NEW @ THCB PRESS: Surviving Workplace Wellness. Spring 2014. Al Lewis and Vik Khanna. e-book edition. # INNOVATION: PCORI APP Challenge

These days my physician colleagues and I are up to our necks in a health technology revolution.  To be honest, its not as captivating as Pinterest or socially-engaging as a Google Huddle but to be sure your life will depend on it.  The revolution ushered in by electronic health record (EHR) is less about the technology than the widespread impact it will have on patient care.  Rather than digging through stacks of paper charts, your doctor will have ready access to all of your health history on a digital device.  And not just your health history, soon I will be able to combine it with the history of other patients in my practice: the digitized data will allow me to track the childhood obesity rate in my clinic and trend it over time with just a click (or tap).  But look out, there are glimmers of another emerging health tech revolution.

I recently attended the Health Innovation Summit organized by Rock Health, a seed accelerator for health startups based in San Francisco.  Coming from the bureaucratic and comparatively stagnant world of health care systems, this event made me feel like I could dream again.  Speakers provided pearls of wisdom for an engaging design.  Panels offered strategic advice to attract VC and Angel funding.  Most exciting was the chance to hear from entrepreneurs, each of whom offered their own incremental solution to improve health.

Take something like Cardiio, which measures heart rate in a few seconds by scanning your face.  Imagine how future related technologies could replace monitoring wires and tubes thereby improving comfort during a hospitalization and reducing hospital acquired infections.

Business wisdom dictates that a successful entrepreneur have an intimate understanding of the intended user.  In health care, the corollary is to know how the product fits into the user’s work flow.  The work flow includes every step from the scheduled appointment to the end of the visit and any follow up contact.  As a busy primary care physician, I can’t afford to use something new unless it is convenient to access and makes my normal work routine easier.  But for a patient, how can the products featured in the conference fit into their personal health work flow?

Here is a case study of a not so distant and very possible future:

My mother has chronic back pain, the second most common reason patients see doctors.  She has been on Health Tap soliciting advice from participating physicians about treatment options.  One useful recommendation comes from a physician who practices in her area so she decides to go see him in his office.  Being a good son, I have been doing my own research for her back pain so I send the doctor some key articles via Docphin, a health information aggregator for health professionals.   During the back exam my mother admits that when busy, she may not pay as much attention to her posture as she should.  The doctor discusses good posture and shows my mother how she can keep tabs on her posture throughout the day by attaching a sensor to her back and using the LumoBack app.  The physician notes that my mom appears to be under a lot of stress and suggests she try the Azumio stress app to assist her with making small adjustments in her lifestyle for large reductions in stress.  And while she is thinking about small changes, she also suggests using Bud.ge to help develop other healthy habits.  My mom tends to forget things so I worry that she is not taking her medications as prescribed.  With these ingestible sensors her physicians and I can track the “when” and the “which” of each medication she takes

Wow.

But lets be honest.  Compared to the central role of EHR, many of these emerging technologies are only tinkering on the edge of vast needs in health.  History says that most startups will fail.  But it is time to pay attention because some of these products or their future iterations will revolutionize our lives.

Ricky Y. Choi, MD, MPH is pediatrician in Oakland, CA and health technology entrepreneur.  He is Co-Founder of HealthBegins, a nonprofit think-tank that demonstrates how smart medicine begins upstream.  He is also a City Brights Blogger for the San Francisco Chronicle where he writes about health technology innovation and the use of social media to improve health. Follow him on Twitter @rychoimd

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7 Responses for “Startups: The Other Health Technology Revolution”

  1. BobbyG says:

    “But lets be honest. Compared to the central role of EHR, many of these emerging technologies are only tinkering on the edge of vast needs in health. History says that most startups will fail. But it is time to pay attention because some of these products or their future iterations will revolutionize our lives.”
    __

    Lawrence and Lincoln Weed would most certainly agree. I could not recommend their new book “Medicine in Denial” more highly.

    __

    “The underlying asset is delivery of medical care. Its affordability depends in large part on the behaviors of both providers and consumers. Their behaviors depend in large part on the system within which they function—on the infrastructure of standards and tools and processes for decision making, feedback and accountability. Transforming that infrastructure must be the foundation for health care reform.

