Wednesday, April 15, 2015

MasterChef in Healthcare: Integrating Social Media


Social Media is rapidly becoming an integral part of our lives. Despite the pervasive nature of the communication channel healthcare remains a technology laggard. This presentation from HIMSS15 Wednesday Apr 15) will offer insights to help understand why healthcare professionals should join the community, participate in the discussion and how can do so successfully.











I presented this topic at HIMSS15 on Wednesday Apr 15 - you can find the listing here. As promised I am posting a summary of the points as well as a link to the Slideshare for that presentation





You can find the presentation on my slideshare (nvt) here
####### Add link to uploaded ppt


Technology is all pervasive in our lives and Social media is everywhere - in fact in a recent survey of 3,000 people conducted in the US, UK and Germany to help counter the limited time with their physicians, patients are seeking information and embracing technology outside of the doctor’s office to come to appointments prepared. Approximately 80 percent of patients feel engaged in their own health:
  • 68 percent of patients bring a list of questions to each doctor's consult;
  • 39 percent have checked WebMD or another online source in advance; and
  • 20 percent bring personal health data from outside monitors.


You can see some 87%o f US adults are online in this Pew internet research so if you are not on board you are missing a huge opportunity but more importantly your patients are forming an opinion about you before they meet you



 
 What is Social Media
  • It’s a conversation, not a lecture
  • It’s an extension of everyday interaction
  • It’s group driven, not top-down
  • It’s messy, disorganized & hard to control
  • It’s a tool, not an end-point
  • But most of all…


If you have not already - go to twitter and sign up for an account



What to Tweet
  • What you have read that you want to share with others
  • When and where you are speaking
  • Something you post on your blog
  • A link to a Web site that you find interesting
  • Listen to conversations happening online using keywords (hashtags, lists and searches) – learn from your colleagues, friends and patients
  • Befriend people – and then earn their trust by solve problems, answering queries, helping and providing useful information
  • Share information, valuable content with them
  • Questions and Requests for information and help – crowdsourcing answers
  • At a minimum – Lurk, Listen and Learn
There are many HashTags to follow and starting by assign friends and colleagues what they follow is a a good start but then get involved - join an online chat and community and take a look at the listing of healthcare hash tags from symplur. Listed below are a few of the healthcare hash tags I follow:
#hcsm (h/c social media)
#HCLDR (healthcare leaders)
#HITsm (health IT social media)#MedEd (medical education)
#mHealth
#eolchat (end of life/elder chat)
#BCSM (breast-cancer social media)
#LCSM (lung-cancer social media)
#BTSM (brain tumor social media)
#S4PM (Society for participatory medicine)
But I received a aggregated list when I polled my followed that included all these:
Others
#QuantifiedSelf
#KareoChat
#HITChicks
#HIT
#healthIT
#hcrefor
#ACA
#ONC
#HL7
#Interop
#IoT
#HIMSS15
#POWHIT - People & Organizations improving Workflow w/HIT
#RareDisease
#foodallergy
#rheum
#bcsm
#gyncsm
#medx
#BlueButton
#patientengagement
Chats
#JACR 4th Thurs 12pm EST
#LCSM Every other Thurs 8pm EST
#BCSM Mon 9pm ET
#HCLDR Tues 8:30pm EST
#MedEd Thurs 9pm EST
and
@twubs @hashtracking or @tweetreachapp

My thanks to all my twitter friends who contributed
@HealthcareWen @HIMSS @lsaldanamd @sjdmd @HealthcareWen @DrJosephKim @dirkstanley @dlschermd @Docweighsin @RossMartin @CraigJoseph @RobertWahMD @ishakir @SteltsMD @JenniferJoeMD @StevenChanMD @CIBR_News @Jim_Rawson_MD @aussiclydesdale @ACRselect @AdamFuhriman @Gregmogel @ruthcarlosmd @techguy @MandiBPro @HITshrink @ahier @RandaPerkinsMD @motorcycle_guy @wareflo @susannahfox @Lygeia @ePatientDave @CMichaelGibson @Colin_Hung @annelizhannan @MelSmithJones @Paul_Sonnier @JennDennard @HIStalk @JohnNosta @2healthguru @lsaldanamd @lisagualtieri @EricTopol @ShahidNShah @DanMunro @Daniel_Kraft

Put yourself somewhere on the Social Media Adoption Curve


Add LinkedIn and Facebook - they offer a different channel and voice - Facebook tends to be more social and LinkedIn tends to be more professional/business orientated
There are some good examples already out there
The Mayo Clinic has several properties and their own published guide book to social media and the University of Maryland Medical Center that has blended many channels

What Not to Do

The JAMA 2012 report Online posting of unprofessional content by medical students highlighted a high proportion of violations and problems and there are plenty of examples of people who failed use basic common sense - I personally like the 12 word Simple Social Media Policy from the Mayo

Don’t Lie
Don’t Pry
Don’t Cheat
Can’t Delete
Don’t Steal
Don’t Reveal

Conclusion
  • Social Media for Physicians is a Game Changer
  • Social media, when effective, will establish a physician’s brand and connect him/her with those in need of their services
  • With increased deductibles, more consumers will “shop” using social media sites.
  • Social Media will Expand the Physician’s Role with Patients
  • Social media is shaping patient encounters with physicians and that impact is expected to increase significantly
  • Extending the patient experience will foster existing patient relationships and improve patient outcomes, especially for long-term chronic conditions.

Where are you on the social media ladder and are you going to climb higher?




Friday, April 10, 2015

HIMSS15 The Year of DigitalHealth, Interoperability and Security

HIMSS is finally upon us and like the 20,000+ people heading Chicago there is a lot to take in, many options and far too much for any one person to see or catch up with. So what do you do?


