Dr. Nick van Terheyden brings a distinctive blend of medical practitioner and business strategist, both national and international, to the realm of healthcare technology. A graduate of the Royal Free Hospital School of Medicine, University of London, Dr. van Terheyden is a pioneering creator in the evolution of healthcare technology. After several years as a […]
This is a sample listing of articles I have had published including links to the original content. My blog can be found here and on these site; The Voice of the Doctor and Navigating Healthcare Articles 2016 National Health IT Week: A Look at Healthcare in 2030 SHIFT Communications (09/2016) In celebration of National Health IT […]
Here’s a sample of my presentations captured on video – either interviews, formal or informal presentations Interview at Exponential Medicine Insights Lounge – Innovations In Healthcare Interview at Exponential Medicine Insights Lounge with Zayna Khayat – Personalized Medicine Presentation – Will Healthcare be Delivered by George Jetson in the Future Future of Healthcare Summit – […]
as their Chief Medical Officer. Dell has been ranked number one in Healthcare Provider Services for six consecutive years by Gartner and continue to expand their presence in healthcare space with an incredible range of solutions and services that are combined with extensive experience offerings of hardware and infrastructure.
This was such an exciting opportunity with a dynamic company with a focus on healthcare that is driven by a guiding principle from Michael Dell:
The opportunity to apply this principle with the assembled first class talented team that have a wide range of skills and deep industry knowledge is empowering and exciting. Healthcare is personal and struggling to deal with technology that has in many cases hindered the personal realtionship between the doctor and the patient. Clinicians want to focus on the patient and not the technology and while patients like technology to be used to improve the quality and safety of care while helping to reduce the costs they also want to doctor to pay attention to them not the device(s) as I have said on many occasions – here in this AMDIS presentation on documentation:
and Healthcare Technology need to include Patients
When I looked at the breadth of what Dell already offers its customers, the range of amazing talent, and some of their innovation projects that included
An impressive healthcare cloud and a focus on Interoperability
Patient engagement, predictive analytics, population health management
Social Media and mobile solutions
Working on Genomics Cloud Storage and analysis that included the recent announcement of the Dell and Translational Genomics Research Institute that is supporting the fight against Pediatric Cancer and helping clinical researchers and doctors globally expand the reach and impact of the world’s first Food and Drug Administration (FDA)-approved personalized medicine trial for pediatric cancer.
This all felt like a perfect match and one that offered me personally an incredible opportunity to have a positive impact on healthcare delivery system here in the US but also around the world.
Amongst the many bonuses of this opportunity was my friend becoming a new work colleague – I am excited to be joining Mandi Bishop (@MandBPro) – social media guru, #HITChick and innovator in data management and analysis.
The big draw for me was that Dell already has a vast amount of products, solutions and data along with insights that they are already integrating across multiple platforms, facilities and technologies. I can’t wait to share more on some of the projects the Dell team are working on soon.
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
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)
#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:
How will the world of medicine change in the next 15 years? Well 15 years ago AOL had just bought Time Warner, the human genome had just been deciphered and published and the first inhabitants of the International Space Station had arrived.
The Year 2030 – my bed has been tracking my vital signs throughout the night and notices I was restless and managed fewer REM cycles during sleep than usual. Prometheus (my personalized artificial automated agent) checks my calendar and traffic and elects to wake me an hour later. Appointments for the morning are rescheduled and my drone pick up is postponed. Prometheus sends an update to “Hestia” (my kitchen AI) with instructions to increase the energy component of my meals for the day to adapt for the lack of sleep and deliver a boost of energy with almond snacks through the day. Prometheus sends my updated sleep and vitals data to my personal health record. While I rest peacefully the rest of the household is awakened and sets about their day.
Time to Get Up
When it’s time to awaken, the bed starts warming to ease the process, the lights slowly turn on and the GPR (Galactic Public Radio) custom news cycle is playing gently in the background. My calendar has been reorganized, and there’s an additional appointment with Asclepius (My health AI) before I leave in the morning. My food is ready and waiting and contains a boost in energy, helping me wake up and acclimate after the poor night’s sleep. I hear the inbound calling for Asclepius and take the call. We review the reasons for my poor night’s sleep and agree I should track this more closely for the next few days to ward off any potential problems. In this instance Asclepius suggests no further investigation is warranted, but if I am worried a drone will be dispatched with some auto investigator tools to apply and track additional parameters if necessary.
As we finish my personal drone arrives and I step outside, catching my foot on a fallen replicator brick discarded by one of the children. As I fall my head strikes the corner of a table and carves into my cheek. Prometheus is immediately on top of the situation checking on my vitals, and while no major damage to my body, the cut will need review and probably some stitches. Checking with local urgent care facilities, the optimal treatment for me today is a quick trip to the urgent care clinic and my drone is reprogrammed to take me there immediately.
Urgent Care in the Future
As I arrive my MedicAlert Digital Bracelet transmits my allergy to lignocaine and identifies me based on the bracelet
and my retinal scan taken as I walk through the door, which authenticates my presence and consent initiates transfer of my medical data and records to the clinic.
I’m guided to a room where a robot nurse cleans my wound and positions me on the bed and brings in the Panacea (the medical repair robot). My medical record shows I have had a recent Tetanus shot, and a comparison of my previous vitals shows there are no serious changes that would warrant additional investigation. Repair completed, my records are updated with the new details and a drone appears to take me to work.
Medical Offices and Care in the Future
As I step into my office my team are all walking in (virtually) and the central console and screens around the room light up with data on our first patient. We process through the details provided by the various Artificial Intelligence agents and data gathering tools. “Jane” (name changed to preserve her privacy) has been having some frequent dizzy spells and falls – her mother had Meniere’s disease and a degenerative disease linked to the A2ML1-AS1 / ADAM20P1 / MTor Complex 2 / WDFY3-AS2 – we think there may be a link. Even though Jane does not have these gene expressions there may be a new epigenetic influencer she received that is affecting her stable sequence. We need to get to the bottom of this. Jane is here too (virtually) – with her mother and father – and they are looking at the same data, shown with basic annotations to help them understand the details.
We think we have an answer, but want to share the details and show Jane and her family the model of the CRISPR editor nanobot and its effects before we decide on the next course of action. Do we create a more realistic model of her body functions with the cell printer and test on that? Or is the confidence in our simulation high enough to warrant immediate therapy? Whatever we decide we will get real time approval from the GMAA (Galactic Medical Agent Agency that replaced the FDA in 2021). Jane and her family have seen a new therapy advertised and they want to understand how that might work for them. We pull up the details and all the data on patients and do an immediate comparison. The data’s questionable but, more importantly, it’s contraindicated in anyone with GRAMS domain, Heat Shock 70kDa protein expression and several others that disqualify Jane.
We elect a wait and see approach – so much easier these days with the real time monitoring and detailed data we have on patients that allows us the scope to wait and watch while reassuring patients. Directives are sent to their family “agents” and a drone dispatched to their location with some additional monitors for Jane to wear to give more detailed data on her for the next few days.
As we complete the consultation a drone arrives with my almond snacks and some water – perfect timing.
This post appeared in abbreviated form on SHIFT communication site – and is included in their downloadable ebook
Population health is the topic du jour for the health care industry, and I’m glad to see us all focusing on this important issue. But there is a lot of confusion as to what, exactly, constitutes population health. Or more correctly, an effective population health system.
A good population health program consists of four major components:
Identification and stratification of risk within a discrete population
Dissemination of information to physicians, care coordinators or others designated to contact patients and arrange follow up.
Appropriate follow up to further understand the risks for individual patients, identify gaps in care and design a care plan to help the patient improve his/her health status.
Ongoing care individualized to each patient’s need. That might be coaching, medication reminders, telehealth visits, remote monitoring or other strategies customized to each person’s condition and socio-economic environment.
The key to making a population health program effective is ensuring that all four components are in place and working well. If there is a break anywhere in the chain, you lose the opportunity to improve patients’ health. The best analytics in the world are useless if the results do not quickly and easily pass into the hands of the people who can take action. And very good follow up and care planning can be ineffective if the ongoing support is lacking.
One of the biggest barriers to effective population health improvement is friction in the flow of information between health plans, hospitals/health systems and physicians. This has been a constant source of difficulty for the entire healthcare ecosystem for years, but with the new focus on population health and improving outcomes, it has reached a new level of urgency.
