last month wight he World Cup it was fascinating to hear from Stacey Burr from Adidas who revealed that most if not all the teams were using technology to help them train and track in extensive detail – she suggested that there is not a single team or sport that is not using wearable technology in some form or another.

You can see some of the gear below

GPS enabled ECG/EKG monitoring Units plug into the back around the neck area
 
Paired with watches to offer players feedback
Digital insides of a ball used to sense how well it is struck

These are the professional versions used by major teams but Adidas is releasing commercial versions that will be available to the general public but lack the GPS capability and the analysis tools they offer

Surprisingly the leaders from a sports and country standpoint are Rugby and Australia and New Zealand who are “light years ahead” of wearable tech in sports

They are ahead in Psyching out their opponents too!

Sensoria demonstrated an exciting interactive future for sports and wearables where we challenge ourselves, other people and are coached by virtual assistants

Sensoria Fitness Shirt with Heart Rate Sensors from Heapsylon on Vimeo.

One of the highlights:Seeing Dick Fosbury of the “Fosbury Flop” Olympic Gold Medal Winner from Mexico 1968 and it turns out he is a Cancer Survivor, has an aneurysm and fully engaged in the intersection between healthcare and wearable technology

Neil Harbisson – Co-Founder, Cyborg Foundation

who was born totally color blind was definitely at the edge of wearable technology. He has an implanted device that turns color into sound and this is directly fed into his brain. He described that it took 5 weeks for the headaches to stop with this sudden input of data and then 5 months before it just became part of him and he now sees in color. Here’s his TED Talk: I listen in Color http://embed.ted.com/talks/neil_harbisson_i_listen_to_color.htmlHe also has a permanent internet connection in his brain so people cane send him colors and images directly (he joked the address is private – but I did wonder given the ease with which spammers seem to find new addresses how he protects this destination from spam!)

I don’t wear technology I am technology, I can’t tell the difference between the software & my brain

The healthcare focused panel: Emerging Wearable 2.0 Health Platforms:

The furthest along and well know was probably Misfitwearables (Sonny Vu, CEO) who try and make sensors “disappear” but still simple sensors

OMSignal (Jesse Slade Shantz – Chief Medical Officer) was the most interesting as they are trying to change the monitoring from attached sensors to using fabric that can be loose fitting but can capture physiological information.

Breathometer(Charles Michael Yim – CEO) focus on analyzing your breath and have a range of products directed at health (over and above their simplistic alcohol breathalyzer available today) that assessed fat burning (using acetone) and asthma

NeuroSky(Stanley Yang – CEO) offer a system that other manufacturers can integrate into their wearables. Typically found in mobile phones or headsets

LUMO(Monisha Perkash – CEO & Co-founder) offering a discreet sensor that is designed to help improve your body posture and works as a tracker.

It’s an exciting future with some fascinating technology to come – one thing for sure – with ubiquitous technology comes ubiquitous complexity and your voice will become an essential tool for successfully managing and navigating. Dragon Assisatnt is one of several tools built to assist in using and navigating technology that is reinventing the relationship between people and technology

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Health Insurance Reform – It’s Not a Bumper to Bumper Warranty

We have some Healthcare reform in the US but we are still challenged with a system that is failing to deliver results. This piece recently: America Ranks No. 1 for Over-Priced, Inefficient Health Care featured the chart from the Commonwealth fund

That ranks the US last in a group of 11 industrialized countries.

As he puts it:

There is one way America is clearly exceptional:  we have a healthcare system that is dramatically more expensive than the rest of the industrialized world, but it doesn’t manage to make us any healthier.While  the Affordable Care Act attempts to address access it does little to address the cost of the system and the inefficiencies. This does not require a reduction in premiums it needs to address the costs built in to the system that we are all paying for in on form or another

Dr Hans Duvefelt wrote this piece on the healthcare blog: A Swedish Country Doctor’s Proposal for Health Insurance Reform that draws on his personal experience in “socialized medicine, student health, cash-only practices and government-sponsored rural health clinic working for an underserved, underinsured rural population.”

