Atul Gawande is the preeminent physician-writer of this generation. His new book, Being Mortal, is a runaway bestseller, as have been his three prior books, Complications, Better, and The Checklist Manifesto.
One of the joys of my recent sabbatical in Boston was the opportunity to spend some time with Atul, getting to see what an inspirational leader and superb mentor he is, along with being a warm and menschy human being. In my continued series of interviews I conducted for The Digital Doctor, my forthcoming book on health IT, here are excerpts from my conversation with Atul Gawande on July 28, 2014 in Boston.
I began by asking him about his innovation incubator, Ariadne Labs, and how he decides which issues to focus on.
Gawande: Yeah, I’m in the innovation space, but in a funny way. Our goal is to create the most basic systems required for people to get marked improvements in the results of care. We’re working in surgery, childbirth, and end-of-life care.
The very first place we’ve gone is to non-technology innovations. Such as, what are the 19 critical things that have to happen when the patient comes in an operating room and goes under anesthesia? When the incision is made? Before the incision is made? Before the patient leaves the room? It’s like that early phase of the aviation world, when it was just a basic set of checklists.
In all of the cases, the most fundamental, most valuable, most critical innovations have nothing to do with technology. They have to do with asking some very simple, very basic questions that we never ask. Asking people who are near the end of life what their goals are. Or making sure that clinicians wash their hands. Continue reading “Computers Replacing Doctors, Innovation and the Quantified Self: An Interview with Atul Gawande”
Filed Under: Tech, THCB
Tagged: Ariadne Labs, Atul Gawande, Epic, Quantified Self, Robert Wachter
Jan 7, 2015
Physicians have always been in the information business. We have kept records of patient data regarding the vital signs, allergies, illnesses, injuries, medications, and treatments for the patients we serve. We seek knowledge from other physicians, whether that knowledge comes from the conclusions of experts from research published in a medical journal or the specialist down the hall. However, a physician will always benefit from additional good information such as the analysis of pooled data from our peers treating similar patients or from the patients themselves.
Over the next few years, vast new pools of data regarding the physiologic status, behaviors, environment, and genomes of patients will create amazing new possibilities for both patients and care providers. Data will change our understanding of health and disease and provide a rich new resource to improve clinical care and maximize patient health and well-being.
Patient Data Used by the Patient
Instead of a periodic handful of test results and a smattering of annual measurements in a paper chart, healthdata will increasingly be something that is generated passively, day by day, as a byproduct of living our lives and providing care. Much of the data will be generated, shared, and used outside of the health system. It will belong to patients who will use it to manage their lives and help them select physicians and other healthcare professionals to guide them in their quest for a long and healthy life.
Based on a patient’s preferences and needs, the data will flow to those who can best assist them in maintaining their health. It will reveal important and illuminating patterns that were not previously apparent, and with the right system in place, it will trigger awareness and alerts for patients and other providers that will guide behaviors and decisions.
Continue reading “Three Ways Doctors Can Use Patient Data to Get Better Results”
Filed Under: Tech, THCB
Tagged: Data, patient data, Quantified Self
Dec 16, 2014
You may have seen some news regarding a study MyFitnessPal recently did with UCLA.
I wanted to take a minute to address this study, since we participated in it directly. We are excited that we got to work with some very smart people to answer a question we also wanted to know the answer to. We jumped at the opportunity to find out—is having your physician introduce you to the app and help you sign up enough to kickstart a health journey?
What we learned is that just introducing people to MyFitnessPal wasn’t enough. People have to be ready and willing to do the hard work.
The app itself does work—if you use it. Our own data and the data from the study show that the more you log on, the more you use the app, the more success you will see. Users that logged in the most lost the most weight. In fact, we already know that 88% of users who log for 7 days lose weight.
We make tools designed to make it as clear and simple as possible for you to see the path to achieving your fitness goals. We are not, however, making a magic bullet—because there is no magic bullet. Ultimately, you’re the one who has to do the work.
Continue reading “MyFitnessPal Works If You Use It”
Filed Under: Tech, THCB
Tagged: Apps, fitness, Health 2.0, Mike Lee, MyFitnessPal, Quantified Self, Tracking
Nov 24, 2014
If you’re wearing a wristband that counts your steps, a patch that monitors your vital signs or a watch that tracks your heart rate, you are in the minority. And if you paid $300 or more for any of those items, you are among the nation’s quantified self-health elites.
Judging by the chatter streaming across our social media feeds, one would think every man, woman, child is sporting a health “wearable.” But in reality, these are the early days of the devices that promise to help us live longer, healthier, more active lives.
Despite the buzz, just 21% of Americans own a health wearable, according to a new consumer survey by PwC’s Health Research Institute, and only 10% of them use it daily. Even fewer consumers – 5% of respondents — expressed a willingness to spend at least $300 for a device. Many wearables today are a passing fancy – worn for a few months then tucked away in a drawer awaiting a battery charge or fresh inspiration to get up and get moving again.