In traditional African societies coronary artery disease is virtually nonexistent, but in the migrant population to Western societies the rates are similar to those of the local population indicating that the primary determinants of these diseases are lifestyle and diet and not genetic. These indicators are a key asset in changing our healthcare system and addressing the current 75% of our healthcare spending that is focused on patients with chronic conditions which have their roots in lifestyle choices and behaviors. To address these challenges we need a way to better target our limited healthcare resources more cost effectively for maximum effect and identification and targeting with a robust population health system is no longer a nice to have – it’s a must.
To help patients improve their health, not just react to a situation that has already developed, requires information and insights. But in a survey of primary care physicians by The Commonwealth Fund, only 31% of U.S. physicians said they are notified when a patient is discharged from the hospital or seen in an emergency department. This is important information for primary care physicians, and is not that difficult to fix. All you need is standard protocol in place and a mechanism for notification. It could be a standard action that happens at every discharge. It could even be automated. If the retail industry can automatically send an email to confirm an order, hospitals and health systems should be able to send an automatic email to a physician with discharge information. But hospitals and health system executives haven’t made it a priority, so it doesn’t get fixed.
Get to know your team mates
This is just one example of the inward-looking approach that still permeates much of healthcare. Hospitals, nursing homes, skilled nursing facilities and other care providers pay attention to what happens within their organizations, but they neglect to look beyond. Organizations act as though the care they give is the only care patients receive. They forget that there are a multitude of other professionals who are also responsible for care and need to know what’s going on. We don’t just have data silos in healthcare, we have attitudinal silos that make data transfer and exchange an afterthought at best.
It’s like each care provider is a golfer alone on the course and the patient is the ball. As long as that lone golfer moves the ball forward, it’s all good.
The reality is that healthcare is a team sport, more like football (or soccer as it is called in the US) than golf. If you can’t make an accurate, effective pass to your team mates, you lose the ball.
But patients aren’t balls, they’re human beings. When one member of the healthcare team fails to inform the rest of the team, a human being gets lost in the confusion with poor outcomes and frustrated patients.
In population health improvement, you have to play on a team, because it takes a wide variety of skills to make this all happen. And you have to be aware of all the other players on the team. The successful population programs include everyone who is part of the community – not just the healthcare system and resources but all aspects of the community. Dell Medical School held an inaugural event to crowd-source their population health strategy, coming up with areas of focus and metrics for success that included input from a wide range of stake holders. This is the kind of team based approach to population health that will help the whole community win – getting people healthy and staying healthy.
It starts with leadership
Most healthcare organizations are at least partly aware of the problem and are making efforts to solve it. But it is a complex problem, involving, as I noted above, attitudes as well as technology. To make data flow freely to those who need it, you have to have effective technology to integrate, manage and analyze the multitude of data streams in healthcare, and you also need leadership who prioritize data sharing over the competitive interests of conflicting health delivery systems. With free flowing information routed to all the interested parties including the oft forgotten but all important patient, in understandable and actionable form that includes the insights and management options we can successfully identify those at risk and develop appropriate interventions. By including the patient and personal care team that typically includes multiple family members we capitalize on underutilized resources that are both essential and highly effective at improving the trajectory for the patient’s outcome.
Custom Communication and Targeting
Traditional systems and methods have targeted the existing clinical systems and communications which, while suited to some, fail to adapt to the changing world of technology and the fact that people no longer go online – they live online. This doesn’t just apply to patients and their families; it’s increasingly true for clinicians. It can be as simple as a text based reminder for medication, timed to coincide with the patients personal schedule and preferences or as complex as an automated avatar with augmented intelligence that engages with the patient to assess their status and determine the need for additional intervention or personal follow up by the care team.
Each year HealthIT week raises awareness of technology in healthcare, bringing together innovators and key healthcare leaders who are diligently working together to make the best use of information technology to improve the healthcare systems and ultimately our each and everyone’s individual health. This past year we lost one of the titans whose personal journey of uncoordinated care she shared in her attempt to correct the system – Jess Jacobs (#UnicornJess). It might be too late for Jess but let this be the year we move past the individual approach in healthcare driven by underlying economics and focus on the team sport of population health and democratize access to the best possible care and outcomes to the widest swathe of people…worldwide.
Honoring those Who Serve (Updated Friday September 9, 2016)
So what’s the 22 Pushups challenge all about? It came from the Honor Courage Commitment organization who’s mission is to create elite veterans through education, mentorship, and community service. They started the #22Kill movement back in 2013 when they learned that a staggering 22 veterans are killed by suicide every day. There is some controversy over this statistic, the original source from a 2012 study and the detailed analysis but there is a higher rate of suicide amongst those who serve and even with controversy it should remain a priority – by any measure, this is a devastating epidemic of staggering proportions
It all started with my good friend and Royal Free Hospital School of Medicine Alumni Sue Roche as she took on the challenge and tagged friends – it inspired me and I followed along daily, adding my own set of 22 pushups to Sue’s each day. After a few days I was tagged and as they say the rest is history – as of writing I am on my 4th official day of 22 with some interesting opportunities to complete the challenge coming up in my travels.
As of today Friday September 9, 2016 I have completed my journey and you can find all 25 videos posted at the bottom of my 22 pushups that were done in: various places around the world including Los Angeles, Phoenix, Maryland, Virginia, Frankfurt Germany, Bangalore, Chennai, Delhi in India.
If you discount my inability to count and keep track of days and assume I did the correct number of 22 days with 22 Pushups
In the 11 days I have been doing this in raw numbers:
In the US (Ranked 50) ~2,590 people committed suicide of which ~484 were veterans
In India (Ranked 11) ~8,136 people committed suicide
In Australia (Ranked 63) ~174 people committed suicide
In the UK (Ranked 105) ~364 people committed suicide
In Ireland (Ranked 59) ~28 people committed suicide
All based on best estimates for most recent data – rankings based on suicide rate per head of population)
In the US for all causes of death suicide is ranked 10th above septicemia, chronic liver disease and hypertension
As of today the counter is at 15.2 Million pushups – and I know the awareness has increased and I am grateful to each and everyone that has participated, contributed and got involved continuing to keep the focus and inspire me to complete my small part in this important project that includes a donation today in my father’s name: A World War 2 veteran who fought in the Dutch resistance and escaped occupied Europe and shipped out to Camp Le Jeune where he trained to become a Royal Dutch Marine. He suffered undiagnosed PTSD that manifested itself when he was undergoing surgery and anesthesia
What do you have to do – the detailed instructions are here – record a video of you doing push-ups – it does not have to be 22 – every push up counts and they are being grabbed automatically to update the counter:
But you have to tag your post with
#22pressups for #22Kill
The number preceding the “press-ups” can be whatever you make it for the number – if you can get some other participants to complete the press ups at the same time you can multiply up. Then post it on Facebook, Twitter, Youtube or instagram and
Can you Hear me Now
Here’s the video from their YouTube channel featuring many contributing and many lost
How do you support them beyond raising the awareness and completing the challenge
I am excited to be elected to the MedicAlert Board joining Jessica Federer, head of digital development at Bayer. As Barton Tretheway, CAE, chair of the MedicAlert Foundation Board pointed out
Their collective experience aligns with our priorities and will be immeasurable to us as we look to leverage the power of new technology to expand the mission of MedicAlert Foundation, which is designed to help save lives
Which succinctly captures my feelings around this additional role. I personally experienced the value of the MedicAlert solution, brand and promise when I practiced as an Emergency Room physician in the United Kingdom. It was part of the standard procedure for any patient who arrived unconscious or confused to look for the signature bracelet
With its iconic Caduceus (similar but different to the Rod of Asclepius) which was the traditional sign of the God Hermes and became established as the symbol of medicine in the United States in the late 19th Century.
History of MedicAlert
The history of MedicAlert dates back to the Early 1950’s developed by parents of Linda Collins who had an who had an anaphylactic reaction to tetanus anti toxin (which in her instance she only received a small scratch test as was the practice in 1953) and had a severe reaction. She survive but her parents Dr Marion Collins and his wife Chrissie realized that she was at risk and made a paper bracelet and note that was attached to her coat detailing her severe allergy.