    Policymakers recognize that transformation requires more than technology. Accordingly, certification and “meaningful use” of electronic health records (EHRs) are required to receive subsidies to purchase EHRs under the 2009 economic stimulus legislation. But the requirements for certification and meaningful use as currently conceived are primitive. They fail to incorporate or even consider most elements of the problem-oriented medical record (POMR) standard (the subject of part VI), which became prominent four decades ago. Since that time, the quality of medical records has declined. Use of the POMR standard has receded, and the clinical purpose of the medical record has been compromised. The latter phenomenon was observed in 1992:

    The medical record is already changing in subtle ways that few people are objecting to or even noticing. Much of the record now functions as an annotated bill prepared for third-party payers. This can have the chilling effect of making our patients appear sicker than they are, as physicians strive to add enough pathologies (and ICD-9 codes) to justify the hospital and physician services the patient is receiving. We need to think about ways to reclaim the chart for the patient.

    This corruption of medical records is now so entrenched that current observers see it as the norm, not as a decline from what medical records used to be. A July 2010 article states:

    “The old problem many physicians are trying to solve with an EHR is the efficient generation of a progress note—a document used to justify payment in a fee-for-service system, in which an office visit is the unit of value. … [EHRs facilitate] more aggressive fee-for-service coding and more frequent use of higher-level primary care billing codes, both supported by more comprehensive documentation. … However, primary care practice poses a different problem: managing the massive amount of information received about patients every day and using it quickly, efficiently, and safely to meet patients’ needs.”

    Failures of quality in medical records, paper and electronic, are a root cause of the health care system’s failures of economy. The HITECH Act reforms effectively acknowledge this reality, but fail to remedy it.”
    __

    The biggest bang for the buck is going to come from a synergy of a variety of tactics, which, to be sure, will include innovative new technologies, But at the core we will have to do a full-court press on effective patient self-management support, especially focused on the major Chronics that suck up so much of the money, e,g., CAD, COPD, CHF, DM, HTN etc.

    One area of tech “innovation” we need is that major of EHR and HIE improvement. Read the Weeds’ book for the full scoop on that.

    • Kaveri says:

      The advent of EHR, though, has a long way to go in terms of revolutionizing health care. While it undoubtedly has potential for improving patient care, it also opens avenues for errors- for example, every institution using a different software makes centralization of health care records difficult. The training required on each new system, as people move through various institutions for medical school, residency, rotations, etc means the possibility for mistakes and wastage of time.
      ” Failures of quality in medical records, paper and electronic, are a root cause of the health care system’s failures of economy. The HITECH Act reforms effectively acknowledge this reality, but fail to remedy it.” This should be a point of focus prior to electronic medical records becoming the norm.

  2. BobbyG says:

    Yes. Read Medicine in Denial. See also the works of JD Kleinke, e.g.,

    http://regionalextensioncenter.blogspot.com/2011/06/use-case.html

    I could not agree with you more regarding oversupply of proprietary EHR systems.

  3. archiemerry says:

    This corruption of medical records is now so entrenched that current observers see it as the norm, not as a decline from what medical records used to be. A July 2010 article states.
    Maaji

    • Kaveri says:

      I do believe the transition to EHR has been beneficial in lots of ways, thus I wouldn’t call the current state of medical records a decline from the past.. I just feel that we need to recognize the great potential for problems this oversupply can and is creating…

      To share a personal experience, I once had a patient’s family member blow up in rage at the fact that he had to repeat his critically ill wife’s medical history, list of medications, allergies time and time again and every institution as he sought second and third opinions. His point that the patient, who may be so ill that he or she may not be the most reliable source for information, should not be the only one with the true medical history, really struck home. While we’ve come a long way in improving efficiency of medical record keeping, we may still have quite a ways to go…

  4. Kristen says:

    “Trust” has been the keyword in many discussion panels here in DC. Figuring out appropriate HIEs that are protected AND accessible across the board is tricky. http://bit.ly/y2rpCt

  5. Very interesting details you have noted , thanks for posting .

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