digital health


Data Response Curve

All medical students learn about the dose response curve in pharmacology lectures. The dose-response curve informs us of how we should dose a medication in the context of its efficacy and its toxicity. Too little medicine won’t have the desired effect, and too much medicine can be toxic.

In the era of digital health, data have become the new “big pharma,” and we are facing the emergence of a data-response curve in which access to too little data is inactionable, and access to too much data can be overwhelming. Digital health devices abound today, and has enabled quantification of nearly every health and wellness metric imaginable. Sadly, in our exuberance about these new sources of data, we often conflate “more data” with “better data.”

In the era in which data have become the booming commodity of exchange in healthcare, we describe an emerging data-response curve. Large data sets can be at best clarifying or at worst self-contradictory. Too little data on the data-response curve, as with medication dosing, can be insufficient for effective action or decision-making. Too much data can be toxic to the user such as the physician, leading to poor decisions or worse, to analysis paralysis.

We live in a world of exploding data, and we need to be thoughtful. Medicine is a people business in need of data, not a data business on need of people. In reductive form, all humans make decisions based on inputs (data) from their environment and on individual analysis of the data in the form of non-linear, non-quantifiable perception. When we as doctors, policy-makers, or simply as human beings receive these inputs, one of three things happens: 1. We make a decision to do something (for example a treatment decision based on abnormal data), 2. We make a decision to do nothing (for example, normal data which we believe requires no action), or 3. We need more data in order to make an informed decision to do item #1 or item #2. More does not necessarily equal better data. More data is simply more.

Better data are actionable data wrapped in the context of the patient and the patient’s condition. Imagine each piece of objective data connected to concurrent subjective data, and surfaced in the context of a specific condition relevant to the patient. HealthLoop enables patients to generate contextual objective data married to their subjective symptoms and served to a clinician in an actionable context. High signal and low noise are the digital health equivalents of on the dose-response curve of a favorable therapeutic window.

See where some folks live on the Chart. Where do you live?

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Apple Senior Vice President of Software Engineering Craig Federighi

I am writing this from the Apple Worldwide Developer Conference (WWDC) here in San Francisco, where I got to substitute for John Halamka at the Keynote (now I keep having urges to raise Alpacas); John missed the most amazing seats [front row center!].

There were many, many, many (I can not recall a set of software announcements of this scale from Apple) new technologies that were announced, demoed and discussed, but I will limit this entry to a few technologies that have implications for healthcare.

If you remember the state of digital music, prior to the introduction of the iPod and iTunes music store, that is where I feel the current state of the healthcare app industry is at; there is no common infrastructure between any of the offerings, and consumers have been somewhat ambivalent towards them as everything is a data island; switching apps causes data loss and is not a pleasant experience for patients.

Amazingly there are 40,000+ apps on the App store at Apple alone, showing huge demand from users, but probably a handful can talk to each other in a meaningful way; this is both on the consumer and professional side of healthcare.

Individual vendors such as Withings have made impressive strides towards data consolidation on the platform, but these are not baked into the OS, so will always have a lower adoption rate. If we take the music industry example further, Apple entering a market with a full push of an ecosystem at their scale, legitimizes the technology in ways that other vendors simply can’t match.

Continue reading “Apple Enters the Healthcare Software Ecosystem”

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jean-luc neptuneWhat Digital Health Innovation Initiatives Did We Pursue at Health 2.0?

In my last post I talked about the many provider- and innovator-facing issues limiting the adoption of digital health technologies in health delivery enterprise settings (e.g. hospitals, physician offices, etc.).  As I alluded to in the piece there are some approaches that are working well and one in particular that I think gives us a chance to really accelerate the pace of innovation.  In today’s piece I’ll talk about some of these initiatives.

At the Health 2.0 Developer Challenge program we focused on using prize competitions as the primary tool to help health care providers and other stakeholders innovate and effect change at their organizations.  Health 2.0, with the support of the Department of Health and Human Services (HHS), Office of the National Coordinator (ONC) and a broad range of for-profit and non-profit partners, pioneered a number of different prize competition formats including - hackathons, challenges, and pilot programs:

Hackathons

A hackathon (what we also called a “code-a-thon”) is an in-person competition event in which developers, designers, technologists, health providers, researchers and others work together closely over a very short period of time (generally 1 to 2 days) to build technology solutions to health care problems.  Hackathons are generally focused on a specific theme and center around the utilization of a specific dataset, API (application programming interface), or other technology.