From these modest beginnings things have developed with early recognition by “Peace Officers”. The California Peace Officers magazine even ran an article back in January 1957 highlighting the MedicAlert bracelet to their members. In the era before mobile phones and always on communication it was a reliable way of identifying individuals and providing immediate access to a 24- hour phone line linked to critical and life saving information for that individual. This function continues today with a live 24/7 Emergency Response Service
The age of computing brought new innovations and the ability to more readily store and retrieve more information for members and track and follow membership and presidential recognition dating back as far as April 9-16, 1978 when then President Jimmy Carter commemorated the occasion of MedicAlert and their contribution to Medic Alert week in April. Even Hollywood got in on the act with appearances of the MedicAlert in everything from the Today Show and Good Morning America to CHiPs
Moving into the Digital Age
The organization is moving into the digital age with solutions around stored medical records, moving to digital mobile formats and storage solutions and even exploring the potential for RFID enabled solutions and in partnership with the American Medical Association has a joint venture on advanced directives.
Back in 1956 Dr Marion Collins commented that
“I think I can save more lives with MedicAlert that I’ll ever save with my scalpel”
Which is much like my own perception of medicine and the opportunity of Digital Health that I saw 30 years ago and continues to be the case. It’s this combination of a storied brand and concept from MedicAlert as a foundation and the opportunity to update for the new Digital world we live in that presents such an exciting opportunity. We are facing a Silver Tsunami of people who struggle to age in their homes and technology and solutions that help them do so, safely and with the support of their relatives and the health system will be in high demand.
I’m looking forward to working with my fellow board members and the MedicAlert team to continue the tradition and build on the brand with a Digital update and twist
Channeling Churchill to deal with innovation, impatience and chaos in healthcare
To say that healthcare is changing is to understate the situation dramatically. The combination of new technology and a demand by payers and consumers for more value for their money has created an environment rich in both innovation and impatience. You may think you are moving swiftly, but no matter how quickly your organization is adapting, both payers and consumers are tapping their collective feet and wondering why it’s taking you so long to get with the program.
Consumers now expect digital access to everything 24x7x365. The online world has taught us that this is not only possible, but even routine – everywhere but healthcare. So their impatience with our slowness is understandable. They can search at 3 a.m. for answers to health questions that we as healthcare providers haven’t given them. Given that many of the answers they find on the internet may be dangerously wrong, it’s time we did a better job answering their questions, even at 3 a.m.
Payers, too, are impatient for change. They want value-based contracting and want to reward results, not volume of procedures done.
Technology is behind much of this, because appropriate use of technology can speed up the process of everything we do. Beyond speed of connection, though, technology will change, at a very basic level, the way we deliver healthcare.
In speaking of a fundamental change in healthcare, I’m thinking particularly of analytics and the progress toward what I call “augmented intelligence.” While artificial intelligence has a long road to travel to match the thinking abilities of the human brain, technology can now augment our capabilities. Technology can take over the tedious task of searching for data and looking for patterns, giving us an invaluable assistant. No human is capable of reviewing clinical data and images from thousands, even millions, of patients to find the knowledge hidden in those terabytes. But a computer with the right software can do it quickly and efficiently, giving caregivers access to new knowledge.
Finding the zebras among the horses
Computers can also profoundly improve decision support systems, broadening the thinking of physicians. If you ever read the New York Times column, Think Like a Physician, you will understand just how useful this could be. In that column, the author presents a diagnostic challenge that has stumped many physicians before being resolved. Often, it takes months and many different physicians before an accurate diagnosis is made.
In training, we learn that when you hear hoof beats, think horses, not zebras. In other words, think of the common things first. But now and again, those hoof beats turn out to be zebras, and we often miss the subtle differences that tell us that zebras are lurking over the horizon, not horses. We keep looking for horses while the zebras roam freely around our feet. Conversely, we may think we see a zebra when it’s just a pony with odd coloring. This happens in part because we are searching in the dark, and it’s hard to tell a horse from a zebra with the lights off. An augmented intelligence system could help sort through a patient’s complex set of symptoms and clinical findings to offer up a broader range of ranked possibilities and recommendations for testing that could pinpoint the diagnosis. It could flip the light switch and make it easier for us to see whether it’s a herd of zebras or a herd of horses making all that noise.
A new kind of medical progress: R2D2 (or possibly C3PO) will see you now
Vinod Khosla, co-founder of Sun Microsystems, has said, “In the next 10 years, data science and software will do more for medicine than all of the biological sciences together.” He has also noted, “By 2025, 80 percent of the functions doctors do will be done much better and much more cheaply by machines and machine learned algorithms.”
But, even if he is right, that doesn’t mean that doctors won’t be needed. On the contrary, it will allow physicians to bypass the really boring part of their jobs and do that 20 percent of functions that require a thinking, feeling human being to accomplish. It will also extend our resources dramatically, which is important, because the US Department to Health and Human Services predicts that by 2020 we will need 20,400 more physicians, just in the U.S., than will be available.
And it’s not just the supply of doctors that will see a shortfall. Globally, the World Health Organization says that 15% of the need for doctors and nurses isn’t being met. Moreover, in Africa, that shortfall is dramatically worse. The continent has about 24% of the world’s disease burden but has only 2% of the global health resources. The unequal distribution of medical expertise is a serious problem that technology can help solve, with telehealth solutions and cheap, portable diagnostic testing solutions.
And it’s not just the role of physicians that will change
Profound as the changes are that will be coming to medical professionals, healthcare executives are facing an even more profound change in the way they will perform their work. The move from fee-for-service and opaque claims and billings systems toward value-based care and transparent pricing is happening rapidly, and it will require a complete overhaul of the thinking and strategizing of most healthcare executive teams.
Everything you thought you knew about how to make your organization financially successful will change. Profit centers like radiology and diagnostic imaging will become cost centers; the more high-end expensive care you give, which once supported all the more mundane services you provide, the lower your profits will be. Instead of filling beds, your job will be to keep them empty.
It’s a big challenge, but the same kind of augmented intelligence systems that will help physicians keep patients healthy can help you keep your organization healthy. Analytics can help you identify and stratify risk, so that you can contract with payers at rates that won’t kill your bottom line. And it can help you identify gaps in care that could lead to the need for expensive treatments and procedures.
Technology can also help you keep patients healthy. Telehealth and remote monitoring are making significant improvements in chronic disease outcomes.
To face the challenge, be like Churchill
The cultural change required by all this progress will likely create anxiety and chaos within your organization. But it doesn’t have to do so. If the CEO and executive teams stay calm and focused, the people they lead will be less anxious and more able to think creatively.
Remember London in 1940? Bombs were falling nightly from Nazi warplanes, and the city was literally on fire. Hitler believed that by bombing population centers, he could sow panic among the people and make invasion possible. But the people of London didn’t panic. Their leader, Winston Churchill, personified the advice to “Keep calm and carry on.” That firm hand at the wheel of the nation gave the people of London and of the entire country a model to follow. Rather than chaos, the Nazi attacks created incredible resourcefulness that resulted in remarkable innovation that helped win the war.
So when the task of facing the upheaval in healthcare seems too much, channel the spirit of Churchill and keep calm and carry on.
You also might want to get your physician to prescribe for you what Otto C. Pickhardt, MD, prescribed for Churchill in 1932, when he was recovering from being hit by a car on Fifth Avenue in New York: “alcoholic spirits especially at meal times. The quantity is naturally indefinite but the minimum requirements would be 250 cubic centimeters.” For my non-scientific American readers, that’s about 8.4 ounces or about 10 shots!
I’d moderate that dose a bit, but I’d go with Churchill’s choice of medicine, whiskey. Sometimes chaos and challenge require you to sit back, take a deep breath and get some perspective. I find that a good single malt Scottish whiskey gives me a broader view of the world and my place in it. And I find that my thinking can become quite innovative after a couple of ounces.
The original appeared on HealthBlawg’s Festschrift Tenth Blogiversary here
Most women know about their own health but not so much about men yet most women have men in their lives – sons, brothers, fathers, partners. Here are some of the highlights of the challenges in men’s Health
More men are born than women but that lead disappears quickly – in 1920 women outlived men by 1 year that’s now up to 5 years women outlive men. Having a “Y” Chromosome is not the reason for the poorer health of men.
Men “lead” in the top 15 causes death with the exception of Alzheimer’s (and that’s because men don’t live as long and as a result experience less Alzheimer’s).
