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Decentralization and home health kits: Thoughts from Health 2.0

By Joe Flower

Take a look at this video from the Worrell design firm, who took part in the recent Health 2.0 confab in San Francisco. They took some insights from following ER folks around and charting their workflow into designing a better way for people to interact with the health system from their homes. At about the 4-minute mark, they start discussing what kind of home health kit/device would work, and then there is a demo of a mother consulting about her child’s flu, and getting actual testing, care, and monitoring from a live nurse remotely, all from this kit. According to the member of the design team whom I spoke with, the kit shown is a real prototype, and all the technology used is currently available.

What this says to me in the frame of my discussion of change in healthcare: If the technology is all there, why don’t we do this already? Because in a fee-for-service system there is no billing code for remote care. But: We are going to see many more healthcare organizations move into ACO-like risk contracting relationships with customers. If the healthcare organization is at risk for the costs of the care for the family in the demo, treating them in the home through such a device (one device per family) could be far cheaper, faster, and more effective than getting them to come into an urgent care clinic — cheap enough that the healthcare organization would simply buy the devices and give them to the covered families.

So as major provider organizations move into risk-contracted relationships, actual medical care that would now be taking place in the built clinical environment would be taking place in the home, supported by a live nurse monitor in a dedicated environment at the clinic. The home becomes an extension of the clinic, not only for the chronically ill and frail elderly whom we now might tend with home care, but for the well family in primary care.

Why Developers Should Enter Health IT Contests

By Fred Trotter

Patient safety is a movement within healthcare to reduce medical errors. Medical errors are a substantial problem in the healthcare industry, with a size and scope similar to car accidents: approximately the same number of deaths per year, about the same number of serious injuries. Personally I think working in patient safety is the simplest way for a geek to make a meaningful difference.

With that in mind I would like to promote a new developer contest sponsored by the Office of the National Coordinator (ONC), Partnership for Patients and hosted by Health 2.0: Ensuring Safe Transitions from Hospital to Home Challenge. As the name suggests, the contest is focused on the process of handing a patient over from an in-patient environment (in the hospital) to an out-patient environment (all the care that is not in a hospital).

I will be one of the judges for this contest and there are already enough “star players” submitting as teams in the contest that I know judging is going to be hard. The first prize is $25,000. That kind of money starts looking like seed-round funding rather than just a pat on the head. That is intentional on the part of both Health 2.0 and ONC. These contests are a way for ONC to find really amazing health IT ideas and help them transition into more substantial projects, with no strings attached. If you can prove to the judges that you have the best new idea and you can flesh it out well enough to make it clear that it has a chance of working, then you can walk away with enough cash to launch that idea. But don’t take my word for it.

Of course, even just submitting in the contest is a good way to get the attention of various investors.

Generally, the coordination of care in the United States is one of the greatest weaknesses in the system. Doctors here in the U.S. are generally well educated and held to high standards. As long as a doctor has a good understanding of your situation and has taken responsibility for your care, the U.S. healthcare system provides excellent care, on par with any other national system. The problem comes when a healthcare transition occurs, where a different doctor takes responsibility without necessarily getting all the needed information and sometimes without knowing that they are “on the hook” for care. Healthcare in the United States is coordinated via fax machines, and coordination for payment, which is sometimes associated with transitions of care, frequently uses ancient EDI standards. When this coordination fails things turn into a kind of communication comedy, which really would be quite funny except that there are sometimes tragic consequences. It actually helps to have a somewhat morbid sense of humor working in healthcare, since laughter, even inappropriate and macabre laughter, can help to manage the stress and pressure inherent in this high-stakes environment.

There are new standards and technologies available for the coordination of care during transitions that ONC is specifically encouraging in this contest, including the Direct Project, which is of course a favorite of mine (I am a sometimes-developer on the project).

These new technologies allow you rethink the basic assumptions in healthcare coordination, (i.e. Direct is basically “email that doctors can use without breaking the rules”) and should enable teams without extensive health IT experience to do something truly innovative.