First off - download the HIMSS Mobile APP that now comes with GPS intelligence which hopefully will start to provide keen insights into activities and opportunities that are nearby as you move around Chicago, the convention center and beyond

Download and print (I know not very environmentally friendly but there is a lot to absorb) the HIMSS Conference Guide (72 Pages) - or if you are feeling really clever send it to you iDevice, Pocket, Kindle or some other reading device

Or use the online version of the HIMSS of the guide - here

For the physician centric guide - head on over to this living breathing dynamic Google Document - put together by Wen Dombrowski (@HealthcareWen)

For the HIT Centric Guide from John Lynn (@TechGuy)

For the latest and greatest news be sure to follow the #HIMSS15 hashtag, and others linked to the conference including #DrHIT

And your best option for keeping up with the latest and greatest from Symplur tracking system on #HIMSS15 and that page features additional topics and tags worth following and tracking

And of course follow your Social Media (#SoMe) Ambassadors can all be found in this list on twitter


Tuesday, March 24, 2015

Digital Health Technology Trends from SXSW

Great graphic that HITConsultant posted in this update SXSW Health Tech Trends

Health and fitness apps, smart devices and connected products are making us more aware of our own health—and more active participants in our efforts to stay healthy. At the same time, health providers are looking to technology for smarter ways to deliver quality care, whether we are in the hospital or at home.



  • Wearable technology - 80% of consumers would benefit from the use of wearable technology
  • Connected devices - Using remote monitoring to reduces readmissions
  • EHRs - 71% of physicians now use EHRs and 85% meeting current meaningful standards
  • Telehealth 70% patients comfortable communicating with their doctor using digital technology vs hauling themselves in to the officer
  • Predictive analytics - More than 80% of standard tasks (BP, glucose etc) and even complex testing (e.g. genomics) will change the way we deliver care as described by Eric Topol​ in "The Patient Will See You Now"
  • Population health management - 70% of providers reporting patient care benefits from population health initiatives
  • mHealth apps - 71% of want providers to use mobile apps not least of because they do...going where everyone else is
  • Data security - rightly ranked as a major issue among consumers given the ongoing debacle of healthcare related security breaches (Premera and Anthem Blue Cross, the HHS wall of shame)
  • Partnerships - increasing healthcare companies entering new healthcare partnership - Tenet seem to be the latest
  • Cloud-based technology - importantly seen in conjunction with "Data Security" expect this to grow at a staggering 20% rate and heading to $5.4 billion in annual revenue.

Saturday, March 14, 2015

The intersection of Science Fiction, super-pi, and technology innovation

Celebrating Pi (3.141592653) 3/14/15 at 9:26:53

Today is super-pi day, a day that comes but once a century and extends to a specific time at 9:26:53 seconds (although when that occurs will depends on your time zone. While pi is an infinite non-repeating decimal, there are still mathematicians and scientists seeking to build computers that can run the computation and see how far they can plot the number. As Spock put it:

"Pi as we know the value of Pi is a transcendental figure without resolution"

Here’s to those who choose to defy reality and instead envision a future world – a world that ventures beyond even Mr. Spock’s wildest dreams.

The sad news of Leonard Nimoy’s passing has spurred tributes to not only to his life and craft, but to Star Trek, and what it has meant to so many over the years. In talking with my friends and colleagues, it seems that regardless of age, most Trekkies are also techies.

One of the neatest things about working in technology is that you inhabit two worlds. The first is our everyday reality—with all of its joys, frustrations, celebrations, and inconveniences. This world has soft tender moments tempered by harsh truths; it is simultaneously disappointing and inspiring.
But from this disappointment is born opportunity and a vision for the future world. Here is where Star Trek is a reality, where innovators take those every day frustrations and disappointments as ask themselves how things can be done better.

I’m lucky to work alongside some incredibly innovative, talented minds and whether in R&D or client services, at the core, we all share an inquisitiveness that pulls us from one orbit to another.

“I grew up watching Captain Kirk, Spock, and the Enterprise crew boldly go where no man has gone before. In the 1980s, Star Trek was big in India and it ignited our collective sparks of creativity and imagination. In fact, as school children, we learned to make “communicators” with matchboxes and rubber bands. When I grew up, I realized this type of voice-activated technology could be a reality, and I have dedicated my career to making that vision something that is accessible to everyone. I still wonder how close our technology today is to what Gene Roddenberry had imagined when he created Star Trek.”

- Vivek Kaluskar, Nuance Natural Language Processing Researcher

“Star Trek introduced me to the idea of being able to talk to a computer, and have it understand and respond. That’s actually what got me into speech-recognition technology: it was that sense of wonder about making technology collaborative—where you could ask a device a question and it could parse through vast amounts of data to help you do something faster.
The show also got me interested in science fiction, which has proven to be an enduring affection. It’s amazing to step back and see many ideas that seemed outlandish, like tractor beams, talking computers, matter transmission, and warp drives, are either becoming a reality, or are being researched and developed. Science fiction, in many ways, has created a technological roadmap for the future. It reminds us to keep dreaming and keep asking ‘why can’t we do that?’”

- Ignace Van Caneghem, Nuance Customer Support Specialist


Finding solutions to seemingly impossible situations is what innovators do. It’s why we wake up in the morning. I’m constantly looking for ways to make health IT more connected, accessible, and more intuitive so physicians can focus on treating their patients.

Working in tech isn’t easy, but some of the most worthwhile pursuits are also the most challenging. Thinking outside the box is the key to solving complex problems. There’s an episode of Star Trek (“Wolf in the Fold,” 1967) where Spock forces an alien entity out of the ship’s computer by asking it to calculate pi to the last digit, an impossible feat. At that time, using speech recognition to control a computer was also impossible.



We are a lot closer to the Hollywood vision that’s been in our minds since 1967, creating innovative technology that continues to amaze us at an incredible pace. It was this sense of amazement, instilled by the creative mind of Gene Rodenberry, which helped open my eyes to the potential for healthcare technology to touch not just hundreds, but millions of patients through innovation.

This Saturday is Super Pi Day, a day that comes but once a century. While pi is an infinite non-repeating decimal, there are still mathematicians and scientists seeking to build computers that can run the computation, see how far they can plot the number. Here’s to those who chase the impossible. To those who know there is a better way to do things and dare to keep asking “how?” They choose to live between two worlds and they are building the future. Super-pi day is for you.


This post originally appeared in Whats Next

Monday, March 2, 2015

Would you swipe left on a healthier you?