This is the Mars vs Venus Gender gap in health. Men, like women have some diseases that are specific to them – prostate disease for example, but despite 1 in 6 being diagnosed with prostate cancer only 1 in 35 die from the disease. But most diseases are a shared problems – they strike both men and women. The leading issues for both gender’s are:
Cardiovascular – men lead in heart un healthiness – but ladies are catching up
Heart disease and stroke – leading cause of death
Men develop atherosclerosis ~5 years earlier than women
Lung cancer remains a threat – tobacco causes 90% of lung cancer and is causing ~158,000 deaths each year but there are gender differences; ~85,000 in men and ~72,000 in women (that’s more than enough to fill the Superdome every year)
But when it comes to Mental Health, Depression and Suicide we thought this affected men more than women but this may just be that men hide their feelings better and men also tend to seek help less for depression and while women attempt suicide more than men, more men die of suicide as they are more “successful”:
If you were born after the year 2000 as a boy your chances of developing Diabetes is 1 in 3
“The combination of diabetes and obesity may be erasing some of the reductions in heart disease risk we’ve had over the last few decades”
So what should women do – as they should for themselves, encourage exercise (30 minutes per day reduces the chances of diabetes by 50% for men) and a balanced and healthy diet. Not ignoring problems and focusing on prevention helping men seek medical help, but above all give them a hug and help them share and talk about their feelings
I struggle to keep my contacts in order and synchronized, not just across devices but across ecosystems and channels. How do you keep your old style digitized version of the rolodex in sync with your twitter followers and LinkedIn connections? How do you know when your friends join a new social media channel that you are member of so you can connect there?
I’ve tried many tools and techniques and had been using Brewster which recently was acquired by FullContact and the transition offered me 3 months of premium access to their service. The free version offers backup and some syncing across limited accounts – the premium version expands to multiple accounts and includes business card scanning.
The early results were surprising – in my contact database the system was offering me updates to over 40% of my contacts. I was suspicious but as I investigated I discovered that using some clever back end algorithms it was revealing updates to many of my connections including some I validated manually that good friends revealed were early forays into social media including a blog on Ice Cream and a corresponding Pinterest account.
So in social media and the commercial world we can link data and people – in fact the commercial organizations do this very effectively that Target collected enough information on individuals linked through a unique identifier to identify a high school student was pregnant and mail her maternity adverts before the “news” had leaker to her father
“Target assigns every customer a Guest ID number, tied to their credit card, name, or email address that becomes a bucket that stores a history of everything they’ve bought and any demographic information Target has collected from them or bought from other sources”
The healthcare system is rife with enough challenges – why is it we have one that is of our own making. Why is there so much resistance to the idea of uniquely identifying a patient so we can attach the correct medical data to the correct person and deliver the correct medical treatment to that same individual?
In 1996 the Health Insurance Portability and Accountability Act (HIPAA) was signed into law and it specifically called for
“a standard unique health identifier for each individual”
But in 1998, Congress eliminated that requirement and even prohibited the use of federal funds to develop a unique identifier. Anyone who knows me will know my passion for privacy and individual rights but in this instance the harm and cost foisted on the system, providers, payers and ultimately the patients is gargantuan!
The prohibitive cost associated with creating a universal healthcare identifier has been one of the primary barriers to the creation of such a system. The Voluntary Universal Healthcare Identifier (VUHID) project takes a radically different approach to solving this problem compared to previous proposals. This article examines the economic impact of this approach and discusses why the unique VUHID approach permits implementation of the system at a small fraction of previously estimated costs.
Implementing a unique patient identifier would add nothing to our health care system beyond coercive surveillance
Or as Twila Brase, RN, is cofounder and president of Citizens’ Council for Health Freedom, says its important not to have it to prevent the creation of a “nationalized” healthcare system (I’d interpret this as a single payer system like the VA and Medicare?)
The most important reason is our opposition to building a national health care system. Without a national identification card for patients, it would be difficult to nationalize health care
Or do you side with Douglas Fridsma, MD, PhD, is president and CEO of the American Medical Informatics Association who says people care a lot about the privacy and security of their medical data but want immediate access and transferability with control over who can see and use their medical data and believes that
Giving every American a unique patient ID could help address all of those issues.
On Tuesday March 15th, 2016 a the Dell Lounge at South by Southwest (SXSW) we hosted the #DoMoreHIT Thinktank event.
This was Dell’s 5th’s annual healthcare Think Tank. Together with my good friend and colleague Mandi Bishop – Healthcare Analytics Innovations & Consulting Practice Lead, Dell, #HIT100 influencer, @MandiBPro we were joined by a veritable who’s who of thought leaders from healthcare and related industries for an outstanding set of panelists:
We divided the session up into three segments – Data explosion in Healthcare, Embracing New Technology and How to be Future Ready
The Data Explosion in Healthcare
Physicians, patients and health systems are over whelmed with data – is there too much noise to discern the signal of relevance?
Is there any focus area for gathering or managing data that healthcare should target over others (wearables vs genomics vs population health vs clinical data vs lab values vs imaging for example)? And are there data sources outside those traditionally considered “health” that you’d consider particularly relevant?
What can patients – and clinicians – do to get ready for the deluge of data and information that they will be receiving and become increasingly responsible for managing?
How can we, as an industry, and our individual organizations help make the vast quantities of diverse data into meaningful information that can be readily understood?
How much do you trust the quality of the data sources your organization is using for BI and analytics? And how do you address it if/when you don’t trust the data quality?
If your organization is collecting data about your patients/consumers, do you offer that data – and any health insights derived from it – back to those patients/consumers? If so, how? And if not, why not?
Embracing New Technology
How do we embrace technology while keeping the focus on patient and compassion?
Is there any new technology that stands out as delivering value that patients, clinicians and health systems can jump on, now?
Do you think there’s a fear amongst healthcare providers that digital health technology, in conjunction with advanced analytics, will change – perhaps reduce – the role of the clinician in healthcare delivery?
What do you see as ripe opportunities for emerging technology to disrupt healthcare? What’s already been done that’s working, and what do you think is on the horizon that’s about to break?
How do we make wearable technology and remote monitoring accessible to the underserved populations who may best benefit?
What do you think are the biggest obstacles to tech adoption (for consumers and for providers/industry)?
Future Ready Healthcare
What does being “future-ready” mean to you and your organization? How can you be future ready in the age of constant and increasingly rapid change?
What one thing do you think will change the future of healthcare this year, in 3 years and in 10 years?
Increasingly people want personalized health and wellness care – how do we deliver that with the current system that does not readily enable personalization (both from a technology perspective and from an incentives perspective)?
Do you believe precision medicine principles – genomics informing personalized clinical pathways – are sustainable across vast numbers of people? Or are they perhaps best narrowly applied to complex disease states with limited number of affected persons? And how will incentives have to change to align?
When was the last time your doctor asked you how you’d like to be engaged? And if they’ve asked you, have they done what you suggested?
Do you have a formal patient/member advisory board/council? If so, how does it work? And if not, why not?
The event was a great success and despite the global LiveStream issues at the time we managed to trend #2 on Twitter just behind #IndianaJones
As of writing there have been over 20M #DoMoreHIT impressions and the material continues to provide additional utility and is in use in other forums. The venue itself was packed and there have to date been 2,500+ Livestream views and ongoing On-Demand promotion and use. In house attendees and online described it as the “best panel yet!”
Watch Dell’s 2016 #DoMoreHIT Healthcare Think Tank on Livestream.com. The fifth annual #DoMoreHIT Healthcare Think Tank, hosted by Dell, once again brings together a panel of leading social influencers impacting healthcare to discuss burning issues and trends to expect in 2016.
On February 21, 1991 President George Bush declared in Proclamation 6253 March 30 would be National Doctors Day:
There is no greater reward in our profession than the knowledge that God has entrusted us with the physical care of His people. The Almighty has reserved for Himself the power to create life, but He has assigned to a few of us the responsibility of keeping in good repair the bodies in which this life is sustained
In honor of my colleagues and the countless others who make up the healthcare service and who struggle daily with the delivery of healthcare and the challenges of a system that is broken but still delivers outstanding care:
Its an exciting and challenging time and the healthcare service is dependent on the clinical skills and dedication of Doctors to deliver excellent healthcare – take a moment to thank your clinical professional for all they do on a daily basis. The glass is full – 1/2 full of water and 1/2 full of air and I’m excited about the future and what’s coming and hope my friends and colleagues are too:
This is an exciting and positive development in Genomics using the CRISPR technology – here source scientists have removed the HIV-1 genome from the genome of human immune cells
Gene editing could now be added to the armament of clinicians to fight diseases including infections
2015 was an incredible year in technology and healthcare; from new consumer technology and personalized devices coming to market to the introduction of new supercomputers that reduce the time and cost of healthcare data analysis. It’s been great to see how innovation continues to penetrate the medical profession, improving patient services and care. As we look to 2016, there are some areas that we can expect technology to further impact.