In terms of the potential to help patients and providers the most impactful hackathon project we managed was the “Code-A-Palooza”, a 2-day event that took place as part of the 4th Annual Health Datapalooza (formerly known as the Health Data Initiative Forum).  The Code-A-Palooza challenged participants to utilize newly-released Medicare claims data and other data sources to help providers better understand their patient panels from both a clinical and financial perspective. The event generated a number of interesting ideas and prototype applications that had real applicability in the provider setting and could make their way into the clinic with further development.  The Code-A-Palooza was successful for a number of reasons, including:

Code_A_Palooza_Logo_200

  • Focus – Our partners at HHS and ONC did a great job in defining a relatively narrow focus for the event and specifying a clear aim – i.e. helping providers develop actionable insights from a very important dataset.
  • High Value Resource - The Code-A-Palooza gave developers access to a very high value source of information, namely Medicare part A and B claims for 2011, a dataset that had been largely unavailable to the innovator community in the past.
  • Support – Finally, teams at HHS and ONC provided a high level of support to event participants, including an excellent “pre-game” orientation session, which allowed the attendees to hit the ground running.   In addition, a number of participants in the hackathon were physicians, as was one of the event organizers (the ONC’s Rebecca Mitchell), which greatly helped the participants develop insight into real issues faced by providers.

Overall, hackathons are an interesting innovation tool with a great deal of potential, which is why a number of major technology companies, most notably Facebook, use hackathons on a regular basis to stimulate internal innovation and experiment with new ideas.  Hackathons can help innovators access the health system and develop a better understanding of relevant health care issues through collaboration with providers sponsoring or participating in an event.

Continue reading “Thinking Out Loud About A New Approach To Digital Health Innovation – PART 3″

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apple storeJe n’ai fait celle-ci plus longue que parce que je n’ai pas eu le loisir de la faire plus courte. —Blaise Pascal

Translation: I have made this longer than usual because I have not had time to make it shorter.

As Appley as it gets.

A while ago I was challenged to write about what an Apple-like approach to healthcare might look like.

That challenge has been weighing on me.

For starters, we’re all over Appled aren’t we? Maligned anecdotes about Steve Jobs and the iPhone make their way into almost every presentation remotely related to innovation or technology. Triteness aside, I’ve been stalled because Apple is really a philosophy, not a series of steps or lessons learned. (Although, they are nonetheless methodical.)

Instead, what I’ve been kicking around in the ole noggin are three notional predictions, which I’ll assert are inevitabilities which will fundamentally disrupt healthcare delivery as we know it today.

What follows is about as Appley as I’m likely to get. Despite big-bang product launches, Apple actually plays the long game. They introduce small features into products to affect user behavior years before a flagship product takes advantage of those reprogramed behaviors.

That’s how they disrupt.

I believe there are three meaningful, unstoppable trends, in our current world which will significantly alter healthcare. The steps taken towards these inevitabilities, along the way, are what will define the innovators and leaders. They are the ones who see this future and know how to drive towards it.

The three trends are:

  • Tools and culture which favor individual empowerment
  • The commoditization and automation of diagnosis
  • Accelerated globalization of treatment options

But wait, there’s Moore.

Don’t worry, I’m not going to leave you hanging. I’ll attempt to rationalize each of these points and explain why, particularly when considered as a bundle, they are a powerful force for disruption. And to prime that pump, we have to talk about Gordon Moore.

Continue reading “Moore’s Law in Healthcare – Three Predictions”

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After years of speculation about a possible name change, Health 2.0 has become mHealth & Associates. My partner Co-Chairman and CEO Indu Subaiya and I didn’t take this move lightly. We were though concerned that the tired “2.0″ moniker is now thoroughly discredited by the emergence of the fully interoperable semantic Web, particularly as it’s been demonstrated in the healthcare sector in the US in recent years. In addition leading luminaries such as Chris Schroeder have finally realized the importance of the brand new smart phone devices that we’ve been ignoring for most of the last decade. And after some prompting, we were convinced by the intellectual rigor of the wider mHealth movement with its clear definition of mobile health, including the incorporation of highly portable technologies such as televisions bolted to the walls of hospital rooms.