As Genentech CEO Ian Clark recently put it, health wearables are “a bit trivial right now.” And it seems even the folks claiming to be wearing the devices can’t be trusted – reports have begun circulating of employees enlisting their more active coworkers to wear the device and collect fitness points on their behalf.
Yet wearables present remarkable opportunities for a nation and industry grappling with the twin challenges of improving health and controlling healthcare spending. Across the board, consumers, clinicians, insurers and employers express high hopes for the power of these new devices.
Continue reading “The Self-Health Era”
Filed Under: Tech, THCB
Tagged: Ceci Connolly, PwC, Quantified Self, Self-Health, Wearables
Oct 29, 2014
Hello. I am Mike Painter, and I track. I don’t necessarily have a compelling reason to track health parameters such as exercise patterns, heart rate, weight, diet and the occasional blood pressure. Yet I do. I do most of my tracking with several small devices, simple sensors and software applications. My tracking is also pretty social—meaning I share much of my data widely and daily. You’re welcome to see it—most of it is on Strava. Admittedly, I still keep some data daily on a paper calendar, and I do monitor diet and sleep in my head—i.e., nobody needs to remind me about my food splurge days. The local bakery is intimately aware of that data point as the employees witness me charge in, wild-eyed and drooling for a giant cinnamon roll every Thursday morning—almost without fail.
It all feels pretty normal to me.
Here’s the rest of the story: I track to enhance athletic performance rather than monitor my health, per se, or even really my wellness. I am an avid cyclist and have tracked miles, location, accumulated elevation, heart rate and power readings and other data for years. I share that information with both cyclist colleagues I know and don’t know on Strava. That site eagerly ingests my data—and among other things, plops it into riding (and running) segment leader boards, riding heat maps—and, most importantly, in training, trend graphs like the attached. All that data is incredibly helpful to me—it empowers me by making me face the numbers—it makes my training data- and reality-based. I don’t have to guess to maximize my fitness and minimize my fatigue level in anticipation of a big event. I follow the numbers.
Is all that bad? To me, my obsession with tracking my athletic performance seems like an extension of observing data for health and wellness.
Continue reading “Confessions of a Self-Tracker”
Filed Under: Tech, THCB
Tagged: Apps, Health 2.0, Health 2.0 Fall 2013 Conference, mHealth, Michael Painter, Quantified Self, Stanford Medicine X, Strava, Wellness
Oct 11, 2013
In a world where big data plays an important role of monitoring individual health care and wellness, Health 2.0’s CEO and Co-Founder Indu Subaiya had an exclusive interview with Christine Robbins, CEO of BodyMedia on the future of health care in the marketplace as well as the role of big data. As we all know, BodyMedia was recently acquired by Jawbone – and we’re excited to have Christine joining us on the famous “3 CEOs” panel at the Health 2.0 Annual Fall Conference next week to tell us more about it.
Here’s a preview of what you should be looking forward to.
Indu Subaiya: We’re really excited for the Health 2.0 7th Annual Fall Conference and of course, I’ve been following news about you and BodyMedia over the last two months, which is really exciting. Congratulations on the acquisition.
Christine Robbins: Thank you. We’re on to the next chapter.
IS: That’s just amazing to me because BodyMedia in and of itself has had so many chapters and we’ve followed you almost from the very beginning. But what would be great is [if you could give] us an overview of the last year. When we saw you at Health 2.0 last — what you were beginning to present at the earliest stages, I believe, were data that BodyMedia had collected that could then be used in partnership with health plans and larger healthcare organizations.
Continue reading “Moving Beyond the Quantified Self”
Filed Under: Health 2.0, THCB
Tagged: Big Data, BodyMedia, Cigna, Jawbone, Quantified Self
Sep 25, 2013
In the future, implanted chips will have the ability to stop food absorption when caloric intake reaches 2200. Cells in our forearm will be able to monitor our glucose levels and adjust our insulin appropriately. These implantable cells or “chips” have their own IP address with their own circuitry that is connected to a network 24/7. Through this network, cells communicate with real-time super computers to synthesize the next step for an individual’s body. If Dr. Anthony Atala can utilize 3D printers to create a new kidney, then it is only a matter of time before we can incorporate the circuitry within an organ necessary to monitor its function wirelessly.
This was the future I was challenged to paint in my talk at TEDMED 2012 at the Kennedy Center for the Performing Arts in Washington, DC. With the conclusion of TEDMED 2013 last week, I ask myself, where are we one year later?
A caveat: The following are simple overviews on novel technologies I had been tracking over the past year and does no justice to the many amazing leaps we have made in innovative science and medicine during this time.
Continue reading “Do Our Cells Have Their Own IP Address Yet?”