Growing patient concern over security
Security is a major concern for consumers and the healthcare industry, and the threat of it is only rising. While technology and data provides patients with the precise, personalized medicine that they want, individuals have not forgotten the security breaches that occurred this past year, which had heightened their concern, particularly with the type of personal information in medical records. Implementing stronger, more reliable and transparent security practices will be a critical objective for medical practitioners, but equally important will be reestablishing trust with their patients and consumers.
The consumerization of healthcare
Consumers have grown to expect personal and custom experiences from technology. The consumerization of healthcare will gather greater momentum and the healthcare industry will see the first effects of this trend on individual behavior in 2016. By treating patients and individuals seeking healthier lifestyles as consumers, the healthcare and related technology developed becomes more and more applicable to serving their needs and meeting them where they are. This is a great thing. As an example, imagine telehealth kiosks now allow patients to engage in a face-to-face video consult with their doctor, or have their vitals taken and receive a diagnosis – without setting foot in their doctor office. Pilot programs for these “pods” are being tested in Rite Aid and the Cleveland Clinic.
The latest innovations will further fuel the moment around treating patients as consumers and developing relevant technology that make it easier for them to monitor their health and seek treatment, driving more adoption and healthier populations.
Embracing the Internet of Things toward patient engagement
The Internet of Things (IoT) connects billions of objects around the world, and in 2016, the healthcare industry will take the first steps in tapping IoT’s full potential through passive monitoring. Leveraging wearables and connected devices, healthcare organizations, with the consent of patients will be able to passively monitor the wellness of patients and personalize their experience. For example, for those with chronic diseases, such as diabetes or heart disease, these devices can monitor all aspects of the patient’s daily life to provide insight to the patient and the healthcare providers, into how different activities, such as eating, sleeping or watching TV, affects his or her body. Connected devices equipped with real-time feedback can provide subtle alerts that prompt, caution or encourage patients to stick with or avoid certain behaviors. These devices can also help them to comply with a treatment or regimen. In 2016, we’ll see the industry understand that subtle patient engagement through passive monitoring can have positive, long-term effects on behavioral change.
The potential of ICD-10
While the rollout of ICD-10 was reluctantly undertaken by some in 2015, the healthcare industry will begin to realize its actual potential in 2016. As a result of ICD-10, healthcare organizations will receive a higher level of granularity in the clinical data that has been collected including patient information and clinical data. Utilizing this data will enable new insights and deeper analysis. This will be the first step in turning descriptive healthcare analytics to predictive and prescriptive insights enabling results like reducing readmission and improving population health management. However, as we see potential benefits being realized, discussions will center on the interoperability of systems that is limiting analysis and holding back potential insights.
More democratized, globalized healthcare
While diseases such as AIDS and malaria are now considered chronic or curable with the proper treatment, there are still geographical, technological and societal barriers that pose great challenges when trying to treat the demographics that are most commonly affected. In the third world and emerging countries, healthcare organizations are leveraging technology, including simple mobile devices, to provide patients with faster, more effective care. In 2016, we will see more companies create technology that democratizes healthcare with innovations that help to lower the cost of healthcare, enhance patient engagement and improve overall worldwide population health.
Not only is it exciting to imagine how we’ll see technology continue to evolve and change everyday life, but also fascinating to see the impact and opportunities for enabling healthcare providers. These trends will manifest in some exciting and innovative changes in 2016 that will have a tremendous impact and further improvements in patient care.
“As we looked more deeply into the specific area of concussions, we realized that there were many more questions than answers,” Mr. Tagliabue wrote. The committee’s chairman, Dr. Elliot Pellman, the team physician for the Jets, emphasized that his group aimed to produce research that was “independent” and “meticulous.”
As reported by the NYT the concussions research was deeply flawed and drawing expertise from companies who cut their teeth working for tobacco companies and as the evidence mounts it is hard to draw anything but a very negative view of the organizations and their behavior towards the players and their health. The big questions is how much did they know and how deliberate was this cover up in the name of corporate profits?
The move toward value-based reimbursement is shaking up traditional healthcare in all kinds of ways, as connectivity and cost-effectiveness become critical attributes in care delivery. Proprietary PACS, used in image acquisition systems, are starting to feel the squeeze from this dual pressure, as vendor-neutral archives take over many of their functions.
A recent study by Markets and Markets predicts a PACS-less Radiology world by 2018. Donald Dennison, Society for Imaging Informatics in Medicine (SIIM) Board director-at-large and the chair of the American College of Radiology (ACR) Connect Committee told attendees at the opening session for SIIM 2015, there are three external market forces that are trickling down into the imaging informatics world and leading to the demise of PACS: Money, EMR adoption and consolidation.
While PACS have traditionally been the workhorses of diagnostic imaging, providing workflows, viewing and archiving, their use of proprietary formats severely limited the ability of an organization to freely share images and created unnecessary and expensive complications in managing storage. They are a prime example of the episodic-care model, in which care delivery processes were created without regard to the broader needs of a patient. With the move toward value-based care, this episodic approach is rapidly being replaced by a patient-centric model, and proprietary silos are rapidly and rightly going the way of the dinosaur. In this case, value-based payments are the meteor strike that will so radically change the environment that these beasts are no longer equipped for survival.
Vendor-neutral archives (VNA), which can gather all the images into a standardized, patient-centered storage model, makes image sharing much easier. And VNAs have added on workflow and viewing capabilities that make PACS mostly superfluous. While having a VNA to unify all your diagnostic imaging is a good idea, it also has limitations. A simple VNA is more evolved than a PACS, but without more evolution and growth, it too will be unable to survive in the changed environment created by value-based payments. Fortunately, the VNA model is more adaptable than most PACS and is rapidly evolving to be far more than a DICOM-image repository.
An important part of value-based care is the ability to unify all data associated with a patient and deliver the right parts of that data where and when they are needed. That requires not only DICOM images, but also associated clinical data and documents and non-DICOM documentary images (such photos to document wound care). And all of that data must be integrated with the patient’s electronic health record. Finally, a layer of analytics is needed to ensure that relevant data can be extracted as needed.
Beyond individual patients, we have an opportunity to learn more about the progression of diseases if we can use this unified data in our predictive and population health analytics. In an article in Clinical Innovation+Technology, radiologists Eliot Siegel, MD and Gary Wendt, MD noted that this larger, unified data may soon offer unique value for diagnostic purposes and new clinical insights.
The article quotes Dr. Wendt (Dr. Wendt is the vice chair of informatics, professor of radiology, and enterprise director of medical imaging at the University of Wisconsin-Madison) saying
“Today when people are talking about big data and data mining, they are still talking about text. They’re not talking about actually mining content out of images. I think that’s probably the next generation, actually processing image data, not just text data. Ultimately, the clinical impact of such next-generation image archiving would come from the creation of more relevant reports [..based on data mining…]. This would be especially beneficial in oncology, where treatments can be modified based on tumor progression, and comparisons to similar cohorts of patients at an oncologist’s fingertips would be useful,”
As the VNA grows beyond image archiving, maybe a new name will be needed. The pre-release statement for a new IDC report (due out in December 2015) suggests a new description: Application Independent Clinical Archive. But I still like Dell’s name for our version of this archive (I work for Dell): Unified Clinical Archive.
By whatever name you call it, we are moving toward a truly patient-centered archive that will offer far more value than PACS or the simpler versions of VNAs. That’s good for all of us.
The move to value-based payments will be the most significant trend of 2016, because it will force both caregivers and health plans to radically change the way they think and act. Population health, which emphasizes identifying risk and gaps in care, and filling those gaps, will be an existential capability for hospitals, physicians and health plans. If they get it right, they will prosper. If not, they will struggle at best or worse, wither and fail.
Effective population healthcare requires both a change in thinking and adoption of new technology for success. Organizations that have focused on episodic care and procedures to pay the bills will be the most challenged, because a completely new mindset will be needed.
If you are a surgeon who has been highly valued by a hospital because you bring in lucrative procedures, your life will change radically over the next couple of years.
Hospitals will be looking to physicians who can reduce costs and avoid the need for expensive interventions to help them succeed.
The surgeons (and other procedure-based specialties) will still be needed, of course, but they won’t have the rarified status in the future that they enjoy today.