More importantly, Partnership for Patients and ONC are providing specific guidance about content. Partnership for Patients is an HHS program that “partners” with hospitals and clinics that have committed to proactively reduce patient error and complications. The Partnership has very specific goals: “To reduce preventable injuries in hospitals by 40 percent and cut hospital readmission by 20 percent in the next three years by targeting those return trips to the hospitals that are avoidable.” This contest is only a small part of how they hope to achieve those goals.

CMS has released a patient checklist for hospital discharge, and the contents must be incorporated into winning contest submissions. But I can tell you from previous judging experience, thinking that “incorporate” = “regurgitate” is not a winning strategy. Instead, try to get your head around the complex hospital discharge phenomenon. PubMed is your friend. In my experience doing something amazing with one of the checklist items would be a better strategy then doing something derivative with all of the items. Doing something amazing with all of the items on the checklist would obviously win, but it may be impossible to do that well. (I’d be happy to be proven wrong on this.)

My day job is with the Cautious Patient Foundation (CPF). They hire me to write software to improve the communication between doctors and patients, which is part of their mission to provide software tools that enable patients to help reduce their own medical errors by being fully engaged, educated and aware. If the healthcare system were a highway the Cautious Patient Foundation would be a defensive driving course. CPF has a grant program that they use to fund innovations that impact patient safety. Contest participants are encouraged to submit their ideas to the Cautious Patient Foundation grant process. We are interested in innovative ideas that impact patient safety generally, not just in transitions of care. So if you have a winning patient safety concept that does not fit into this particular contest, we might be interested.

Moreover, there is nothing to stop you from submitting the same technology to one of the other Health 2.0 contests or even to another joint ONC/Health 2.0 contest. Many of these contests could easily be won by an application that does something with a patient safety impact. If you have a great idea for improving healthcare with software, just wait … there will eventually be a contest asking for just the kind of innovation you have.

All of this is to say: There is some real money in these developer contests. Traditional health IT experts who feel trapped can use contests to fund and promote their non-traditional ideas. Developers who are new to the field of health IT can use the contests as a way to break in and get attention for their ideas. Great ideas that improve the healthcare system can get traction, funding and attention. If you can get your great idea working and you submit it to one of these developers contests you can get some feedback.

Maybe your idea actually sucks, but if you knew why, then you could come up with a new idea that really would be great. In any case, it is pretty hard for a developer to just lose by participating in these contests. Worst case scenario is that is ends up being a free education. Who knows? You might be an important part of another developer’s free education.

No matter what, working on software that addresses patient safety issues is one of the few ways that a software developer can impact quality of life rather than convenience of life. These contests, especially the in-person code-a-thons, are fun enough that you might even find yourself forgetting that you are changing the world.

Fred Trotter is a recognized expert in Free and Open Source medical software and security systems. He has spoken on those subjects at the SCALE DOHCS conference, LinuxWorld, DefCon and is the MC for the Open Source Health Conference. This post first appeared at O’Rielly Radar.

He is co-author of Meaningful Use and Beyond. THCB readers can buy the ebook at 50% off until the end of November by mentioning “HITBlog.”

The Value of Moodscope

By Seth Roberts

In 2007, Jon Cousins started tracking his mood to help NHS psychiatrists decide if he was cyclothymic (a mild form of bipolar disorder). After a few months of tracking, he started sharing his scores with a friend, who expressed concern when his score was low. Jon’s mood sharply improved, apparently because of the sharing. This led him to start Moodscope, a website that makes it easy to track your mood and share the results.

I was curious about the generality of what happened to Jon — how does sharing mood ratings affect other people? In January, Jon kindly posted a short survey about this. More than 100 people replied.

Their answers surprised me. First, in a survey about sharing your mood — not about tracking your mood — most respondents did not share their mood. It is as if, in a survey about being tall, most respondents were not tall. Second, although Jon’s mood sharply rose as soon as he started sharing, this was not the usual experience. Sharing helped, some people said, but other people said sharing hurt. For example, one person said her mood was used against her in arguments. Finally, the respondents gave all sorts of persuasive reasons that rating their mood helped them. To me, at least, the value of mood rating isn’t obvious. I can list a dozen hypothetical benefits but whether they actually happen is unclear to me. I rated my mood for years and did it only to learn about the effects of morning faces. MoodPanda, another mood-rating site, gives a few brief vague unenthusiastic reasons to track your mood. And their site is all about mood rating.

