Several years ago both Microsoft and Google invested millions of dollars on a flawed assumption: If they built a useful and free healthcare application, people would flock to it. In both cases, the effort failed. At its peak Microsoft HealthVault was only able to enroll a few thousand—largely inactive—users. Google Health was discontinued after a few years.
The problem was (and is) that unlike almost any other business, healthcare is a negative good.
Even if it’s “free,” as was the case with both the Microsoft and Google offerings, most people find tracking their health to be, in some sense, an admission of frailty, imperfection and mortality. Except for occasional blips related more to vanity (weight loss is the prime example), when it comes to our health most of us are in denial. So when people talk about technology for patient engagement, I tend to pause and wonder: Should we be building apps and services just for patients, or for the people who care about them too?
Much has been made of Mark Cuban’s medical knowledge since he tweeted, “If you can afford to have your blood tested for everything available, do it quarterly so you have a baseline of your own personal health”. Charles Ornstein shared the tweet and many physicians and others, myself included, weighed in on the costs and potential for harm from unnecessary testing.
I’ll admit that, when I tweeted to him, I expected Cuban to agree. But he didn’t. In fact, he grew increasingly resistant. I stopped responding when he announced that the opposition to his idea his had convinced him he needed to take his proselytizing to his TV show.
Instead of poking the sore, I began to wonder about the origins of Cuban’s conviction. I remembered that he is not alone in wanting tests that clinicians who worry about value, cost, and harm think he shouldn’t have.
But where do these attitudes come from? Is it possible that clinicians are contributing in any way to this situation? Quite the contrary: most Americans want tests, even when you tell them that nothing can be done with the information. Furthermore, Americans are more convinced of the benefits of tests like mammograms than people in other countries, and then go out and get more of them.
I think that we are. My team has studied why patients get so many electively placed coronary stents, when cardiologists readily admit that randomized trials have demonstrated that there are few situations in which such stents improve survival or reduce the risk of heart attacks.
Studies of the beliefs of patients who have just received an electively placed stent give a big clue: 80% thought stenting would reduce their risk of death, even though their cardiologists knew that this was not the case.
Businessman and maverick, Mark Cuban recently opined “if you can afford to have your blood tested for everything available, do it quarterly so you have a baseline of your own personal health.” I’m unsure why he said quarterly, not weekly, daily or hourly. ‘
He further opined that this must be done to “create your own personal health profile and history. It will help you and create a base of knowledge for your children, their children, etc.” I assume etc. refers to grandchildren’s children.
I’m unclear what my grandchildren would gain from knowing my serum free testosterone levels in 2014. That’s a lot of data to enter in ancestry.com. For that matter, the size of my grandfather’s spleen in 1956 probably doesn’t affect the way I think about my mortality. That year he had a bout of Leishmaniasis, which, thankfully, isn’t a problem in Philadelphia.
Cuban further explained “a big failing of medicine = we wait till we are sick to have our blood tested and compare the results to “comparable demographics.”
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…
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.
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.
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.
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.
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.
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.