Welcome to Day 2 of the Health 2.0 conference.  There was an interesting talk this morning focused on “Consumer Aggregators”, which demoed new applications from WebMD, Google Health, and Microsoft Heath Vault.

Wayne Gattinella of WebMD summarized the state of affairs, saying that people want to access information on the go, and there’s a drastic need for medical applications to go mobile.  According to Gatinella, this means creating applications for both physicians, in a point-of-care setting, as well as patients, who want on-demand information about their health.

All three companies agreed that people are sharing more and more personal health data online these days.  Gattinella paralleled patients sharing their medical information to using credit cards online 10 years ago.  At first, people were skeptical and scared.  After successfully trying it out a few times, fears subsided, and the convenience benefit far outweighed the perceived risk.

Each application displayed different, but equally cool, themes.  Microsoft built their application around the idea that patients should be able to customize the layout as they wanted — place your blood pressure widget here, your LDL cholesterol level widget over there.

Google Health’s application stressed the fact that less than 25% of what a doctor tells a patient during an office visit is actually remembered by that patient when they get home.  Google closes this gap in communication in the MDLiveCare application by feeding all of the doctor’s notes back into the patient’s Google Health record, so that the patient can recap the visit at a later time.

WebMD had a nifty iPhone application with a ‘symptom tracker’, which launched with of a cartoon-like drawing of a human body (i.e. the “virtual patient”).  Sore ankle?  Click on the virtual patient’s ankle, and you’ll be presented with some common symptoms that involve the ankle, such as ‘swelling’, ‘rash’, or ‘laceration’.  As the patient navigates through the menu system and answers questions, their symptoms are further refined until the system figures out what is wrong.  Ultimately, the patient is presented with a description of the possible problem, e.g. “Click here for information on ankle sprain”, which takes you to the WebMD entry for sprained ankles.

I really liked how the focus of this group was “on-demand” information, and all of the applications were tailored to helping the patient gain control of their medical information.  The data is theirs to begin with, let’s give them a way to harness it…

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The morning session focused on clinician-patient interactions.  Executives from Myca, VisionTree, AmericanWell, and ReachMyDoctor, presented their virtual doctors’ office visit tools.

All of the tools had similar features, such as online scheduling, and the choice of different types of offices visits, such as IM chat or video.  Most integrated well with personal health records, so that during an office visit, the physician had access to the patient’s medication refill history, or overdue routine preventive medical tests, such as blood-work, prostate screens, or mammograms.

At the end of the panel discussion, several good questions were asked.  People wondered what incentives were in place for physicians and patients to use the system, especially if each doctor was using a different system.  Does this mean that the patient will have to log on to two different websites if their general practitioner uses HelloHealth, but their cardiologist uses AmericanWell?  The panel responded that each of these web applications was part of a larger central platform.  It may be more helpful to think of each web tool as an individual iPhone app.  iPhone apps can communicate with each other and run on a single system (phone), so it’s possible for these individual web tools to play nicely together in the future.  One question I had: where are all of the patient tools that plug into this central platform?  Maybe that’s tomorrow’s talk…

The second session brought out some pretty tough critics of the virtual doctor’s office idea.  Although these new panelists liked what they were seeing and hearing, at heart, they were still physicians that saw many challenges to using these products in their own practice.  A psychiatrist was the first to challenge, saying that good psychotherapy demands face-to-face interactions.  I’ve seen this type of push-back from doctors before while consulting at medical device start-up companies.  No matter how transformative or revolutionary the new technology could be, unless doctors can easily integrate the technology into their current practice, the idea may flounder.

Yesterday at the Kaiser HealthCamp Un-Conference, a cool term surfaced — “minimally disruptive technology” — which was used to describe an approach to reform health care technology that pushed progress, while not upsetting the status quo, so to speak.  Granted, there is a learning curve associated with any new technology, and to implement an idea such as virtual doctors’ office visits will require significant infrastructure changes in the medical community.