2015 health IT innovation holds the promise of turning massive amounts of personal health data into usable information that can keep you healthier -- and it's conveniently accessible on your phone.


It’s always comical to watch movies from the 1980s, not only for the distinct style choices that typified that decade, but to see the type of technology most of us can still recall using. It’s nearly impossible to believe we used to happily lug around three pound mobile phones with antennas and back-up battery packs, but they offered a convenience the likes of which we had never seen before. While heading to the 2015 Mobile World Congress (MWC)


one of the most prominent tradeshows in the tech industry, I couldn’t help but think about the pace of change and get excited about the digital health innovations that will be showcased.

We tend to take for granted the conveniences and time-saving effects such innovation has on our lives. Prior to the pervasiveness of mobile technology, if you were walking down the street and you saw someone collapse, you would need to find the nearest store or phone booth to call for help. In fact, most of us probably knew which corners on our daily commute had pay phones. Now, even if you’ve left your phone in the car (an unthinkable these days) you can comfortably rely on the fact that someone nearby will have theirs in the case of an emergency.


Is your heart in it?


From a healthcare perspective, the interconnectivity of devices is fascinating and holds a lot of potential for engaging patients and improving health outcomes. Innovations such as smart watches, which are being outfitted with fitness trackers and heart rate monitoring sensors, can alert the wearer he has achieved 10,000 steps that day or that a runner has reached her target heart rate



While innovations such as these are always exciting, the bigger picture is about creating a healthier population. According to the World Health Organization, cardiovascular disease is the number one cause of death in the world today. Factors such as poor diet and lack of physical activity are some of the main contributors to the disease— and they are also elements most of us struggle to balance. In other words Lifestyle is the biggest contributor to your health as you can see in this video




Wearable devices designed with intuitive interfaces hold the possibility of helping us maintain that balance, remind us of our inactivity, track our daily caloric intake, remind us of how many hours, minutes, and days it has been since our last cigarette (even Spock spoke out against smoking)

When smart watches and fitness bands are tethered to mobile devices, we can layer on more practical applications for personal health management. What if you were walking down the street and your wearable could sense you were having a minor heart arrhythmia, send a signal to your phone, and have it call for help or advice? Or, perhaps, much like our phones can now alert us to poor traffic for our daily commute, what if your wearable, knowing you are diabetic, could sense low blood sugar, sync this data with your phone and tell you some appropriate restaurants and grocery stores nearby? They will be able to translate personal health data into steps and actions we, as patients, can take to better manage our care and keep ourselves healthier.


Engagement ROI

The benefits of an engaged patient population are numerous. Not only will people be healthier, but consider the above World Health Organization cardiovascular disease statistics and the associated costs of care, medication, and lost productivity, not to mention the personal impact on each of us. For coronary heart disease alone, the U.S. spends $108.9 billion. If people were more dialed in to their health— tracking, monitoring, and being rewarded by insurance companies for adherence to healthy lifestyle activities— imagine the savings both in lives and dollars. And with the pervasiveness of health IT innovation, we are seeing more consumer-facing health apps, such as Sharecare’s AskMD, becoming standard features on mobile devices. People can now use these apps to walk them through their symptoms, offer guidance on managing chronic conditions, and remind them to check in with their doctors.

We’ve come a long way from the shoe-box sized mobile phones of the ‘80s and it will be interesting to see a glimpse of our future technologies, widgets and devices on display at CES 2015. One thing is certain: whether you’re a physician or a patient, we’re all still consumers and our expectations for efficiency and conveniences on mobile devices will play a large role in the next phase our health evolution. In fact, I imagine the current wearable will be considered clunky and dated in as little as 10 years. We might find our lives equipped with even more svelte tools integrated with all of our healthcare data and real-time advisors, apps or avatars that coach, coerce or cheer us on through daily choices to keep our lives and health on the ideal track.


The original article appeared in WhatsNext

Saturday, February 28, 2015

Honor Spock's Logic - Follow the Science


Like many I was saddened to hear the loss of one of my heroes growing up - Leonard Nimoy was Spock to me as he was to many others. He epitomized the value of science and logic in the resolution of problems

As my good Friend Jane Sarasohn-Kahn highlighted in her tribute on Healthpopuli: Learning from Mr. Spock and Leonard Nimoy about living long and prospering. Her selection of this iconic moment with Spock were right on target - from one of the great movies from the franchise - Wrath of Khan


Spock: “Do not grieve, Admiral. It is logical: the needs of the many outweigh…”
Kirk: “The needs of the few…”
Spock: “Or the one.”
He spoke out on smoking - something that in the end killed him before his time in this tweet from January 2014:
I quit smoking 30 yrs ago. Not soon enough. I have COPD. Grandpa says, quit now!! LLAP
30% of people will suffer serious Chronic Obstructive Airways Disease (COPD) as a result of smoking - and that's just one of a slew of diseases inextricable linked to smoking. Smoking while in decline in some countries is on the rise in others and this major health risk remains one a negative impact on personal health

You can explore WHO data in this interactive chart from who here

But don't limit the application of science to health and smoking - you can put Vaccines in the same category of Science and Logic. Jimmy Kimmel captured the sentiments aptly in this segment featuring real doctors




So much of your health boils down to Lifestyle choices that was so elegantly captured by Brigitte Piniewski, MD in this chart




Where would you rather be - fun or no fun


Spock the Hero with Super Powers
We may wish for the seriously cool vulcan Nerve Pinch



But we don’t need the vulcan nerve pinch. He and his character have taught us that science while not infallible has been working for us for millennium. We have started to tap into the power of science and the opportunity offered to our health and well being.

When it comes to science and healthcare Doctors are your trusted advisor - the relationship may be changing from the paternalistic role to a collaborative role as Eric Topol so eloquently describes in his latest book - The Patient will See you Now. But as captured in this piece by this Trauma Surgeon (@DocBastard) on the Daily Beast: Why You Trust the Internet More Than Your Doctor
...for god’s sake don’t think that you know as much as a doctor because you Googled something. Medical training takes up to a decade or longer (depending on the specialty), so a 0.452 second Google search does not substitute for consulting with an actual physician whose only interest is your health.
We are only at the beginning - what comes next and in our future is unimaginable. Our innovation, inventiveness and abilities continue to expand our universe and our understanding. Science wins- every time. Be logical with that splash of human emotion and honor his legacy - open your mind, analyze the facts and apply the science. As Jesse: Yeah, Mr. White! Yeah, science!