In contrast, Moodscope users were clear and enthusiastic about the value of tracking. Here are some reasons they liked mood-tracking:

It is useful to look back sometimes to help you find ways of ‘keeping up’ a positive mood/outlook.

My mood range has definitely narrowed since starting mood stabilizers, so using Moodscope has given me solid evidence that the treatment is working well. I also run statistical analyses of my mood charts against variables like sleep, medication use, and alcohol consumption. The correlations were not particularly meaningful using a 9-point Likert-like scale from a standard mood chart. When I used my Moodscope scores instead, I suddenly found that some of the correlations are (ridiculously!) statistically significant, which also made me feel more certain about what I need to do and change to better manage my mental health.

Continue reading…

Navinet: Health 2.0 Poster Child

By KIM KRUEGER & MATTHEW HOLT

What was once an enterprise software company designing bespoke systems for each client has over the course of the past three years transitioned to a national network-as-a-service with configuration tools and a soon-to-come open API. Could there be a better example of Health 2.0 in action? Say hello to the ‘new’ Navinet, a 15 year-old network that connects over 400,000 providers to more than 40 health plans, covering more than 47 million lives.

Matthew Holt spoke with Navinet CEO Frank Ingari about both Navinet’s stealthy evolution, as well as the company’s new goals moving forward. Navinet still performs the core handful of transactions health care providers have always used the system for — eligibility checks, payment status, referral approval, and treatment authorization among others – but now with a connected network, the emphasis is on collaborative workflow and combining clinical information with reimbursement transactions to improve care.

Ingari said it best: the health care communication infrastructure sucks. Consumers know it, and it isn’t any better for payers and providers. To hear more about how Navinet plans to be that communication infrastructure health care is so sorely missing, watch the interview below.

Kim Krueger is a Research Analyst at Health 2.0 where Matthew Holt is the Co-Chairman.  

Looking to Get Funded? Thoughts From An Entrepreneur Who Just Did

By PASCAL LARDIER

GET_imagePascal Lardier, Health 2.0 International Director, recently interviewed Omri Shor, CEO of Medisafe, for the EU funded GET Project. Shor has showcased Medisafe on stage at Health 2.0 several times and recently closed a $6 million Series A funding round. His advice? Shor says “Investors care about two things: the product market fit and the business model fit.” Read on for more.     

Pascal Lardier: Omri, to start can you say a few words to describe your solution and what it does?

Omri Shor: For sure. MediSafe is an intelligent medication management platform helping people manage their medications correctly. When we go into details, we’re a cloud and apps company. We have apps, iPhone and Android, that are synced together for a cloud service that we have developed.

In general, we remind people to take their medications. We keep a log of what they took and what they didn’t take. And we’re able to share that data back with physicians. The new layer that we’ve just added is a personalized feed that is dealing with more than just a reminder, it’s now dealing with persuasive technology to make sure that patients understand the need to take their medications as well as the ability to track some measurements and vital signs inside MediSafe and correlate this with the medication that the patient has actually taken.

PL: Can you say a few words about your niche in digital health? How many competitors and what makes MediSafe different and better than other solutions?

OS: MediSafe is dealing with a big problem called medication non-adherence. The niche is actually patient engagement, specifically in the medication management space. There are hundreds of companies from cloudware companies to software companies to app companies. We’ve chosen to be mobile-first because we thought that this is the best place to help patients manage their medications mostly because we all engage with our smartphones so much and we think it’s only going to grow. We have iPhone, Android, and we have smart watches now as well. Some of that have already come, some of that are coming just around the corner.

In the medication management space in terms of apps, there are hundreds of competitors. MediSafe’s first differentiator is the user experience. We’re quite fanatic about user experience. We made sure that we are well-designed. MediSafe looks like a virtual pill Box. We have the design patent on the way that we integrate with the users.