Will only a fringe group of early adapters use this technology?  Is it realistic to think that a majority of doctors will use such a system?  Too early to tell, but it wouldn’t hurt to get some of the nay-sayers involved with the design while the concept is still in its early stages.

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As a prelude to the Health 2.0 conference in San Francisco, I went to Kaiser Permanente’s HealthCamp today, located at their amazing Garfield Innovation Center.  Being a scientist, I’ve attended my fair share of conferences over the past years, but none prepared me for what I experienced today at my first “un-conference”.

First, for those who don’t know, an un-conference has no set agenda; the sessions are made up by the attendees the morning of the conference.  This way, the topics covered throughout the day truly reflect the attendees’ interests.

First up, were three introductory talks by leaders in the Health 2.0 community.  Dr. Robert Pearl, from Kaiser Permanente set the tone for the day when he described a sign he noticed over a decade ago at Oregon Health & Science University that read “Quality, Service, Cost”.  Dr. Pearl said that the 20th century mentality for health care could only focus on 2 of the 3 at any given time.  But now, in the 21st century, we need to address all three simultaneously.  Dr. Pearl challenged the notion that doctors are old-school, or that they are unwilling to learn new technologies, claiming that they are constantly looking for innovation.

A common theme in the opening talks was best summarized by Dr. Kaveh Safavi of Cisco, who said we need to distinguish between “personal care” and “in-person care”.  Dr. Pearl agreed, and believes we are on the cusp on integrating tele-medicine in the emergency room, so that patients will have more, and faster, access to specialists, which will streamline medical care.  Patricia Perry, of Intel, concluded the opening remarks with her insight into “Aging at Home”, where in-home patient medical monitoring and video-based doctors’ visits can actually improve medical care for senior citizens.

I spent the rest of the day floating around to different sessions, trying to absorb as much information as humanly possible.  I heard some really interesting concepts being discussed, such as creating a “LifeScape”, which is the intersection of our different worlds: such as work, health, and communication.  People thought that to be truly innovative, we had to find ways to create “stealth health”, where healthy decisions are simply a consequence of another easier choice.  One design example was a school’s lunch line: research shows that if apples are placed before the sweets in the line, kids are more likely to make the healthier choice.

In another session, I learned about a cool new social media site called Aardvark, which answers users’ questions by connecting them with “experts” in the field.  So opposed to crowd-sourcing your question to your friends on twitter, now your questions gets directed to the people who may best answer it.

Self-tracking was a popular topic, and I see more and more people unleashing the power of personal data.  I heard the battle-cry for more effortless sensors, where data is collected without any extra work by the user.  But I found out that many people still aren’t interested in the nitty-gritty details of the data.  Rather, they wanted all personal metric information to boil down to one measurable “health score” — a single number that defined their health.

All in all, a solid day of innovation, great conversations, and a heck of a way to kick off Health 2.0 week.  Lastly, the organizers did a fantastic job with the event.  The un-conference format is great way to initiate dialogue and get involved.  I’ll definitely be back to HealthCamp next year.

Stay tuned the rest of the week for my updates from the Health 2.0 conference!

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There’s no way around it, smoking is bad for you.  On top of the negative health effects, smoking also strains our economy.  In fact, current estimates suggest $100 billion health care dollars could be saved each year by reducing the number of smokers.  So to offer some food for thought for any smokers out there, I wanted to share some of my recent findings.

First, I came across some interesting statistics that I wanted to share (from Science Progress):

19.8 percent of adults in the United States (43.4 million people) were current smokers in 2007.

30 percent of all cancer deaths involve smoking as the primary cause.

443,000 people died prematurely every year as a result of smoking and exposure to tobacco smoke during the period between 2000 and 2004.

During that same period, smoking caused $98 billion in productivity losses each year.

For every person who dies of a smoking-related disease, 20 more people suffer with at least one serious illness from smoking.

20 percent of high school students were smokers in 2007.