Admittedly, while mHealth Intelligence and the mHealth Challenge roll off the tongue, we were a little stuck by what to call our main Fall conference–our organization’s best known event. But while mHealth Summit, mHealth Conference and most other variants are already use, we think that clear market visibility will surround out new name. So instead of the 8th Annual Health 2.0 Fall Conference, this September we’ll welcome you to the First mHealth Confabulation.

Finally we wanted to acknowledge the role of  our wider movement, our team and our 75 chapters across the globe, so we have added the “*& Associates” moniker to the name. In recognition of their contributions all mHealth colleagues will now be known as Mobile Health Associates or in its shortened version, as an “mHealth Ass.” Indu has suggested that I adopt the title of “Biggest mHealth Ass.”

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Apple transformed portable music players. It redefined what we expect from cell phones. It brought tablet computing to the masses.

Is the company planning to do the same for mobile health?

Some industry watchers think so.

This isn’t a small venture. Apple executives suggest that Healthbook is being positioned as perhaps the key selling point when the company releases its next operating system for iPhone, likely later this year. And the app also may pair with a new “iWatch” that’s under development and will contain biometric sensors.

In his lengthy post, Gurman further details how Healthbook is expected to work. Its interface is ”largely inspired” by an existing iPhone application called Passbook, which is intended to centralize a user’s boarding passes, loyalty coupons, and so on in one place. Beyond fitness and diet, the app also has sections devoted to tracking physical activity, our sleeping habits, and hydration.

And Healthbook will offer blood monitoring features—”perhaps the most unique and important elements of the application,” Gurman writes—although it’s unclear exactly what it will track beyond oxygen saturation and glucose levels.

App’s appearance not unexpected

The long-awaited screenshots of Healthbook follow months of reports that Apple’s readying a push into the health care space. While the company’s interest in the sector is nothing new—my team has spent years covering its health-related innovations—Apple’s recent focus has been much more discrete.

Continue reading “The Apple Has Landed”

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For the last five year or so, digital health has been the Rodney Dangerfield of investment sectors, getting more attention than respect, and garnering more page views than dollars.

However, two important events reported in the last several days suggest all this may be about to change.

First, Fortune’s Dan Primack broke the news on Saturday that Castlight Health — a startup co-founded by U.S. Chief Technology Officer Todd Park in 2008, with the intention of providing increased transparency to healthcare costs – has secretly filed an IPO; an astonishing valuation of around $2B is anticipated.

That’s both impressive growth and serious money, and suggests it’s possible to win – and win big – in digital health.

Second, two complimentary reports from last Friday collectively suggest that Apple is starting to take healthcare very seriously.

For starters, the New York Times reported that Apple executives met with the FDA in December 2013 to discuss mobile medical applications.

In addition, 9to5Mac, a website devoted to “Apple Intelligence,” claimed that the next version of the iPhone operating system, iOS8 – slated for release later this year – will introduce an application codenamed “Healthbook” that is “capable of monitoring and storing fitness statistics such as steps taken, calories burned, and miles walked,” according to 9to5Mac.

Continue reading “Apple Said to Weigh Digital Health Play”

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A few weeks ago, I went for the first time to Stanford’s Medicine X conference. It’s billed as a conference that brings a “broad, academic approach to understanding emerging technologies with the potential to improve health and advance the practice of medicine.”

Well, I went, I saw, and I even briefly presented (in a workshop on using patient-generated data).

And I am now writing to tell you about the most important innovations that I learned about at Medicine X (MedX).

They were not the new digital health technologies, even though we heard about many interesting new tools, systems, and apps at the conference, and I do believe that leveraging technology will result in remarkable changes in healthcare.

Nor were they related to social media, ehealth, or telehealth, even though all of these are rapidly growing and evolving, and will surely play important roles in the healthcare landscape of the future.

No. The most remarkable innovations at MedX related to the conference itself, which was unlike any other academic conference I’ve been to. Specifically, the most important innovations were:

  • Patients present to tell their stories, both on stage and in more casual conversational settings such as meals.
  • Patient participation in brainstorming healthcare solutions and in presenting new technologies. MedX also has an ePatient Advisors group to help with the overall conference planning.

These innovations, along with frequent use of storytelling techniques, video, and music, packed a powerful punch. It all kept me feeling engaged and inspired during the event, and left me wishing that more academic conferences were like this.