The second piece that differentiated us from the beginning is our ability to sync via the cloud. We have the ability to sync family members. That means that if my father who is diabetic accidentally didn’t take his meds, I get notified and I can help him get reminded and make sure that he takes his meds or at least that he thinks of taking his meds.

These were the first things that differentiated MediSafe. Currently, the most important thing that is differentiating us is that we’ve taken a personalized approach. That means that we’ve created a feed that is dealing with patient’s condition, medication, et cetera. This feed is communicating to the patient how important it is to take his meds safely, correctly, that it would actually help him; and the ability to connect back to the healthcare system and back to the physician to make the physician more knowledgeable of the immediate outcomes of the medications that the patient is taking.

One other thing that is now differentiating MediSafe is that we currently have well over a million downloads of our solution with hundreds of thousands of active users. This is putting us in a position, I would say, in the class that just a handful of the medication management solutions were actually able to achieve. And this is accelerating, so we will see more of those users coming to choose MediSafe to manage their medications correctly.

PL: You have jumped ahead to my next question. The user experience, the personalized approach, this is what makes you different in the eyes of the users. This is why they’re going to choose MediSafe rather than another solution. My next question is, specifically in your niche that you described with hundreds of solutions, what did you think exactly make a difference in your discussions with investors?

OS: Investors care about two things. Investors care about the fact that there is a product market fit. That means that patients are using our solution. The second thing that investors care about is that there is a business model fit. That means that our customers, pharmaceutical companies, are willing to pay us money for the use of MediSafe and for different things that we do with them. These two together, the growth that we’ve seen organically without investing money and marketing and the ability to monetize users, brought them to the conclusion that the company has the ability to be a leading company or a leading solution for a multi-billion dollar problem.

Continue reading…

The Individual Mandate, a Brief History — Part I Conservative Origins

By BRADLEY LATINO

In recent years, politicians of every stripe have eaten their words about the wisdom of requiring all Americans to possess health coverage. This hasn’t been real news since the 2007 Democratic primary debates, when candidate Obama claimed his reasons for opposing the mandate were similar to those expressed by Hillary some 15 years ago.

A few years later it was President Obama’s turn. And by 2010, the entire Republican party performed a synchronized heel-face turn, virulently opposing the solution they advocated decades earlier. All of this culminated with the recent passage of the “Repealing the Job-Killing Health Care Law Act” in the House, by which point the mandate had become a 21st century Intolerable Act.

The media have dutifully reported each foible as if such strategic backpedaling were something new under the sun. But the 22-year path to ACA § 1501(b) is a story in its own right, a sort of philosophical history of American health reform policy.

Part I – The think-tank solutions (1989 – 1992)

Back in the late 1980s, the individual mandate wasn’t controversial at all–just another idea being kicked around in conservative think tanks. Although economist Mark V. Pauly, an adviser to the first Bush administration, is often cited as the mandate’s creator, conservative thinkers Stuart M. Butler and Edmund F. Haislmaier were dreaming up similar proposals at the Heritage Foundation as early as 1989.Continue reading…

Susannah Fox on Teens & Digital Health Study

By JESSICA DAMASSA, WTF Health

How are teens and young adults engaging with digital health? Results of a national survey asking just that were released today by Susannah Fox (Former CTO at US Dept of HHS) and her research partner, Victoria Rideout.

You can check out the full report of the findings here, but I spoke with Susannah in April, just as she and Victoria were starting to draw some insights from their work.

Hearing her talk about the survey at this stage of synthesis is not only unique (most researchers won’t talk until the findings are published) but more so because it adds a layer of understanding to the final results now that they’re here.

We get her candor about how teens and young adults are a wildly viable – yet very overlooked – market for digital health…

We see how she’s trying to formulate a much larger hypothesis about what healthcare can learn about social media from a generation that has never lived without it and, more importantly, view it as having a positive impact on their well-being…

And, probably most inspiring to me, we see an approach to health data that stands out for its warmth. For it’s love, really. In a world of big data and clinical trials, it’s endearing to hear from someone who is taking a more anthropological approach and who has fallen absolutely, head-over-heels in LOVE with the personal side of her dataset.