3,600 people between the ages of 12 and 17 pick up smoking everyday.

I also found an interesting study that discussed the paradox of nicotine use: Users are thin and have low body fat, but are at an increased risk of cardiovascular disease.  So what is it in cigarettes/nicotine that’s causing heart problems?  A research group at Charles Drew University investigated the effects of giving nicotine to mice.  Although the mice lost weight and ate less than the control animals, the nicotine-fed mice developed insulin resistance, which is a precursor to diabetes, and may explain the increased development of heart disease in nicotine users.

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When I discuss the ideas of creating a proactive patient with others, I often sense a bit of hesitation and skepticism in their voices.  “Is our current health care system ready for a patient participating in their own care”, they’ll ask.  The optimist in me wants to say “of course”, but realistically, I know there are many challenges we’ll face in trying to change the status quo.

Despite the bumps in the road ahead, I simply don’t believe we can wait for the health care infrastructure to come up to speed.  I was recently reminded of this when reading The New York Times feature on the fact that health care and insurance companies are not accepting new cancer therapies.  Rather than traditional intravenous (i.v.) drugs, some chemotherapeutic medicines are now available in pill format.  The patient no longer has to visit the clinic to receive treatment — they can just pop the pills at home.  Although it seems like a logical step in medical treatment, the pill therapy has not been well received by health providers and insurance companies.  Doctors may be reluctant to prescribe the cancer pills for a number of reasons, such as wondering whether patients will remember to take the pills on their own, or loss of revenue, since doctors can charge for the clinic time required to administer the i.v. drugs, but cannot do so for pills taken at home.  But most damaging to the pill therapy is the fact that insurance companies are not reimbursing this treatment at the same level as i.v. treatment, which means high out-of-pocket expenses for patients.

While this case describes a very drastic change in the health care status quo, it’s essence highlights the common lag between progress and acceptance.  Change is occurring, the health care infrastructure is resisting, and, most importantly, patients are losing.  That’s why I think it’s important to address the issues involved in making the next generation patient now, before they create such a large divide between the traditionalists and the progressives.  Incremental changes are easier to digest than large ones.  Perhaps if just a small number of us start arming ourselves with genetic information, personal biometrics, and an increased knowledge of medical and scientific information, we can help smooth the road ahead.

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In my opinion, our inalienable rights should be restated as the title of this post suggests.  But despite my wishful thinking, health care costs continue to rise.  By 2030, the boomer generation will place 57.8 million people in the 66-84 age group, further burdening current government funding for Medicare.  The outlook is bleak, and the system needs fixing.  One idea for lowering health care costs is to move health services out of the clinic, and into the home.  New web-based services and personal diagnostic equipment now enable patients to receive medical care from the comfort of their living room.  Is it realistic this model will reduce costs and stick?  I’ll cover the web-based services in this post, and follow up with another post on home diagnostic equipment.

Web-based doctor’s appointments are now available in several states.  For example, at $10 per month, and $50 per consultation, SwiftMD offers an online health care plan in New York and New Jersey.  Within 30 minutes of scheduling an appointment, subscribers have either a phone conversation or an online video chat with an available physician.  If prescriptions are required, the physician sends the request electronically to the pharmacy of the subscriber’s choice.  A step further in service, Hello Health adds conveniences such as the ability to text, instant message, or tweet your doctor, and also offers clinic appointments or house calls for more serious conditions.  Both SwiftMD and Hello Health do not cover major medical expenses, so if the subscriber has to go to the emergency room or be admitted to the hospital, the cost is theirs.  Also, neither accepts insurance, but compared to ever increasing health insurance premiums and the number of uninsured patients, an affordable “pay for what you need” model may just work.