These innovations point the way to much better academic conferences. Here’s why:

The  power of patient presence

I wasn’t surprised to see lots of patients at Medicine X, because I knew that the conference has an e-patient scholars program, and that many patients would be presenting. I also knew that the director of MedX, Dr. Larry Chu, is a member of the Society of Participatory Medicine. (Disclosure: I’ve been a member of SPM since last December.)

I was, on the other hand, surprised by how powerful it was to have patients on stage telling their stories.

How could it make such a difference? I am, after all, a practicing physician who spends a lot of time thinking about the healthcare experience of older adults and their caregivers.

But it did make a difference. I found myself feeling more empathetic, and focused on the patient and family perspective. And I felt more inspired to do better as a physician and as a healthcare problem-solver.

In short, having patients tell their stories helped me engage with the conference presentations in a more attentive and meaningful way.

Now, some will surely be tempted to wave this off as a gauzy touchy-feely experience that is peculiar to the fruit-cakes of the Bay Area; a nice conference touch that isn’t materially important to the purpose of an academic conference.

Continue reading “* Patients Not Included”

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I recently attended the flagship Health 2.0 conference for the first time.

To avoid driving in traffic, I commuted via Caltrain, and while commuting, I read Katy Butler’s book “Knocking on Heaven’s Door.”

Brief synopsis: healthy active well-educated older parents, father suddenly suffers serious stroke, goes on to live another six years of progressive decline and dementia, life likely extended by cardiologist putting in pacemaker, spouse and daughter struggle with caregiving and perversities of healthcare system, how can we do better? See original NYT magazine article here.

(Although the book is subtitled “The Path to a Better Way of Death,” it’s definitely not just about dying. It’s about the fuzzy years leading up to dying, which generally don’t feel like a definite end-of-life situation to the families and clinicians involved.)

The contrast between the world in the book — an eloquent description of the health, life, and healthcare struggles that most older adults eventually endure — and the world of Health 2.0′s innovations and solutions was a bit striking.

I found myself walking around the conference, thinking “How would this help a family like the Butlers? How would this help their clinicians better meet their needs?”

The answer, generally, was unclear. At Health 2.0, as at many digital health events, there is a strong bias toward things like wellness, healthy lifestyles, prevention, big data analytics, and making patients the CEOs of their own health.

Oh and, there was also the Nokia XPrize Sensing Challenge, because making biochemical diagnostics cheap, mobile, and available to consumers is not only going to change the world, but according to the XPrize rep I spoke to, it will solve many of the problems I currently have in caring for frail elders and their families.

(In truth it would be nice if I could check certain labs easily during a housecall, and the global health implications are huge. But enabling more biochemical measurements on my aging patients is not super high on my priority list.)

Continue reading “Knocking on Health 2.0′s Door”

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Today marks the beginning of the 8th annual Healthcare IT Week. Healthcare IT Week was started and continues on as a collaborative forum for public and private healthcare constituents to discuss the value of health information technology (health IT) for the U.S. healthcare system.

It is amazing to see how far health IT has come over the last 10-15 years.  It has its own week!  If, a decade ago, you told people that health IT would be a core focus of investors, entrepreneurs and everyone else in healthcare, the energy produced from the eye rolling alone could power the lights on the Las Vegas Strip for a month.  The basic sentiment back then was this: Why would anyone invest in, think about, care about health IT when the consumer Internet was rocking and companies selling online dog food could get started on Monday and sold on Friday for a bull mastiff’s weight in gold?

Today it is quite clear that healthcare IT is a hugely significant part of any success we are having and will continue to have in transforming our healthcare system from one where 30% of cost and care is wasted or the result of error to one where value reigns supreme.  We do not believe anyone rational would now argue that healthcare IT is non-essential to improving the quality, productivity, efficiency, cost and outcomes we produce in our healthcare system, although the path is not always smooth.

And it’s about time. Technology has been used to optimize and redefine virtually every key industry except healthcare. Manufacturing has gone from human assembly lines to robotics; banking has gone from tellers to home banking; travel has gone from agents with brochures to Travelocity; and yet in many ways, the fundamental practice of medicine hasn’t changed in decades.

Continue reading “Can Entrepreneurs “Cure” Health Care With Technology?”

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