As we all clamor for a patient-centered end, we’d be remiss to underestimate the value of a human-centered starting point. Watch Susannah Fox for a strong model of how this can be done in health research.

Filmed at Health DataPalooza, Washington DC, April 2018. Find more interviews with the people pushing healthcare to better tomorrow at www.wtf.health. 

Digital Health and the Two-Canoe Problem

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By DAN O’NEILL

Digital Health and the Two-Canoe Problem

As healthcare gradually tilts from volume to value, physicians and hospitals fear the instability of straddling “two canoes.” Value-based contracts demand very different business practices and clinical habits from those which maximize fee-for-service revenue, but with most income still anchored on volume, providers often cannot afford a wholesale pivot towards cost-conscious care.  That financial pressure shapes investment and procurement budgets, creating a downstream version of the two-canoe problem for digital health products geared toward outcomes or efficiency. Value-based care is still the much smaller canoe, so buyers de-prioritize these tools, or expect slim returns on such investment.  That, in turn, creates an odd disconnect.  Frustrated clinicians struggle to implement new care models while wrestling with outdated technology and processes built to capture codes and boost fee-for-service revenue. Meanwhile, products focused on cost-effectiveness and quality face unexpectedly weak demand and protracted sales cycles.  That can short-circuit further investment and ultimately slow the transition to value.

To skirt these shoals, most successful innovators have clustered around three primary strategies.  Each aims to establish a foothold in a predominantly fee-for-service ecosystem, while building technology and services suited for value-based care, as the latter expands.  A better understanding of these models – and how they address different payment incentives – could help clinicians shape implementation priorities within their organizations, and guide new ventures trying to craft a viable commercial strategy.

Continue reading…

Who Cares About the Doctor-Patient Relationship? A Review of “Next In Line: Lowered Care Expectations in the Age of Retail- and Value-Based Health”

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By KIP SULLIVAN, JD

A mere two decades ago, the headlines were filled with stories about the “HMO backlash.” HMOs (which in the popular media meant most insurance companies) were the subject of cartoons, the butt of jokes by comedians, and the target of numerous critical stories in the media. They were even the bad guys in some movies and novels. Some defenders of the insurance industry claimed the cause of the backlash was the negative publicity and doctors whispering falsehoods about managed care into the ears of their patients. That was nonsense. The industry had itself to blame.

The primary cause of the backlash was the heavy-handed use of utilization review in all its forms –prior, concurrent, and retrospective. There were other irritants, including limitations on choice of doctor and hospital, the occasional killing or injuring of patients by forcing them to seek treatment from in-network hospitals, and attempts by insurance companies to get doctors not to tell patients about all available treatments. But utilization review was far and away the most visible irritant.

The insurance industry understood this and, in the early 2000s, with the encouragement of the health policy establishment, rolled out an ostensibly kinder and gentler version of managed care, a version I and a few others call Managed Care 2.0. What distinguished Managed Care 2.0 from Managed Care 1.0 was less reliance on utilization review and greater reliance on methods of controlling doctors and hospitals that patients and reporters couldn’t see. “Pay for performance” was the first of these methods out of the chute. By 2004 the phrase had become so ubiquitous in the health policy literature it had its own acronym – P4P. By the late 2000s, the invisible “accountable care organization” and “medical home” had replaced the HMO as the entities that were expected to achieve what HMOs had failed to achieve, and “value-based payment” had supplanted “managed care” as the managed care movement’s favorite label for MC 2.0.

Continue reading…

Will Computers Really Replace Radiologists?

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By SAURABH JHA

There is hope, hype and hysteria about artificial intelligence (AI). How will AI change how radiology is practiced?  I discuss this with Stephen Borstelmann, a radiologist in Florida and a scholar in machine learning.

Listen to our discussion on the Radiology Firing Line Series, hosted by the Journal of the American College of Radiology and sponsored by Healthcare Administrative Partners.

About the author:

Saurabh Jha is a radiologist and contributing editor to THCB. He hosts the Radiology Firing Line Podcasts

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