Those who can find innovative ways to help patients improve their health status without a hospital stay or other expensive interventions will be the most successful in this new world.
Hospitals and physicians will also need to add technological capabilities to succeed. They will need to integrate data, analyze that data and use telehealth and remote monitoring to provide more effective use of resources and delivery of care. For many organizations, data integration probably seems overwhelming with too many applications speaking disparate languages.
The good news is that technology exists now which can create a nearly seamless interface among all these silos and allow data from a wide variety of sources to be used for population health, better treatments and more efficient operations.
Physicians will find a light at the end of the tunnel for those who hate their EHRs, as new vendors provide applications that make using an EHR simpler and more efficient. These vendors are creating applications that use the EHR and other clinical applications like a database, presenting patient data in a simpler, more clinically relevant user interface. This will mean that organizations can make their caregivers much more satisfied and efficient without having to ditch the huge investments they’ve made in clinical technology.
The next year will be a wild ride for many organizations, as they adapt to all these changes, but the work and effort should pay off in all kinds of important ways, liberating data for effective use in traditional clinical and patient care and unleashing innovation for its use and in new and unimagined ways.
This article originally appeared on the HIMSS16 Conference Blog here
As pointed out low-income households have access to mobile technology with 8 out of 10 sending and receiving text messages – in fact mobile phone usage and ownership mirrors the experience in Africa where many of the communities have little choice given the paucity of existing infrastructure and have bypassed the traditional communications systems in favor of mobile networks
and gave rise to a whole innovation of mobile banking that originated that pre-dated, is more flexible and is more widely used than anything developed in the west (The M-Pesa system) – servicing the unbanked people of Africa without requirements to have a smart phone nor to use an app. I’ve written about the opportunity we have of learning from our African friends in the past)
In the case of the undeserved here in the US many of these people mirror these experiences and providing easy access using simple tools is effective not just from a cost standpoint (as Healthcrowd showed $1 for mobile messaging vs $34 for paper mailing) – and that’s even before you consider the engagement/response rate we find with mobile applications and interactions…think about it, when you want to reach your children do you send them an email or text them
Take the time to read about the multiple projects that are reaping big benefits and doing so cost effectively. These are real working projects with a range of technology that has demonstrable impacts and could be applied to many more groups and environments. The extensive piece takes you on a journey from everything as simple as text messaging from Healthcrowd to the medication adherence and tracking concepts of Proteus Digital Health of digestible sensors that track your pill from manufacture to ingestion.
There are a few guiding principles to help steer you to success
Meet people where they are – widely varied and none are typical
Build Trust – under promise, over deliver; everything is fragile for this community and failure can be far more catastrophic for them than “average” users
Address social determinants of health – just providing a ride to get to the clinic could mean the difference between success and failure and an Uber Ride is a lot more cost effective than an ambulance required for the crisis that could have been averted
Consider the cost of data service – data is expensive on many plans treat it like memory used to be in the days of 640K
Recognize the many layers of health literacy – not just comprehension but basic literacy and even language
Speak in the Vernacular – and make it culturally sensitive too
As Aman Bhandari said
“The new sexy is scaling what can work”
Proven solutions that have been effective provide great opportunities for those looking to make that impact on their own area.
This year will be my 19th year at HIMSS – things have grown significantly since 1997 when HIMSS was held in San Diego with a record number of attendees – 15,800 and 408 exhibitors (you can read more of the history going back as far as 1961 here). At the time I remember being overwhelmed adn that was before things had grown to the most recent statistics for 2015 now at over 43,000 attendees
This year I am part of the HIMSS Social Media Ambassador program joining my 19 colleagues to help provide a guide that was not available back in 1997 to help guide you through the landscape of the HIMSS conference and get the best experience possible
If you do nothing else – follow my friends and colleagues on the list at the bottom. Their feed and content will keep you up to speed on the latest news, events and any last minute gems to keep you getting the most from the events and activities
As part of this opportunity I also the present the following 7 rules/suggestions things to help you get the best from HIMSS 16 in Las Vegas
Rule 1: Have Fun
Rules 2: Hack your Conference Badge to Include your Social Media Handle
This used to require some clever editing of the name in the system but it has gotten easier – all you need to do is put you Twitter handle in Nickname field
Rule 3: Look up
Don’t bury your nose in your phone and technology the whole time – part fo the value is the exchange with real people and real activities. When you get in the inevitable line for a taxi or shuttle at Las Vegas airport talk to your fellow travelers – you never know who you might meet and what they might share about their business, news or the conference. You might even be able to shorten the wait and share a ride.
Rule 4: Prepare and Plan and then Adapt
Your plans will change but if you come with no plan you will end up missing more. Depending on your organizational preferences either fill your gmail calendar with your plan or download the Apple or Android HIMSS16 App and use it to checkout the daily sessions and listing of keynote speakers, exhibitor listing, maps and the social media activity feed which will have the latest news from the show floor
Look for the sessions you really want to attend and grab the details and add to your schedule now – you may not make it but you stand a better chance of making it if its on your plan.
Rule 5: Enjoy the Parties but Don’t Stay Late
How you manage this may depend on what time zone you came from but be warned the days are long and can be physically and mentally exhausting
Celebrate but my advice is enjoy the parties and social activities but don’t burn the candle completely – get to bed especially so you can get up early to exercise before hitting the show floor. You may get your steps just walking the floor but even if you do 30 minutes in the gym will energize you to cope with the busy days on the show floor
Rule 6: Leave the Laptop in the Hotel Room
I know a full sized keyboard is great to have but the additional weight of a laptop will weigh heavily on your shoulder. If you can use your phone as your main device and carry a spare battery or a Portable Battery Charging device like this one and/or charging cable and plug
An extra long one would be helpful when accessing difficult and hard to reach ports)
If you really need the larger device – go with the tablet format but bear in mind the bigger the device the more weight you are carrying around every day
Rule 7: Stay Connected Socially
Use social media to stay connected and find out the latest adn greatest things going on at the conference. You can use Social media just as a lurker and to access information but this is a great opportunity to ascend the social media ladder of engagement
Use your phone to take pictures – post your experiences and things you see and tag everything with the official #HIMSS16 hashtag. But its not just twitter – there are other channels and some can help you share to a wider audience. If you set up your instagram account to link to twitter and facebook you can post from here and populate both your twitter and Facebook feed.
For short videos (less than 6 seconds) – Vine is great for capturing and sharing across multiple channels
And expect some addition of live streaming from Twitter’s Persicope and the more recent interactive streaming from Blab
Enjoy the conference – it presents a host of opportunities to learn, meet new people and renew old friendships. You are in Las Vegas – you never know you might win some great new friends – to start you off here is a list of my colleagues and friends who are also Social Media Ambassadors
Once again I am headed to CES this year. Last year the DigitalHealth pavilion was overflowing with people, innovation, and wearables designed to influence us to a healthier life.
The show still features the big sections of technology for cars, televisions and 3-D printers but much of the show is being turned over to healthcare and the Digital Health pavilion. Like my friend and colleague Jane Sarasohn-Kahn I see the big move towards high-deductible consumer driven health plans (HDHP) beinge a key part of the major uptake in digital health devices and wearables. We already got a sneak peek into this post the holiday period with FitBit rising to the top of the Apple App store charts and coming in in the top 3 of Amazon’s list of holiday gifts.
So this years hot trends
Wearables and the Internet of Medical Things
With personal financial responsibility comes a much bigger focus on the costs of healthcare services and how to avoid them. To avoid expensive costs later in life requires focus on behavior now on as captured in this excellent graphic from Bridgitte Piniewski, MD:
Expect CES 2016 to feature much more Digital Health and especially focused on the Internet of (Medical) Things – the key to engagement is making the workflow frictionless. Its no use creating yet another app or solution that requires consumers to download, install, learn or use yet another option. The success in this space will be around integrated solutions.
Wearables will expand and include even more data and the recent announcement of Samsung of the expanded capability in their new health-focused chip
that will add body fat, skeletal muscle mass, heart rate and rhythm, skin temperature, and stress level to the biometric tracking capabilities.