Live Long and Prosper (LLAP)

or perhaps

Live Long, Logically and Prosper (L3AP)


On a side note - if you are interested in the history of the Spock Vulcan Salute - Live Long and Prosper you can watch his explanation of his Jewish Origins here (derived from the Hebrew letter shin  and the first letter of several hebrew words Shaddai (god), Shalom (hello/goodbye/peace) and Shekhinah (feminine word for god) - How Fascinating!




Monday, January 26, 2015

Will 2015 be the year your watch teaches you about your health?


There is no known medical condition that enables an individual to predict the future. While such an ability would be extremely useful for myriad reasons, we have, instead, learned to hone and leverage our analytic skills to deduce what might occur, relying on the data we cull and parse to help forecast the future. So, when it comes to predicting the year ahead, we should consider the one we just had.

Regardless of which side of the exam table you sit, we’re all healthcare consumers

Consumer technology is often a good indicator of what type of capabilities and functionalities might be in store for health IT. This past year, we saw major players in the tech space announce their forays into healthcare. While this will not be without its challenges, it does not diminish the underlying fact that there is a need and want for better technology in healthcare— regardless of whether you are a patient looking to effectively manage your weight or a physician struggling to juggle patient care and administrative duties.

In the last year, we saw a wave of next-generation wearable devices flood the market, and as a result, we, as patient consumers, now have streamlined access to information such as our daily step count and average heart-rate on our watches. We know that ease-of-use, understandability, and some level of gameification:
“Congratulations! You’ve reached your target heart rate today!”

are vital to maintaining engagement.

I believe this is the beginning of something much larger, a groundswell movement that will result in patients wanting more information about their health data, and, more importantly, craving a better understanding of what all these numbers actually mean and how to positively impact them. Achieving this level of engagement demands a simpler intelligent interface that doesn’t require a learning curve, but is one that consumers can just use. Clever user interface designs can only go so far, particularly given the small visual real estate available on wearable devices, and the addition of capabilities such as intelligent voice assistants will be an integral part of this explosion of personal health management.

Having a heart-to-heart about your heart

Technology holds the potential to create clinical synergy, bringing patient consumers (who have become professional health IT consumers, or health prosumers) better intelligence about their personal health data and outlining the proactive measures they can take to become better partners in their own health. The average patient consumer may not have a reaction to the phrase

“Your Protime this week is 3.3,” but for someone with a heart condition, this number is very important and indicates how fast her blood is clotting. The data, while extremely useful to a clinician, is only helpful to the patient if she understands what it means and how she can take the right actions as a result.

The future is about patients managing their own care and working alongside clinicians to drive better outcomes. To the woman who has a Protime of 3.3, access to these results supplemented with clinical guidelines would mean that she wouldn’t need to wait for her physician to call with diet recommendations, she would know her blood is clotting too slowly and that she might have an inadequate protein consumption or might need to increase her vitamin K intake. If the number required that her Coumadin dosage be adjusted, this would be the point where her physician would reach out to her to discuss.

Although a basic example, it is one that has endless permutations when it comes to building a more engaged patient population. There is no one more invested in your health than you, and the person who cares the next most about keeping you well, is your physician. I believe that clinical synergy will be driven by both patients, who want to actively manage their chronic conditions and take meaningful preventative care measures, and physicians who want to empower their patients to better understand how the choices they make have significant health implications. Technology is the connective fiber that can enable the transmission of this important data, and help translate it into wisdom. And that truly is the crux—the data flowing between patient and physician must be relevant and meaningful. That ability for technology to determine the relevancy of health data information is just around the corner and soon our wearables will be able to notify our health information data that deviates from our personal “normal” results.

Approximately 75 percent of U.S. healthcare expenditure is related to chronic care management, imagine the impact this level of clinical synergy will have on driving a healthier population while reducing cost. I’m ready, are you?

This post originally appeared on WhatsNext





Tuesday, January 20, 2015

CES 2015 - Turning a techie into a modern-day Odysseus

As a physician and a CMIO, I’m forever seeking the latest technology offerings that might help us solve some of the very complex problems that exist in healthcare. With that goal in mind, I set out across the CES 2015 showroom floor, seeking the best in health innovation.

While it was interesting to see all the fitness and consumer health apps, I found myself spending extra time looking at non-healthcare related technologies, drawn in one direction or the other based on the “oohs” and “ahhs” of crowds marveling at incredible and unfettered innovation. I made countless stops along the way, and spoke to many different creators about the potential healthcare implications of their products, and I quickly realized that the future of health IT innovation will be a combination of various consumer technologies that are carefully sutured together.

Internet of Healthcare Things (IoHCT)

The interconnectivity of devices has been a growing trend in the consumer world, but it is one that has not really made its foray into healthcare. When it does, the potential will be astounding. I spoke with La Crosse Technology,


They collect data from weather systems, such as temperature, humidity, etc. They have developed the ability to leverage this data to adjust home heating and cooling systems according to the current weather conditions. Practical and money-saving for sure, but it is easy to extrapolate the benefits of such technology to patient consumers.


Imagine the impact this could have for someone suffering from chronic respiratory issues or severe asthma: they could receive guidance on what is going on outside and perhaps take extra medication to cope with poor air quality.






Additionally, such data could be used to send important reminders to help patients better cope with their medical issues, for instance, a virtual assistant that says “Heavy snow is on the way for the next three days, and I noticed your drug supply was down to two days, you should refill today so you don’t run out while the weather is bad and traveling is difficult.”

I also met with Butterfleye

a company that develops in-home monitoring systems.

Although there were many players in the home-monitoring space, I found this one compelling as it was easy to install and designed to learn, adapting to daily occurrences and routines as opposed to being programed. Imagine the value of setting this device up in the home of an elderly patient or loved one and using it not for security purposes, but for peace-of-mind, to make sure there is activity and movement and to learn of a fall or worsening condition more quickly.