Filed Under: Tech, THCB
Tagged: Abiliti, Ali Ansary, e-patients, FutureMed, Innovation, Quantified Self, wearable sensors
Apr 23, 2013
You’d be forgiven if, after reading last month’s Health Affairs, you came to the conclusion that all manner of wellness programs simply will not work; in it, a spate of articles documented myriad failures to make patients healthier, save money, or both.
Which is a shame, because – let’s face it – we need wellness programs to work and, in theory, they should. So I’d rather we figure out how to make wellness work. It seems that a combination of behavioral economics, technology, and networking theory provide a framework for creating, implementing, and sustaining programs to do just that.
Let’s define what we’re talking about. “Wellness program” is an umbrella term for a wide variety of initiatives – from paying for smoking cessation, to smartphone apps to track how much you walk or how well you comply with your plan of care, and everything in between. The term is almost too broad to be useful, but let’s go with it for now.
When we say “Wellness programs don’t work,” the word work does a lot of, well, work. If a wellness program makes people healthier but doesn’t save lives, is it “working”? What if it saves money but doesn’t make people healthier?
Continue reading “Wellness Programs Aren’t Working. Three Ideas That Could Help.”
Filed Under: THCB, The Business of Health Care
Tagged: automated hovering, Employees, Employers, gamification, Health Affairs, Mike Miesen, Population Health, prevention, Quantified Self, Readmissions, The ACA, Wellness
Apr 1, 2013
The author in early 2010 and mid 2011
I’ve been thinking about how to write this story for a long time. Should it be a book? A blog? A self-help guide? Ever since I realized I’d lost 60 pounds over the course of a year and a half, I knew I wanted to find a way to talk about it, and maybe help others. This is my first public attempt.
A note about the rounding of my roundness: My peak weight, shortly after I began weighing myself in 2010, was 242 lbs. My lowest weight since I started weighing myself has been 183.2 lbs — right in line with where I should be, at 6’3″ tall. I’m sure that I weighed more than 242 lbs. at peak, but frankly, I don’t care that I don’t have the data to account for those last 1.2 lbs.
Adam Davidson’s New York Times Magazine story, “How Economics Can Help You Lose Weight,” helped organize my thinking about how to finally write this. In his story, Adam explains that the rigid protocol his doctor puts him through acts as a kind of economic incentive for him to stay on the diet. I’m highly skeptical that the special liquid meals he can only buy directly through his dietician will help him keep off the weight. I tried all sorts of diets in the many years that I was overweight and though I never tried the Adam’s solution, it doesn’t sound like a recipe for long term success. At least twice, I lost weight and then gained it all, and more, back. (Meta note: I feel terrible writing that. Adam, I wish you the best. Maybe something you read here will help you keep off the weight you have already lost, and congratulations on that difficult achievement.)
Now that I’ve managed to make weight loss sound simple, and sound smug about my success (I’ve stayed within the 183-192-pound range for more than two years now), what’s my big secret? It’s data. Just like I said in the headline, I keep a Google Doc spreadsheet in which I’ve religiously logged my weight every morning for the last three-plus years, starting on January 1, 2010, when I knew I had to do something about my borderline obesity.
Continue reading “The Data Diet: How I Lost 60 Pounds Using A Google Docs Spreadsheet”
Filed Under: Tech, THCB, The Vault
Tagged: Google Docs, Obesity, Paul Smalera, Personal responsibility, preventive health, Quantified Self
Mar 28, 2013
In January we started asking ourselves, “How many people self-track?” It was an interesting question that stemmed from our discussion with Susannah Fox about the recent Pew report on Tracking for Health. Here’s a quick recap of the discussion so far.
The astute Brian Dolan of MobiHealthNews suggested that the Pew data on self-tracking for health seems to show constant – not growing – participation. According to Pew, in 2012 only 11% of adults track their health using mobile apps, up from 9% in 2011.
All this in the context of a massive increase in smartphone use. Pew data shows smartphone ownership rising 20% just in the last year, and this shows no signs of slowing down. Those smartphones are not just super-connected tweeting machines. They pack a variety of powerful sensors and technologies that can be used for self-tracking apps. We notice a lot of people using these, but our sample is skewed toward techies and scientists.
What is really going on in the bigger world? How many people are actually tracking?
A few weeks ago ABI, a market research firm, released a report on Wearable Computing Devices. According to the report there will be an estimated 485 million wearable computing devices shipped by 2018. Josh Flood, the analyst behind this report indicated that they estimated that 61% of all devices in wearable market are fitness or activity trackers. “Sports and fitness will continue to be the largest in shipments,” he mentioned “but we’ll start to see growth in other areas such as watches, cameras, and glasses.”
One just needs to venture into their local electronics retailer to see that self-tracking devices are becoming more widespread.
So why are our observations out of synch with the Pew numbers?
Continue reading “The State of Self-Tracking”
Filed Under: Tech, THCB
Tagged: Apps, Ernesto Ramirez, Fitbit, Gary Wolf, Quantified Self, Susannah Fox, Tracking for Health, wearable computing devices
Mar 17, 2013