A recent article highlighted the services of Hello Health, and discussed the ways electronic media is reshaping health care.  More important than describing cool, new ways to communicate with your doctor, and boutique concierge services offered by modern clinics, the article does a fine job pointing out the importance of social networking in the future of health care.  Physicians use websites such as Sermo and UpToDate to stay abreast of advances in health care and treatment, as well as to network with other doctors in the field.  Patients, on the other hand, have traditionally been stuck with tools such as WebMD, NIH’s MedlinePlus, and the Mayo Clinic site, all of which just give background information on diseases, and pave the way for dangerous self-diagnosis.

Such patient websites provide little help to the proactive patient who is curious if others with a certain condition are experiencing similar symptoms or medication side effects.  Enter PatientsLikeMe, a website that focuses on user-generated data (via self monitoring and reporting) and lets others know what to expect on the road ahead.  PatientsLikeMe provides a useful social networking community if you are already diagnosed with a condition, but what if you are a 40-something male with a BMI of 28, blood pressure at 135/85, and recently diagnosed with metabolic syndrome?  Is there anyone out there with similar stats that can offer information about what regiments have kept them healthy?  In other words, let’s not wait until we are diagnosed with heart failure to seek out advice from our peers — we need social networking tools when we are still just “at-risk” for the disease.

While electronic access to your physician is much cheaper than going to an office visit, to truly drive health care costs down, we need to increase the personal responsibility of the public — we need to heighten our medical knowledge, track our own body metrics, and pool our data.  Social networking sites provide the necessary framework to disseminate such information and personal experiences across large populations.  Armed with the proper information, patients will be able to make their own decisions about their health.  Now that’s a true health care revolution — so go tweet your way to better health.  I’ll discuss home diagnostic testing soon…

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Suffering an orthopedic injury can be devastating. It can preclude us from athletic competition or force us to take time off work, not to mention the added strain it puts on completing normal daily tasks while partially immobilized or in pain. Regardless if surgery is required, a physical therapy rehabilitation program is usually prescribed to aid recovery. Say hello to countless hours of sweat, pain, and foul language (primarily in the form inner monologue, often directed toward the therapist that you are certain is trying to tear your limbs from your body, but occasionally a choice expletive might just slip out in frustration or exhaustion). Well, not necessarily, says Caitlin Kelly, who recently blogged about what she felt was the unsuspecting upside of physical therapy– the healing power of the friendships formed during the sessions. Day after day, through all the pain and suffering, she got to know and relate to other patients, and maybe even more importantly, developed an open-communication relationship with her therapists. Ultimately, the injury healed, and the unforeseen personal bonds persisted long after the pain subsided.

Read more…

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The ideas behind The Decision Tree, in a sense, focus on ways to create the next-generation patient.  This new kind of patient will have to understand the context of their own medical self through a combination of genetics, personal metrics/data, and statistics.  Needless to say, understanding one’s own medical self will also require an increased medical literacy, where patients understand both their conditions, as well as where they fall within the spectrum of their disease.

Creating the next-generation patient will inevitably require new tools.  Website services, such as PatientsLikeMe, have been a step in the right direction towards increasing patient knowledge by empowering people with general knowledge of their conditions, as well as and providing information of what others in their shoes are experiencing.  However, focusing on the patient may only address half of the problem.

MedEncentive, a start-up company founded in 2003, approaches the issue of medical literacy by addressing both players in the problem, the physician and the patient.  MedEncentive’s product focuses on developing, or even better, redefining, the doctor-patient relationship.  A statistic listed on their website states that on an average office visit, the physician will interrupt the patient within seconds of entering the room, while the patient only comprehends a fraction of the information given to them by their doctors.  Drawing from my own mixed experiences dealing with physicians – including a recent diagnosis botched 3 times in a week – I could see how this could be true.  If a patient had an increased understanding of their conditions, perhaps this interaction would not be so one-sided.