Because the system is able to learn, it can discern the difference between a dog or cat roaming about the house and a person, so if there was an incident, a pet won’t “trick” the system into thinking the individual is actually walking about the room. While personal alerts are helpful if the individual is conscious and is wearing a medical alert device, a system such as this could help identify more severe life-threatening health conditions, and, with an intelligent virtual assistant, could ask residents if they are okay and call for help, if they get a negative or no response.

A Modern-day Techie Odysseus

Those familiar with the story of Odysseus know that he spent seven years sailing the seas trying to return to his homeland, Ithaca. What started out as a point A to point B trip, became a journey that forced him to see things differently. He was drawn in by all sorts of alluring (and not so alluring) options along the way, and when he finally returned home, he did so a wiser man. Meandering through the labyrinth-like CES showroom floor, I saw everything from robots that attach to windows
Solving that challenging problem of dirty windows on the outside

And clean the outside, to alluring bionic sensor


 Technology that allows users to control devices via subtle muscle movement from behind their ears.

A Nod to 3-D Printing

3D printing is taking off and I saw multiple exciting innovations of the technology on the show floor that included developments around materials and the ability to print metals and food. As you can see from this Geek Beat clip we are heading for a reality of the Star Trek Replicator



Healthcare is just scratching the surface and you can get a sense of some of the excitement in this piece by Dave deBronkart (ePatientdave): The Future Is Leaking In: "The Patient Will See You Now" Is 3D Printed Reality

Health and Fitness Apps Get a MakeOver

As my colleague Rebecca Paquette pointed out in her post on CES we are getting people to talk to things more naturally.
Chances are if you’re into staying fit, you’re into tracking all of the data that goes into keeping you happy and healthy. But tracking that data shouldn’t be a workout unto itself. The amount of time we spend logging meals, activity and sleep could be much better used burning more calories, or, if you’re like me, getting more shut eye (I forget to log it, then scramble to get it in before I fall asleep).
This consumer health prototype app on the Samsung Gear S from Nuance turns the process of interacting with these devices on its head as featured in this interview at CESLive


You lift your wrist, say “I had two eggs with multigrain toast, and coffee,” and voila – meal logged, calories tracked.

But the best thing about wandering the show is that it makes you see things differently, helps you think about things in a new way. It’s about pushing the limits, finding new use cases, new possible technology partnerships to create an even more robust, more powerful solution to address what people need.

Healthcare impacts many different types of people, from patients and clinicians, to administrators, coders and compliance officers— just to name a few. The common denominator, regardless of who you are, is that we all seek the best possible health outcomes. Having the opportunity to not only see, but experience, all different types of technology with untapped healthcare potential was incredible. It wasn’t about finding the health-specific applications and devices that would magically solve any one challenge, but about seeing the copious options available to consumers en masse, and talking with innovators about the potential cross-over and blending of technologies to advance healthcare today and in the future

This post originally appeared on WhatsNext





Tuesday, January 6, 2015

CES 2015 - The Year of Digital Health and Wearables

This year I have the privilege of attending CES2015 in Las Vegas - for those of you who have not been before its big..even by Las Vegas standards.

CES attracts 150,000 visitors (all looking for the same cabs so I’m willing to bet that Uber is not going to work as well), occupies 2,000,000 sq ft of space (35 football fields - American or the rest of the world soccer) and includes 3,500 companies

This year the DigitalHealthCES meeting runs concurrently and I believe is in its 4th year. Further evidence of the merger of health, consumer and the engaged patient equipped with mobile technology and wearables.

As my friend John Lynn said in his post Initial CES 2015 Observations. He sees the top trends as

  • 3D Printers
  • Drones, and
  • Wearables

The first two not closely linked to healthcare (except perhaps this recent recent student suggestion of an Ambulance drone to deliver help to heart attack victims).

Wearables are front and center and John cites the Amstrip company with a band aid style monitoring concept. I expect clothing and in particular sports to lead this charge with the initial interest in optimizing training and athletic performance as we saw from the World Cup last year and the miCoach system from Adidas that was in use by the winners Germany.


Needless to say others are joining the fray with clothing brands such as Asics, Under Armour and Ralph Lauren now offering clothes to monitor all sorts of parameters

This year may see the emergence of more from the Internet of Things (IoT) - or the new term the Internet of Everything (IoE).


Everything connected and controlled through a consumer friendly hub which will include the wearable and monitoring concepts.

This is as simple as ceiling fans and cooling systems and thermostats but with healthcare making this even more interesting and the learning potential of these intelligent systems and their Artificial Intelligence offering insights into our lives to help turn unhealthy behaviors and activities into healthy choices.

So much of our healthcare expenditure is related to chronic care management, imagine the impact this level of synergy and motivation will have on driving a healthier population while reducing cost.

I’m ready, are you?

Wednesday, November 12, 2014

Speech and Medical Intelligence – Allowing Doctors to Focus on Patients Not Technology

I am at Medicine 2.0 this week and will be participating on the panel Bridging the Digital Divide and will then be presenting: Speech and Medical Intelligence – Allowing Doctors to Focus on Patients Not Technology

This is an exciting time for mobile devices and while we know there is a discrepancy in the accessibility of mobile technology (I’ll be participating on the panel Bridging the Patient Digital Divide) some of this divide in access can be linked to the complexity of this technology.
With ubiquitous technology comes ubiquitous complexity - adn this is especially true for doctors who face challenging User Interfaces - captured here in this post: How Bad UX Killed Jenny. As doctors we feel we are loosing touch with the Art of Medicine


Which for many of us was the reason we started on the journey to being a healer. Physicians don’t go to medical school because they want to document and code clinical information. Doctors choose their path because of their compassion and desire to deliver care to patients in need. There are increasing physician frustrations with technology and their struggle to keep the focus on patients and not data entry.