Reaching new levels of innovation. Simple ideas like creating 3-D models base don actual patient anatomy prior to taking on complex surgery, printing prosthetics that are customized to the individual but now increasingly merged with wearables and printing biosensing strips that can be used for in home diagnostic testing. Researchers at Florida Atlantic University printed strip with bio material including antibodies and nanoparticles that can detect bacteria and viruses
Take a look at Lunit that helps physicians make accurate diagnosis with machine learning that offers object detection (application of existing technology to the healthcare domain)
In my review from CES 2015 there were plenty of drones (with some medical applications) and technology to aid flying and use. Many were showing image stabilization as captured in my video here:
and I captured this on a custom video gimball
We have so much opportunity to innovate in healthcare by repurposing existing technology for DigitalHealth. This image stabilization technology has been applied to the task of eating which for most of us is easy but for some eating is a challenge of hand stabilization due to tremors:
Parkinson is one of the leading causes of these tremors (about 1 Million americans are living with Parkinson’s and an estimated 7-10 Million worldwide). Its a simple idea (not to diminish the brilliant application and innovation by the founders) and a testament to the bright minds that fill our world and will continue to find solutions to problems we face in healthcare.
Join me at CES16
We’ve come a long way from CES in 1967
So I invite you to follow along for #CES16 my twitter handle (@DrNic1), my Instagram (DrNic1) account for pictures and Vine (DrNick) for insights, posts, pictures and short video segments of innovation throughout the course of the show
If you are here come join me and my fellow panel participants:
Shai Gozani, M.D., Ph.D., CEO and President, NeuroMetrix, Inc.
Beth Bierman, Partner, Morgan Lewis & Bockius
Bakul Patel, Associate Director for Digital Health, FDA, Center for Devices
The New York Times pulled together a list of memorable stories from 2015 (Medical and Health News that Stuck with us here)
– The discovery that Ebola is not cured nor over
– The ongoing war against epidemics and debilitating and now potential treatable diseases
– Anxiety and stress increasing (or is it increasingly diagnosed) and little progress in treatment
– The ongoing Drug Nuclear arms race of blockbuster (and unaffordable) prices for new drugs
– valuing time with the clinician for discussion of end of life care
– the sorry state of mental health in this country pales into insignificance with the chain therapy in Africa
– Despite real progress in treating Type 1 Diabetes unnecessary limitations are still being placed on children
Its been an interesting year and we have made much (rapid) progress. These stories are just the tip of iceberg and next year expect many more and heres hoping for some real change to a broken healthcare system
Jerome Groopman’s highlights of medical advances form 2015: source
Coming at the bottom of his list but what continues to amaze me is the Placebo effect – well known in its effectiveness when offered without explanation but more surprisingly is that it is still effective even when the patient knows he is being given a placebo!
Other highlights include a new approach to cancer treatment that blocks its growth, the incredible insights emerging from our continued expansion of knowledge on the human genome (a different approach to cholesterol management)
We live in exciting times of innovation and medicine is benefiting greatly from advances in our understanding and science behind disease and the workings of our world and bodies
Human capital – the stock of knowledge, habits, social and personality attributes embodied in the ability to perform labor so as to produce economic value.
When reading the above definition of human capital, a particular word jumps out… habits. I am passionate about habits because poor lifestyle choices—or bad habits—are the number one driver of today’s health crisis. Chronic illnesses—such as heart disease, stroke, asthma, diabetes, and obesity—are responsible for 7 of 10 deaths each year, and treatment of chronic diseases accounts for 86% of U.S. healthcare costs. However, while they are among the most common and costly of health problems, chronic diseases are also the most preventable and manageable, because they often result from choices we make in our daily lives. To conquer chronic illness, we have to change our bad habits. And that’s not easy.
If I had to prescribe one medication to cure bad habits, it would be patient engagement. When we are effective at engaging patients to participate in their care, they begin to take more responsibility for their own health and adopt healthier habits. Effective engagement of chronic disease patients can lead to reductions in hospital visits, decreased morbidity and mortality and improvements in treatment adherence and quality of life.
To truly influence positive behavior changes, health goals must fit meaningfully in patients’ everyday lives. People must be surrounded by opportunities to embrace healthy lifestyles, and that requires the involvement of the entire community – care providers, governments, businesses, and of course, the people living there.
It’s no surprise that 7 of the top 10 Future-Ready cities overlap with the American Fitness Index’s list of healthiest U.S. cities. These developed cities are arguably some of the most connected and most educated, and they have infrastructure that supports recreational activity. But health is not only an outcome of development, it is a prerequisite for it, and never before have communities had such an incredible tool to engage people in making healthy lifestyle changes… technology.
Technology gives caregivers unprecedented opportunity to engage patients and provide excellent care, anywhere, while also giving both patients and doctors a valuable feedback loop. Telehealth, remote biometric monitoring, and technology-assisted health coaching are powerful tools in the fight to improve chronic care outcomes because they provide in-the-moment support to patients struggling with diet, exercise habits, and medication routines.
For example, an FDA-cleared mobile app that delivers real-time motivational messages, behavioral coaching and educational content right to the mobile devices of patients with Type II diabetes has demonstrated significant drops in their A1C levels.
Even simple text message programs can make a difference. Text2Breathe, a program of the Children’s National Medical Center, sends care information and reminders to parents of children with asthma and has helped help reduce emergency room visits.
State and local government
State and local government agencies have immense power to use technology to spearhead healthy lifestyle and disease prevention programs. For example, in response to Philadelphia’s high rates of chronic disease, city officials recently launched PhillyPowered, a multi-media campaign designed to encourage Philadelphians to become more physically active. The campaign features a mobile-friendly website, which lists free or low-cost places to get fit in the city, provides educational information, and includes a social media component that enables Philadelphians to share tips on how to fit exercise into their busy lives.
Portland University, in conjunction with the Oregon Department of Transportation, is piloting a smartphone app called ORcycle
designed to collect data and feedback about bicycle routes, infrastructure and accidents in order to improve infrastructure suitability for bicycling in Oregon.
Businesses suffer from the impact of chronic illness through absenteeism and retention problems, yet they are uniquely positioned to promote healthy lifestyles for workers and their families. Employers can work with their health plans to identify need for wellness programs and services such as preventive screenings, tailored to lowering both health risks and costs.
Companies are increasingly integrating technology into their wellness programs. For example, Dell’s Well at Dell program includes a virtual wellness portal that imports numbers from onsite health screenings and provides employees with an action plan, educational information, and email and text reminders to stay on track. Some companies are adopting wearable technology as part of their wellness programs to incent employees to get fit. It is worth noting that data security and privacy is paramount to protect employee health information and need to be designed in as part of all of these initiatives to maintain the trust that is essential for an effective healthcare system.
Technology today gives communities in all geographies the means to invest in the health of human capital and very real opportunities to shape the future of healthcare… now.
Life has changed and access to information is no longer the definition of value – we have seen these changes in the past as far back as 1494 when the printing press was introduced making books and knowledge more widely available:
And proceeds through newspapers, the steam engine, photography and the death of painting, the telegraph, movies and the death of theaters, the telephone, phonograph, radio, television, computers and the internet and if anything the speed of change is accelerating. So too in medicine have things changed with a shift away from paternalistic experts to wide knowledge access and cooperative systems of healthcare delivery.
The Sorry State of Medicine
But the physician is still a key part of healthcare delivery and for many in the profession there is a sense of despondency and even despair with profession and their ability to deliver the care they aspire to deliver each and every day. This recent piece in the Wall Street Journal Why Doctors Are Sick of Their Profession captured the spirit – only 6% of doctors surveyed describe their morale as positive and that’s not just bad for the doctors – its bad for patients too.
The sad part is we chose medicine because we thought it was worthwhile and noble, but from what I have seen in my short career, it is a charade
Physicians fulfill a special role within our society. While they are given many privileges and rewards, they also carry serious responsibilities. Physicians are expected to be healers, available to others whenever a crisis occurs or a medical need arises. They are expected to have unfailing expertise and competence, to be compassionate and concerned, and to provide universally successful care in a cost-effective manner. Such idealized expectations emanate from patients, from families, from society (including payers and regulatory and accreditation agencies), and from within the profession of medicine itself. Self-imposed expectations inhere in the institutions of medicine — medical colleges, clinics, hospitals, professional associations, and collegial relationships — and are internalized by students of medicine as they are socialized to become practicing professionals. These expectations become a part of how physicians define themselves.
So when I came across a picture of this mug:
I posted it to my social media feed with a commentary
I wanted to highlight that clinicians are still an essential part of the healthcare system and their contributions are valued. This mug captured a strength of feeling that caught me by surprise.
It is available for purchase from a British eBay store and has been subject to several posts including this one from ePatient Dave – here and here and plenty of likes, dislikes, tweets, and even some fairly hefty criticism including one comment about starting a holy war.