His focus is as a primary care physician but most would agree this is one of the most challenging areas for reform with the shortage in clinicians and low reimbursement rates that is driving doctors out and certainly no encouraging our new generating of clinicians to dive into this essential area.

His main proposals center on basic services that are covered by a flat rate for populations

  • Have the insurance company provide a flat rate in the $500/year range to patients’ freely chosen Primary Care Provider, similar to membership fees in Direct Care Medical Practices.
  • Provide a prepaid card for basic healthcare, free from billing expenses and administration.

but importantly changing the responsibility and feedback on the cost from a central purchasing authority (the government for example) to the user themselves.

  • Unused balances can be rolled over to the following years, letting patients “save” money to cover copays for future elective procedures.

And offers a pathway to specialty care with some appropriate oversight and appriroate levels of reimbursement.

  • Keep prior authorizations for big-ticket items, both testing and procedures, if necessary for the health of the system.
  • Keep specialty care fee-for-service.

 These are clever suggestions and would do much to encourage the patient engagement that will be, as Leonard Kish stated

Patient Engagement is the  Blockbuster drug of the century

He rightly points out that the current health “insurance” products are often poorly named – given that insurance that pays and copiers to identify diseases with screening but then stops short of paying to treat conditions and diseases when they are found through that screening. But most of all Insurance should be user driven and priorities and decision left in the hands of the individual and their clinician and not relegated to others who sit in offices emoted from clinical practice and focused on fiscal drivers not on care and quality fo life

Health insurance is not like anything else we call insurance; all other insurance products cover the unexpected and not the expected. Most people never collect on their homeowners’ insurance, and most people never total their car. Health insurance, on the other hand, is expected by many to be like a bumper-to-bumper warranty that insulates us from every misfortune or inconvenience by covering everything from the smallest and most mundane to the most catastrophic or esoteric.

His point about setting of priorities is important – no matter how you cut it there is no unlimited pot of money o resources to treat everything and everybody. These are difficult conversation and ripe for abuse by those with their own agenda’s through fear mongering and use of emotive terms like “Death Panels”.

None of this aspect of reform is simple but it needs to be addressed and included.

The United Kingdom’s National Health Service (NHS) may not be perfect but they have started this process of addressing the challenge of allocating resources in an open manner. They developed the the quality-adjusted life years measurement (QALY) out of the National Institute for Health and Care Excellence (NICE). There has been criticism and push back as there will always be but the concept and methodology use is not limited to the UK. While imperfect as Laozi (c 604 bc – c 531 bc) stated: A journey of a thousand miles begins with a single step

There is lots of detail in this piece and I would encourage you to go over and read it

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How Americans Die

How Americans Die This is a fantastic visual presentation of data that you can look at in more detail on the Bloomberg Site If the embedded page does not work head over there directly here

The main points highlighted

  • The mortality rate fell by about 17 percent from 1968 through 2010, years for which we have detailed data…Almost all of this improvement can be attributed to improved survival prospects for males
  • The surge in for 25- to 44-year-olds was caused by AIDS, which at its peak, killed more than 40,000 Americans a year (more than 30,000 of whom were 25 to 44 years old)
  • AIDS was the single biggest killer of Americans who should otherwise have been in the prime of their lives (Sobering Statistic)
  • 45- to 54-year-olds are less likely to die from disease, they have become much more likely to commit suicide or die from drugs
  • How does suicide and drugs compare to other violent deaths across the population? Far greater than firearm related deaths, and on the rise. (Suicide and has recently become the number one violent cause of death) – (Sad Statistic)
  • The downside of living longer is that it dramatically increases the odds of getting dementia or Alzheimer’s
  • The rise of Alzheimer’s and other forms of dementia has had a big impact on health-care costs because these diseases kill their victims slowly. About 40 percent of the total increase in Medicare spending since 2011 can be attributed to greater spending on Alzheimer’s treatment

They do a great job of slicing the data by cohorts of age groups showing how much we have improved mortality and how our 25 and under age group is benefiting from the health improvements with the lower mortality and higher life expectancy than any other cohrot