Medicine is part science, part art. The relationship between physicians and patients is at the core of healing. This begins with hearing and understanding but is followed by focusing on the patient not the technology. I will be presenting our prototype “Florence” that combines artificial intelligence and speech recognition to offer innovative new speech technologies that help capture and understand not just what the clinician says but what they mean. With new tools that speech enabled systems we simplify access and empower clinicians to capture information and thoughts as they occur. Through the innovative use of natural language tools, context awareness and the generation of high-value clinically actionable medical information clinical systems become efficiently integrated into care delivery process offering the opportunity for doctors to return to the Art of Medicine and focus on the patient.

Here’s a video showing off Florence



Tuesday, November 11, 2014

Bridging the Digital DIvide

This week I will be at the Medicine 2.0 Conference on a panel Bridging the Patient Digital Divide moderated by
Melody Smith Jones


and includes
Lauren Still

and
Nick Genes


The session was put together by Melody to take on the oft talked about but perhaps poorly understood “Digital Divide”. Patients spend less than 1% of their time with doctors - the balance of our time represents (lost) opportunity to interact with people helping them live fulfilling healthy lives and making the best possible choices.
On average, patients only spend 1% of their time in the clinical care setting.  Traditional medicine has focused upon patient engagement during that eight minute doctor visit.  Yet, it is the other 99% of the time, when patients are at home, at work, at school, and in their communities that matters most.  It is outreach to patients while they are living, working, and playing that determines how their overall wellness is managed.
We have seen a plethora of technologies that attempt to address this area with everything from diet and fitness apps to specific applications designed to address long term health issues.
But there is variability with access in the community to information technology preventing access and knowledge and skills necessary to derive the value from these tools. Melody has addressed this divide specifically focusing on apps doe Low-Income Mothers in her recent post: 3 High Health Apps for Low-Income Moms. Check out Melody’s top 3 picks for low income mothers - some great apps focusing on the Food stamps including clever use of Bar code scanning technology to check eligibility of food and the nutritional value and a novel use of simple text messaging to improve maternal and newborn health <----- approach="" font="" love="" of="" simplicity="" the="" this="">

As she points out many of us make assumptions about accessibility to technology in lower social economic groups- as she puts it
Many make an assumption that those with low income or low education levels would not have mobile technology to use in the first place
But despite the budgetary restrictions we see a very high level of adoption of mobile technology - this is true worldwide as demonstrated by the statistics of mobile phone in the world: More People Have Cell Phones Than Toilets, U.N. Study Shows.


Out of the world’s estimated 7 billion people, 6 billion have access to mobile phones. Only 4.5 billion have access to working toilets.

In one of my personal areas of passion - Africa that is replete with examples of successful use of technology to impact the health of the population at levels that we can only dream of here in “the West".  Here in this study: Text message reminders improve healthcare practice in rural Africa
and this piece in the Atlantic: Medicine by Text Message: Learning From the Developing World

It might seem counter intuitive to spend money on what some might consider a luxury or discretionary spend - but for some this is the only means of communication replacing the plain old telephone line (POTS) and these devices come with capabilities and a reach that was pervasively unavailable to many in our society. The statics suggest as many as 80% of low income consumers own a mobile device.

But despite this opportunity the technology and apps are often times targeted at the higher income who already have fitter healthier lifestyles. Some of this is because of the existing developer community (higher social economic group) who develop for the problems they perceive and the harsh economics - this is where the money is (or at least we think it is). Despite Malaria being such a big killer there is limited investment in prevention and treatment of the disease as it affects the poor nations with limited capacity to buy any solutions that are developed despite significant progress and the impact of World Malaria Day


This was covered eloquently by J.C. Herz at wired in this piece: Wearables Are Totally Failing the People Who Need Them Most. We are awash with wearables, new devices and new apps and buckling under a Tsunami of data but:
...developers continue flocking to a saturated market filled with hipster pet rocks, devices that gather reams of largely superficial information for young people whose health isn’t in question, or at risk. It’s a shame because the people who could most benefit from this technology—the old, the chronically ill, the poor—are being ignored. Indeed, companies seem more interested in helping the affluent and tech-savvy sculpt their abs and run 5Ks than navigating the labyrinthine world of the FDA, HIPAA, and the other alphabet soup bureaucracies.
There are some economic reasons for these current trends, some social aspects of the development community but these may be based on false belief of the economics when you consider the opportunity exists to shake up the $2 trillion annual cost of chronic disease….!
I’m with Kabir Kasagood, director of business development for Qualcomm Life who said
Go from the children’s table to the grown-up table...If you’re serious about this, embrace the FDA. Learn how HIPAA works... move away from fitness and go hardcore into health. That’s where the money is
Around 45% of US adults are dealing with at least on chronic condition and picking on one Diabetes and look at the market opportunity of $6.3 Billion spent on blood glucose strips gives you a sense of the economics of this market. These are motivated people for whom the quantified self can mean the difference between an (expensive) admission to hospital or managing and improving at home.
At some point, you’ve got to ask yourself whether it’s just the friction created by health-industry regulation—the HIPAA security rules and FDA approval (or waiver) process and the hassle of integration with legacy systems. Or is it too daunting for a twenty-something engineer to develop technology for people who aren’t like them at all? An obese diabetic on a motorized scooter? Or a frail old lady with memory loss? Or her caregiver? Someone who’s three bus transfers away from a doctor’s office? 
We plan to address these issues in our panel - if you can’t join us maybe you can join the conversation using the hash tag from the conference #Med2 here at Symplur

Monday, November 10, 2014

Dunkirk Spirit: How physicians support patients overcoming adversity

This article originally appeared on WhatsNext: Healthcare
One in eight U.S. women will develop invasive breast cancer over the course of her lifetime.  In 2014 alone, an estimated 295,000 new cases of invasive breast cancer are expected to be diagnosed.  That’s approximately 808 cases per day.

That’s ~640 cases per day or a little over 1 case per hour (26 per day)1

But these statistics don’t matter.  Whether it’s one-in-eight or one-in-3 million, the impact of the illness is what matters—not the numbers.  It immediately becomes a reality to you.  We can never forget that healthcare is personal, something my colleague, Melissa Dirth, articulated beautifully in her recent post “When 1 in 8” was no longer just a statistic to me.”