The company’s core product is an incentive program for doctors and patients that centers around the exchange of medical information. Doctors who participate in the medical literacy program can earn about 20% more (~$15) per office visit by assigning their patients a “to-do” list.  The company mentions some of what this list might include, such as questionnaires which determine how much a patient understands about both their current health status and the conditions they’ve been diagnosed with, as well as how they would rate their doctor’s performance.  The patients earn rewards, such as copay reimbursements or health savings account credits, for completing their reading assignments and the questionnaires.

According to the company, a medically literate patient will communicate more efficiently with their physician, while medically illiterate patients will consume more health care resources.  But do people really care about this?  Sure, it would be nice to reduce health care costs and make doctors and patients best friends, but is it really a big deal if a patient doesn’t understand the ins-and-outs of their conditions? If you are not sold on the benefit of developing the doctor-patient relationship, consider the following figure.  It was taken from a study conducted by physicians at Northwestern University and Emory University on the 5-year mortality rate of an elderly population.  Medical illiteracy can become dangerous when it leads to an increased risk of death.  So based on the outcome of this study, MedEncentive’s thesis makes sense: when patients know more about their medical conditions, they have better health.

I acknowledge that there is a confounder to this study — it was conducted in an elderly population.  As we all know, the cognitive abilities of the elderly vary drastically across the population.  For example, your 90-year old grandfather may be self-sufficient, living on his own, and sharp as a tack, while my 90-year old grandmother requires assisted living.  So one question I asked myself when looking at this study was: are the people who are in the medically illiterate group also the ones who are in assisted living?  In other words, is the increased risk of death due to the fact that the patient doesn’t understand medical jargon, or is it due to an overall decline in their mental capabilities?  Luckily, the clinical team already addressed this question.  They found that both an increased medical literacy and a higher cognitive ability both independently indicated a longer, healthier life.  So those that understand their medical conditions will live longer, but so will those who can still do the New York Times crossword puzzle themselves.

My take: The benefits of medical literacy, as outlined here, are: 1.) knowledge can improve the doctor-patient relationship, and 2.) knowledge can improve health. The Decision Tree is not about a single factor influencing a healthy life, rather it discusses a collective set of behavioral changes that lead to new way to think about and treat disease. I think the results discussed here show that medical literacy is an important piece of the next-generation patient puzzle.  In the future, we will be asking a lot from patients, as more of the responsibility for staying healthy will be shifted to them.  So I like the approach of MedEncentive to get the doctor involved as well.  In the end, what we end up with is the next-generation patient, as well as a new breed of physician — one who is willing to break the current mold.

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A couple observations on the official announcement today that Obama will nominate Tom Daschle as secretary of Health and Human Services as well as oversee an office of healthcare reform. This officially designates healthcare as a leading issue for the administration – but not in the 100 days sense. Daschle talked about a process of several years, which may be simply a way to carve out some breathing room but also to avoid the impression that they’ll go in there guns-a-blazin’ like Clinton did in 1992, only to come up empty (is that one metaphor or two?).

Also, very intriguing to hear Daschle talk about soliciting input from all Americans, via house meetings (Daschle promises to sit in on a few) and suggestions posted on Change.gov. “Over the next few weeks, we will be coordinating thousands of healthcare discussions in homes all across the country through our Web site, change.gov, where ordinary Americans can share their ideas about what’s broken and how to fix it,” Daschle said.

Obama calls this part of an “open and transparent process,” but another word for it – if he’s serious – is opensource healthcare reform. In this case, I think that’s a great idea. One, it gets buy-in (or creates the impression of buy-in) from the populace, getting them on board with what has been demonized as freightening change or “socialized medicine.” And two, it acknowledges that healthcare is an infinitely complicated beast, and demands to be considered from every perspective. Crowdsourcing has been used a bit by some government agencies – most inventively by NASA and its “clickworkers” effort a few years back – but never far as I know to hash out real policy reform. It’ll be interesting to see what, if anything, the power of the crowd comes up with that 50 years of expert (though failed) wonkery hasn’t thought of.

One side note: I think this is also the first official suggestion of what the Obama administration might do with Change.gov post-inauguration, as well.

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