Doctors Under Siege
I know many of my colleagues feel besieged. The system has drained every last ounce of empathy and compassion out of many with overhead requirements that detract from direct patient care and turn highly qualified, talented and well intentioned clinicians into data entry clerks and automatons. I have always believed and still do that every clinician gets up in the morning with all the best intentions to deliver high quality, compassionate car. There may be a small percentage of individuals who do not but if they exist are a tiny minority.
We selected the career because we care. We selected the career because we want to offer support and compassion to our fellow human beings. We get our reward from these actions and there is no replacing the privilege of the trust that is placed in our hands in a personal and intimate relationship with our patients.
To get into medical school required an incredible climb up an academic mountain that was littered with others who did not make it. The experience tends to reinforce the sense of importance and verges on narcissism for some as the course and hurdles demand a level of self confidence in our own skills and knowledge. It is little wonder that what emerges from the medical school sausage machine can appear devoid of compassion, over confidant and unwelcoming of other opinions. It is any wonder that there is any compassion left by the time a doctor emerges with his degree and board certification – and that’s before he steps into a the healthcare quagmire and finds himself unprepared for healthcare as it is delivered today.
But many patients and patient advocates perceived this negatively and as an affront to their place in participatory care. The perception from patients appeared negative and there were multiple reports of patients who had been blocked when bringing information to their doctor and Dave even cites the sad instance in the UK of the 19 year old girl who had fibrolamellar hepatocellular carcinoma (a rare cancer that with ~200 cases diagnosed worldwide annually) that was treated and then returned. Despite her pleadings to the contrary the Hospital and clinical team refused to believe her and told her to “stop googling”
There were even a few physicians who saw this mug negatively – as Bryan Vartabedian a pediatrician at Baylor said:
and he posted this piece “Doctors and the Google Threat“. I don’t disagree with him that information access brings huge value and makes healthcare more accessible to a wider population but the systems in place don’t support the time aspect that this new sometimes unfiltered and unscientific data brings to many of the clinicians I talk to. One of the main challenges with this was captured by one friend who said:
You came in to see me with 9 minutes of reading material but I only have 7 minutes of time to care for you
And the deluge of information that arrives on everyone’s phone is replete with snake oil and pseudo science oftentimes amplified by celebrities who’s impact with their millions of followers can be incredibly damaging to individuals health.
Dave did take a constructive approach to the participation of patients
I personally am completely opposed to a patient going in and saying “I’ve decided I have condition X, and I want you to prescribe 42mg QID of medication Y.” I mean, have you ever seen the things medical students have to learn to get their license?? But I’m all in favor of a patient saying, “I have symptoms A and B, and from what I can tell from websites J and Q, that sounds like it could be M.” Explain your thinking, identify your source, and try to solve the diagnostic puzzle together: Collaborate.
While there are still doctors who see this as a challenge to the traditional model of care and the paternalistic distribution of knowledge and care, most do not. I leave it with these two tweets that for me captured the underlying spirit I felt when I posted the original image:
Most physicians say the best part of their jobs is taking care of people – its the human moments, the taking care of people that make our jobs so satisfying. We are all on the same side – the structure of the system forces behavior that is not always ideal but despite this physicians do want participatory interactions – we love patients, especially ones that are engaged in their own health and care and we do not (and cannot) know everything.
You may well bring information to us that we are not aware of or have not read or heard about and we hope there will be enough time and opportunity to review this and help include scientific knowledge, no matter the source, in our review and guidance on the best course of treatment for you.
Looking back at the history of medicine is fascinating (Victorian Medicine – from Fluke to Theory). Medicine was a combination of chance and quackery but over the course of the the last century has made incredible leaps. Science became an integral and training more formalized and increasingly specialized.
From Macbeth-like preparations of arsenic, iron or phosphorous to white coats and x-rays, the Victorian era witnessed a medical revolution
It is worth pausing and looking back to see the progress to date….likely small steps as we move forward at an incredible and accelerating pace this century
Its an exciting time to be in healthcare and medicine – technology is bringing so much innovation and opportunity to improve the delivery, quality and reduce the cost of healthcare. Much remains to be done
As Dr. Jai Menon vice president and chief research officer for Dell Research Data said data may well be the oil of the 21st Century and in healthcare this is especially true as we see an explosion of insights and data into our health, clinical status, genome, biome and beyond
We finished sequencing the first human genome in 2003
and things have only accelerated from there with sequencing now taking less than 24 hours and costing less than $1,000
Just this one area is going to add huge amounts of data that needs to be turned into knowledge as I shared in this presentation to the Austin Healthcare Thinktank Roundtable
But even before we get to that point there are so many opportunities emerging into our daily lives to improve the service and the healthcare delivery system. Telehealth or Telemedicine is a clear winner and the regulatory and reimbursement systems seem to be catching up (details in this presentation form Connected Health).
Integrating the data and providing intelligence and insights from the mass of data that is sweeping over healthcare will be important but as we gather more our understanding improves expect this area to accelerate with deeper more meaningful insights tied closely to the ability to integrate the data from multiple (and importantly non-traditional sources).
To get a sense of the opportunities and changes coming watch the video compilation form the conference below:
Its a great time to be in healthcare as we open new doors to knowledge with the data
The title on the article is actually “Why all Retina Doctors Should be on Twitter” – but i think should read all doctors source
Social media is an open forum for learning, sharing and engagement and is where the patients. It offers a concise (140 characters or less) which helps with speed and especially useful for busy people like doctors
It comes with a great infographic and listing of the basic jargon on twitter that would help anyone just entering this space
Time to get on board – here’s a pathway
– I’ve been experimenting with this for the past few days. Incredible insights into how active our brains are and offering a way to calm and relax. Especially useful if you are like me and struggle to focus on any form of relation with your mind wandering. It senses your brain waves using a series of electrodes positioned at the front of the band and then links to your phone and the accompanying app that provides exercises using feedback to help you focus and improve your focus and ability to relax
I’m still new but in a few days I have already noticed a small improvement in my ability to focus and relax for slightly longer periods. I will be reporting back on experiences on this
MDMouse – Measuring your Blood Pressure with your Mouse
I was intrigued by the idea of measuring my blood pressure on a more regular basis by incorporating technology into a sensor into a commonly used interface device
The unit has a fold out cuff that you insert your finger into and accompanying software will use this to measure your blood pressure on demand. As we have seen with other devices making the process as easy as possible improves use and compliance and this adds more granularity to blood pressure readings and trends. I’m expecting this to show some improvement based ont he effects of the other activites.
Intelligent fabrics are coming to a fashion store near you and soon and Hexoskin is one of the early examples.
Amongst the metrics a real time ECG
But there is so much more and power of this is as much about the accompanying application and the deep insights into training regime that is customized to you, your body and current fitness levels. I’m going to start down the path with this – measuring my VO2 Max and then start a program to see how much I can improve on this.
Fitbit have been in the wearable monitoring space for some time (founded in 2007) and I personally have owned a wide range of their devices. The latest – the Surge offers GPS tracking with heart rate tracking in a battery efficient package
Early days for my journey but again expecting to use the interaction alongside others to help customize training and keep myself motivated – especially while on the road
Based on a simple “Stone” that clips to the inside of your belt or bra and tracks your breathing as the basis of its feedback. It comes with a charging plate – no need to plug the device in to charge
Simple design but packs an interesting punch that keeps offering feedback via your Bluetooth linked phone and Spire App. An interesting (and useful discovery) – it is waterproof! For those looking for simplicity this may well be a great match and I will be comparing the interactions and results over the coming weeks
We are made up of much more than our own cells and in fact there are 10 microbes for every 1 human cell. Increasing amount of science suggests this is a big contributor to our health status but until recently we have been unable to assess it. This kit changes that offering
I have not had a chance to gather samples but will be doing so in the next few weeks to explore this new frontier in medicine and understanding of our bodies and health and wellness
In this innovative smartphone based tool – offering vision exams using an iPhone and an attachment
Like the other iPhone attachments this device stands to open up access to the millions of people in the world who walk around with uncorrected vision – this is the first step in letting people see
And a special shout out to the 88pmh investment house in Africa (@88mph_Africa) – who have invested in 36 companies between 2011 – 2014 in Kenya and South Africa and as Ashish Thakkar puts it: The Lion has Awoken and this powerhouse of innovation is creating some incredible technology – watch this space