As a physician, sharing unfavorable findings and test results is always a sobering moment, no matter how many times you’ve done it before.  We all struggle to find the right words, and look for ways to be supportive as you allow your patient to handle the shock that accompanies such news.  We all have different viewpoints and our perspective on the disease is colored by our own life experiences and the individual circumstances.

What never ceases to amaze me, however, is the strength of the human spirit.  Despite the hard road stretching before them, so many of our patients face breast cancer with what the British would term “Dunkirk Spirit,” that inner strength that helps patients and their families overcome tremendous adversity.

Dunkirk Spirit



It is, in my opinion, one of the reasons that make cancer sufferers and survivors such an important and compelling tableau of courage.

Unfortunately, one of the essential elements that quickly becomes lost in the morass of technology is the Art of Medicine, and our ability as doctors to spend the time focused on our patient and their relatives.  As clinicians, we intuitively know the statistics associated with the disease and can interpret them to understand the impact the diagnosis we have just communicated with the patient is likely to have, but there is so much more to providing care.  We don’t just treat the condition, the physical body—we are caregivers and healers, and we seek to help the whole patient.

Technology can help in healthcare, but it is not the goal nor should it ever be the focus.  Yet, in some cases, it has detracted from our ability to provide care and compassion.  To deliver on the promise of great healthcare we have to return to the Art of Medicine and enable, not disable, our clinicians with the technology we develop.

To learn more about the role technology plays in the Art of Medicine, read: “There’s no room in technology in end-of-life care decisions"

Monday, October 27, 2014

The #EMR, #Ebola and #Bigdata - what Can We Learn

After all the hype and knee jerk politics and media I was delighted to read this piece Ebola US Patient Zero: lessons on misdiagnosis and effective use of electronic health records by Upadhyay,  Sittig and Singh (PDF file here)

A thoughtful piece that drilled in to the detail of events surrounding the arrival and subsequent consultations, admission and treatment of Thomas Eric Duncan

who sadly died on October 8 succumbing to the ravages of the Ebola virus

As the authors state
The mishandling of US Patient Zero is receiving widespread media attention highlighting failures in disaster management, infectious disease control, national security, and emergency department (ED) care.....also brought decision-making vulnerabilities in the era of the Electronic Health Record (EHR) into the public eye
Much of the commentary generated "fear, uncertainty, and doubt about the competence of our health care delivery system" and while there were problems I agree with the authors that this is a “teachable moment”  and a chance to identify the missed opportunities and key issues that we can learn from

The authors used the publicly available documents and testimony in their quest and it is important to note that they did not have access to the full record, the EMR used or indeed all the pieces of the puzzle and made up for this in some areas with educated guesses.

It is interesting to note that in the first visit to the ED the patient's temperature spiked to 103 degrees accompanied by pain described by the patient as 8/10 in severity.
This from a Malaria Study but typical of the Spike in Temperature found with this disease

He was diagnosed on initial discharge included sinusitis but "but that CT scans of “head and abdomen” ordered during the ED visit showed no evidence of sinusitis" and perhaps with more attention and importantly time made available to the clinical staff would offer them the opportunity to focus on the history and examination and less on high tech investigation. In many cases clinicians are forced into their use not by clinical practice but rather to meet the production pressures - as the authors put it
A host of system-related factors detract from optimal conditions for critical thinking in the ED, leading clinicians to lose situational awareness. These include production pressures, distractions, and inefficient processes
The upshot was a discharge and subsequent return days later at and even then:
even after the second ED visit which led to hospitalization, strict Ebola isolation precautions were not followed for 2 days, until the diagnosis was confirmed by the CDC
Offering a window into the events that is made so much easier with the benefit of 20/20 hindsight

The authors offer some learning opportunities that are worth highlighting

Top of the list in would be working with software developers to improve EHR usability
As this case illustrates, EHR-based clinical workflows often fail to optimize information sharing amongst various team members, leading to lapses in recognizing specific clinical findings that could aid in rapid and accurate diagnosis
As an interesting addition none of the systems (or incentives) have any form of feedback loop built in to allow clinicians to learn from their actions.

As for the process of information capture - we have lost site of the information that is relevant in the fog of billing and regulatory driven template driven charting.
Condition-specific charting templates, drop-down selection lists, and checkboxes developed in response to billing or quality reporting requirements potentially distort history-taking, examination, and their accurate and comprehensive recording.. Clinicians also tend to ignore template-generated notes in their review process; often the signal-to-noise ratio in these notes is low. EHRs can lead to less verbal exchange, which is all the more needed and more effective when dealing with complex tasks and communicating critical information 
Right on except to say this does not "potentially distort history-taking" - it does distort history-taking and
not "EHRs can lead to less verbal exchange" - EHRs do lead to less verbal exchanges

The data entry requirements place an enormous burden on our clinical professionals

who are tasked and measured not on clinical practice and the delivery of great care but on specific content of documentation that is mandated to capture clinical information in specific ways determined by the reimbursement, coding and regulatory system.
Other factors, such as heavy data entry requirements and frequent copy-and-paste from previous notes, detract from critical thinking during the diagnostic decision-making process... For EHRs to be most effective, they need to be able to automatically sort through patient data, identify the pertinent findings, and present them in an easy to understand manner. Computer algorithms could combine patient-specific information with the latest evidence-based clinical knowledge to help clinicians reach the correct diagnosis
This is the next frontier of Healthcare technology and in particular clinical documentation - we know we can sort through patient data, identify the pertinent findings - focused in these examples on quality of care and evidence based guidelines and we know computer algorithms can use patient specific information combined with evidence based knowledge to help

Technology can help but there are some fundamental flaws in the design and management of healthcare that are fed by the current incentives. Many initiatives attempting to improve patient safety and value-based purchasing but don't focus on accuracy and timeliness of diagnosis and in particular Outpatient reimbursement policies do not reward diagnostic decision-making, teamwork, or quality time spent with the patient in making a diagnosis.

What you incent is what you get and this needs to be changed as well.



Wednesday, October 22, 2014

Tracking #Ebola Effectively hindered thanks to #ICD10 (double) delay

This graphic
Offers a timely reminder that the US Government delayed a second time the implementation of ICD10 coding system that is used in the rest of the world

There is no code for Ebola in ICD9 - just a non-specific 078.89: Other specified diseases due to viruses which covers:

Disease Synonyms
Acute infectious lymphocytosis
Cervical myalgia, epidemic
Disease due to Alpharetrovirus
Disease due to Alphavirus
Disease due to Arenavirus
Disease due to Betaherpesvirinae
Disease due to Birnavirus
Disease due to Coronaviridae
Disease due to Filoviridae
Disease due to Lentivirus
Disease due to Lone star virus
Disease due to Nairovirus
Disease due to Orthobunyavirus
Disease due to Parvoviridae
Disease due to Pestivirus
Disease due to Polyomaviridae
Disease due to Respirovirus
Disease due to Rotavirus
Disease due to Spumavirus
Disease due to Togaviridae
Duvenhage virus disease
Ebola virus disease
Epidemic cervical myalgia
Infectious lymphocytosis
Lassa fever
Le Dantec virus disease
Marburg virus disease
Mokola virus disease
Non-arthropod-borne viral disease associated with AIDS
Parainfluenza
Pichinde virus disease
Tacaribe virus disease
Vesicular stomatitis Alagoas virus disease
Viral encephalomyelocarditis
Applies To
Epidemic cervical myalgia
Marburg disease

ICD-10 has one specific code for Ebola: A98.4 - Ebola Virus Disease
Clinical Information
A highly fatal, acute hemorrhagic fever, clinically very similar to marburg virus disease, caused by ebolavirus, first occurring in the sudan and adjacent northwestern (what was then) zaire.

Accurate tracking and reporting stop at the border of the United States

This is one of many examples of codes "missing" in ICD9 for conditions and care we are already delivering and dealing with

Wednesday, October 15, 2014

Connected Health and Accelerating the Adoption of #mHealth

I attended the Connected Healthcare Conference in San Diego yesterday
Accelerate mHealth Adoption: Deliver Results through Data Driven Business Models for End-User Engagement

Never has there been so much to play for in the mobile health landscape, a revolution is just round the corner with key players from the health care and consumer markets coming together to develop the mHealth industry. This Connected Health Summit will create a bridge bringing together hospitals, clinicians, providers, payers, software and hardware innovators, consumer groups and the wireless industry.

You can find the agenda here and the organizers will be publishing the presentations - there were many interesting insights

Andrew Litt, MD (@DrAndyLitt) (Principal at Cornice Health Ventures, LLC) opened the conference with a great overview of the industry and a slew of challenges and opportunities.

He sees our industry in Phase 1 - the Capture and Digitization of records
and we have yet to really move and explore Phase 2:
Move and Exchnage Data AND Analyze and Manage Data that is linked to Information Driven decision Making
And Phase 3:
Managing Patient Health
In our need to move from data to analysis and information he cited a statistic from a white paper: Analytics: The Nervous System of IT-Enabled Healthcare that sadly puts 80% of data in the EMR unstructured.
This is a fixable problem today with Clinical Language Understanding and we are seeing some results and a change in the industry to stop looking to doctors to be data entry clerks
He also cited Hospitals:
Technology offers tremendous scope to not only fix these problems but get ahead of the problem (as is done in other industries like the Airline industry that has rebooked your flights before you even land and miss your connection). As he suggested could we use data to understand who is likely to develop a heart attack in the next 2 hours and try and change this outcome

But integrating mHealth into our workflow requires an mHealth Ecosystem:

mHealth needs an ecosystem that improves workflow and integrates data to reduce clinicians workload. This is why doctors and clinicians are resisting mHealth - they don’t like the change to the workflow that has little if any positive effect (for the doctor - they may have a positive effect for the individuals health) of reducing clinicians workload

Interesting comment on wearables and the perspective of doctors on these devices:
What bothers the doctor - mostly the people who are buying and using wearable fitness/activity trackers are the people that are young healthy fit and want to prove to (themselves/others) that they are young fit and healthy?
His graphic on Security and privacy was on the money:


Essential to balance Privacy of Health with interoperability but trust is the imperative
The stats he presented were troubling (at best)

  • 96% - Percentage of all healthcare providers that had at least one data breach in the past two years
  • 18 Million - Number of patients whose protected health information was breached between 2009 and 2011
  • 60% - Proportion of healthcare providers that have had 2 or more breaches in the past 2 years
  • 65% - Proportion of breaches reported involving mobile devices
  • $50 - Black market value of a health record

The healthcare industry is under attack and is the most attacked industry today:


You might find these figures of the value of Healthcare data as it is valued on the black-market

Another interesting data point:

HIMSS records a total of 11,000 Healthcare Technology companies - less than 100 are large size and the balance of 10,900 are small business that are essentially capturing and scattering your data across many systems and data repositories...
Multiple other presentations and panelists that were all insightful. As always Jack Young (@youngjhmb) from Qualcomm Life Venture fund had some great insights - impossible to capture all of them but here are some:

Healthcare is moving out of the hospital into the home for many reasons but cost is a big driver:



and he suggested there was at least $1.5 Trillion in economic value as the industry shifts (shifting vs replacement?)



Many were surprised by his stat that users check their smart phone at least 150 times per day (just looking around my world this seems low) - in fact a quick check online suggests this is no longer valid and it is probably 221 times per day. Given this device is the one thing we will not leave home without and it now contains a range of sensors including:

  • Accelerometer
  • Gyroscope
  • Magnetometers
  • GPS
  • Cameras
  • Infrared
  • Touchscreen
  • Finger print
  • Force
  • NFC
  • WiFi/Bluetooth/Cellular

We have the potential for more passive compliance with our patients (and as many stated in their presentations likely more accurate as self reported data is notoriously inaccurate)
He predicted a a 10x growth in wearables from 2014 - 2018 with 26% of this growth attributable to smart watches (I know hard to believe at this point but I think if you looked back 4 years ago the iPad had nothing like the level of penetration it does today)
iPad Growth Rate

I liked his assessment of the werable market place by researching the eBay Discount against the price of the new device:
and even worse for Smart Watches


I also presented “mHealth Reimbursement - Who Will Pay:
You can see it here at Slideshare or below: