Perficient Healtchare Solutions Blog

Subscribe via Email

Subscribe to RSS feed

Archives

Posts by this author: RSS

Creepy or Cool? A View of Connected Health in 2025

One of the fun aspects of my job is research.  I get to research the Connected Health trends to understand where the market is headed and how to then prepare healthcare organizations for those changes to capitalize off of the advantage of public health meets good timing meets technology.  I typically chart the trends out through the next ten years.  Some recent information that caught my attention include this infographic by Bupa and a study by Thomson Reuters IP & Science.  Want to know what the world of Connected Health will look like in ten years?  There will be four major themes:

the-futureMicro Mobile: The biggest net delta to be seen in the world of Connected Health between now and 2025 will be in the form of mobile technology.  Mobile capabilities will continue to be provided in smaller form providing the Healthcare industry with opportunities to, for example, use contact lenses that can take pictures of the retina to identify early symptoms of diabetic retinopathy. Sensing capabilities from fiberoptics are currently being used within telehealth in the form of smart carpets that relay signals from footstep patterns.  These capabilities are forecasted to innovate into a form that could signal the possible onset of diseases such as skin cancer when applied to human skin.  Mobile capabilities imbedded in shoes, socks, and baby diapers will impact our ability to monitor weight, fitness goals, hydration, temperature, sleeping patterns, and other symptoms of illness.  Nano tattoos are already used to measure blood glucose levels.  These tattoos, that are half the width of a human hair, are expected to be able to detect precise temperature changes to indicate cardiovascular activity in the future.

Personalized Prevention: Now lets take microscopic mobile and pair it with the more prevalent DNA mapping that will occur in 2025.  Babies born in that year will be tested at the DNA level with full genomic mapping.  We are not talking once or twice.  We are talking continuously tested using nano-probes inserted in the body to identify potential onset of disease.  When it comes to the most costly chronic conditions (both in terms of dollars and hardship), a simple and inexpensive genomics test can be used to help a patient, and their team of clinicians, understand the risk of certain disease states. These individuals can then be given the right treatments and education from the start and throughout life.  Imagine the impact of this level of personalized prevention can have not only for the individual involved but for population health in terms of obesity, diabetes, cancer, and the like.

The Internet of Everywhere: The “internet of things” is defined as an environment where everyday physical objects are connected to the internet and are able to identify themselves to other devices.  We do that at some level today.  By 2025, the internet of things will be everywhere, and everything will be connected.  A report from Thomson Reuters IP & Science states “Thanks to the prevalence of improved semiconductors, graphene-carbon nanotube capacitators, cell-free networks of service antenna, and 5G technology, wireless communications will dominate everything, everywhere.”  What does that mean for Connected Health?  That means your nutrition can talk to you medication because your fridge can talk to your prescription bottles.  Really.

Continuous Data Collection & Instant Reporting: These Connected Health innovations not only provide the ability for healthcare organizations to continually monitor health conditions but also with the ability to collect and report on this data.  This can drive positive behavior change through incentivizing verifiable behaviors.  At the organizational level, this can be used to augment current loyalty programs that rely upon CRM data.  Just imagine the power this also provides to public health research programs worldwide.

Creepy or cool?  What do you think about what is to come in the world of Connected Health?

Social Media Experiments & Public Health. To be or not to be?

So, I’m guessing you heard about the “Experimental evidence of massive-scale emotional contagion through social networks“, no?  That’s the official title for the Facebook study published in The Proceedings of National Academy of the United States of America that you’ve likely already heard about.  In this study you have a Facebook data scientist Adam Kramer and two academics, Jamie Guillory of UC San Francisco and Jeffrey  Hancock of Cornell University, that “subtly tweaked the news feeds” of approximately 700,000 Facebook users. The researchers used an algorithm for one week’s time to eliminate “negative” messages from some users’ news feeds. For others the algorithm eliminated “positive” messages.  For a control group they simply deleted a random selection of messages. Here is the stated significance from the research results:

We show, via a massive (N = 689,003) experiment on Facebook, that emotional states can be transferred to others via emotional contagion, leading people to experience the same emotions without their awareness. We provide experimental evidence that emotional contagion occurs without direct interaction between people (exposure to a friend expressing an emotion is sufficient), and in the complete absence of nonverbal cues.

FacebookPrivacyExperimentThere has been quite a media frenzy around the study.  Most of it has been negative.  The most compelling of those arguments is around “informed consent”.  The belief there is that even if we can agree that the results are of scientific importance (some don’t) and the methodology of the study is concrete (some don’t), it still violated the rights of research subjects.  After the ethical calamities that are the Tuskegee Syphilis Experiment and Project Chatter, informed consent essentially means that a research subject in a study needs to have basic information about the study, understand the nature of the experiment along with its risks and benefits, and have the ability to withhold consent without fear of harm or retribution.

However, there are also supporters of the study.   Ethicist and lawyer Michelle N. Meyer states that as a private company Facebook is not subject to an academic institutional review board.  She goes further to say that had it been, then this study would have likely passed muster. Supporters further state that, with social media being a relatively new phenomena, Facebook has a moral obligation to inform its users of the social or psychological impact of their website.  It’s likely that studies like this will continue.  With the media firestorm that erupted it is likely, though, that they will not be published.  That comes with its own set of problems.

My concerns move into the realm of public health.  As I mentioned in a 2011 post called “New Tools for Managing a Public Health Crisis“, data is the most important component in managing public health.  With a successful suicide committed in this world every 30 seconds, mental health is a major public health concern.  It takes precious time and resources to manage the health of a planet inhabited by 7 billion people.  This is an interconnected planet, and a public health crisis knows no barriers and time does matter.  One of the breakthrough lessons I received in my life was from Dr. Greg Smith, my graduate data mining professor at Xavier University.  He explained that “like things tend to cluster”.  This makes social media a great way to find the useful data needed to uncover a public health crisis. Social media technology enables two-way communication.  As such, experts are turning to social media outlets like Facebook and Twitter to not only communicate with the public about disease outbreaks and health issues but to also gather necessary data to discover outbreaks at their source.  Social media can also be used to recruit medical volunteers to a location and align response efforts once on the ground.  However, to make this all work, public health officials need to be given access to social media data, and this is often an issue.

So, ultimately, my feelings on the study are quite mixed.  I am a staunch supporter of ethics.  However, I am of the belief that this study passed the ethical bar.  Even more, I have strong feelings on the topic of mental health.  I do believe that social media, with all of its countless benefits, has a new and not yet verified impact on mental health.   I believe that it is data that will help us understand ourselves in ways that we did not before, and that data can save lives.

What the market says you need in your patient portal

I had an interesting chat with some healthcare execs a few weeks back.  We were discussing the real impact of increasingly shifting regulatory compliance deadlines.  Think about it: when the government puts forth direction, and incentive, to effectuate a certain change that often leads to healthcare executives realigning their own strategies in favor of this mandate.  This means, in the case of Meaningful Use, putting off previously considered initiatives in favor of the new ticking patient portal time bomb.  When the timeline then gets shifted, sometimes again and again, it can seem like a cruel joke.

As we are all well aware, the Meaningful Use timeline is now delayed.  The Centers for Medicare and Medicaid Services has added a third year to Stage 2 of the EHR meaningful use program and has delayed the start of Stage 3 until 2017. Under the revised timeline, Stage 2 will be extended through 2016 and Stage 3 will begin in 2017 for those providers that have completed at least two years in Stage 2.  It is now expected that in fall of 2014 CMS will release a notice of proposed rulemaking for Stage 3 along with the 2017 Edition of the ONC Standards and Certification Criteria, which will outline more details of the new timeline. The final rule, with all requirements for Stage 3, would follow in the first half of 2015.

173907.strip

With these facts as the undercurrent to our discussion, our conversation ventured into a discovery session on what true patient engagement means and whether strategies should adhere to government regulations or, instead, market demand.  Want to guess what side of that debate I argued from?  Yes, there are providers that will continue to drag their feet.  I’m not saying that Meaningful Use is not warranted because yes, indeed, it is.  However, the market will ultimately be the truest driver for competition among healthcare providers seeking to engage with patients.  As a result, the forward thinking strategists in healthcare organizations nationwide should have their sites on the marketplace horizon.

What does the market think of patient engagement?

For the answer to this question I refer to a report by Frost & Sullivan that was released before the delay was announced entitled “U.S. Patient Portal Market for Hospitals and Physicians: Overview and Outlook, 2012–2017″.  This report predicted growth in the patient portal market over the next five years.

“The need to fully engage patients as a member of the care team is fundamentally about encouraging individuals to become more involved with their healthcare, so they will be motivated to make behavioral changes that can positively impact their health status. That need will only grow as the healthcare system moves towards accountable care and value-based reimbursement. The importance of this movement cannot be underestimated.”

The report then categorized those EHR module patient portals (aka “The Meaningful Use Portal”)  as “Patient Portal 1.0.” and qualified these solutions as not being capable of providing the “advanced interoperability and functionality needed to support clinical integration, accountable care and ongoing and sustainable patient engagement.”  No arguments there.

However, they also predicted a significant disruption in the years to come.  The report states that as healthcare reform and transformation advances, providers will seek new ways to engage patients and influence behavior using connected health and will increasingly look for more advanced solutions that are proven to consistently motivate sustained behavioral change. These solutions are referred to as “Patient Portal 2.0.”  The report estimates that this new era of patient engagement will make its way to reality between 2015 – 2017.

Setting Patient Portal Strategy to Market Demand

The Patient Portal 2.0 that the market requires relies on a host of functions that think outside the confines of Meaningful Use.  If you want to develop a portal that truly reaches out into a population and makes a difference, then you must, better than anyone else, understand the purpose of the portal.  You must know to whom your portal is targeted.  I’ve never met two patient populations that are the same, which makes implementing an out of the box portal for every population a bit discomforting.  You must devote a lot of time to figuring out what motivates your intended audience.  That understanding must be crystal clear before you even consider how the portal should be designed.  Document, in detail, what your experience needs to communicate with the patient.  What kinds of tools best match this experience?

Want some ideas on what others are doing to meet market demand?  Here are some features that the market is currently pushing towards:

  • Telehealth that moves beyond the virtual visit
  • Dynamic scheduling
  • Social collaboration
  • Gamification and serious games
  • Avatars for personalized health coaching
  • Health information exchange across diverse care settings
  • Integration of clinical and financial data,

Any others you are seeing out there in the marketplace?  I’d love to hear about them in the comments section below.

Google Health Fail Doesn’t Mean You Can’t Win

This morning one of my portal colleagues published a post that I wanted to share with our healthcare community.  As you can see from the Twitter log below, we are quite passionate about portals and, more importantly, all of the business problems portals can solve within the healthcare industry.

Screen Shot 2014-06-12 at 11.54.48 AM

The article in question was written by Forbes, and it explores, as Mark states in his post, “Google is big, smart and has a lot of resources. If they can’t get a health portal right who can?”

So, how do you succeed in a market where Google has failed?  Here are some principles to consider:

  1. Think like a patient, not like search vendor, database vendor, cloud vendor, etc.  Patients who want to access a healthcare portal have specific needs for information and action, not just data.  As a patient, its nice to see my red blood cell count. But I also want to know what it means when I’m outside the normal range.  Can I quickly ask my physician or a nurse advice on what to do?
  2. A patient portal doesn’t have to add a huge workload to doctors who are already under pressure to see lots of patients.  As more doctors get paid on outcomes vs procedures, doctors should welcome greater patient engagement whether its in the office or online.
  3. Electronic medical records vendors don’t have a lock on patient portals.  In the real world, patient data is spread out among several EMR systems.  Current EMR vendors are great at pulling in data, but most won’t share data to other systems. A patient portal must be able to integrate with many vendors’ EMRs and other systems like billing, content, analytics, etc.

Have any more ideas?  Feel free to comment here or respond to our ongoing conversation on Twitter.

 

 

Smoking Cessation Apps are good. Text programs are even better.

We are big fans of mobile health.  Why?  Because there is 91% US adult adoption of mobile phones.  That same percent keeps their phone with them 24/7.  As a result, these billions of tiny devices the world over create a networked lifeline that can be a critical tool for healthcare.

craving_smokingThat’s why we originally wrote the post, “Texting Bridges the Mobile Health Digital Divide.”  In that piece we highlighted three great text messaging programs that are making a big difference.  Why are text messaging programs so important?  Because, while 91% of the population has a cell phone, only 56% of the population has access to a smartphone (and the health apps that come with it).  Text messaging programs are an inexpensive means to potentially reach almost the entire population if done correctly.

With that in mind, hearing of another mobile health text messaging program with great results, though not at all a surprise, makes me quite happy.  It’s called Text2Quit.  The program works by sending text messages with advice as well as telling users how much money they have saved by quitting (a big correlation to quitting, it seems).  Users can also text keywords, like CRAVE, to receive a tip to keep to their smoking cessation program or SMOKED to communicate a relapse.  The program then gives tips for getting back on track.

Want more information?  You can read about the program here and here and here.

What can health education learn from Netflix?

Last week I happened upon a journal article for the Annals of Internal Medicine entitled, “What Can Medical Education Learn from Facebook and Netflix?”  The study was written under the pretense that the tools that are used to entertain medical students are far more sophisticated than the tools that are used to teach medical students.  Facebook and Netflix use algorithms to service up user-focused content.  If that works for entertainment, then why isn’t it being used to teach some of life’s most important lessons?

Taking the Guess Work out of the Wellness Model

100903778-167539930r.530x298As pointed out in the article, medical education would be a great use case for algorithmic and social learning.   Beyond the obvious, the awesome side effect is that, perhaps, doctors that use these tools successfully when they are educated would then find ways to incorporate them into health education for patients.  In my (completely biased) opinion, health education contains life’s most important lessons.  Education is provided throughout the increasingly complex and interconnected episodes of care that run through integrated networks.  These networks include hospitals, health systems, ambulatory care centers, community clinics, long-term care facilities, home care agencies, and medical groups, that work together to coordinate care and share accountability for quality, cost, and outcomes.  In order to make this work, care providers can’t simply be manufacturers of “sick care”, which has been the norm for far too long.

The old guard of care is an environment where all care takes place within the brick and mortar of an eight-minute doctor’s visit. Reimbursement took place under a fee-for-service model. There is a seismic, and stress inducing, cultural shift taking place that transforms our “sick care” model into a “wellness” model that impacts care outside of the clinical setting in a transformational way. The market has reached a place where the industry has both the incentives and information needed to move towards this new model of care. The business practice challenge will understandably take much more time to heal.

Algorithmic Health Education

In today’s day and age we have many methods to personalize preventive medicine.  You can call it creepy or cool when you see Facebook algorithms that can be used to tailor personalized prevention messages to patients.  Healthcare organizations can also use self identification programs to offer up personalized content on dynamic portions of the public website or the patient portal.  On a grander scale, data from relatively inexpensive genomics testing can become powerful data that the algorithm can use to personalize preventative medicine throughout a lifetime.

Bringing patient and clinician into a partnership towards better health will be the foundation upon which this trend will flourish. Technology that bridges the divide between the brick-and-mortar and into the everyday lives of patients at home, at work, at school, and in their communities is the ultimate catalyst for wellness care.  Using the power of Netflix, many doctors and patients have undoubtedly succumb to a good binge watching session of House of Cards.  If we play our cards right, then perhaps we can get patients to watch their health with the same level of enthusiasm.

Imagine all the people…without healthcare insurance?

This morning a colleague forwarded a Fast Company article entitled “The Mayo Clinic’s New Doctor is an iPhone.”  The article describes a new Mayo Clinic concierge medicine via mobile device that is subscription based.  For $50 per month (per household) the Mayo Clinic basically offers unlimited access to their nurse’s line powered by iPhone virtual visits.  The service includes:

  • 06FOB-MEDIUM-SPAN-articleLargeReal-time video chats with Mayo Clinic nurses
  • Personally-tailored health information culled from Mayo Clinic databases
  • A “symptom checker” that incorporate’s individual user’s health histories
  • Access to a personal medical concierge who can provide more information or schedule patients’ doctor appointments

Programs like this are becoming increasingly popular.  As I mentioned in the Connected Health trends seriesTime Warner Business Class announced it was venturing into the world of virtual medicine through a partnership with the Cleveland Clinic.  The program is part of Time Warner Cable’s Home Health Monitoring network that was designed to connect healthcare providers to patients in their homes.  It will provide secure, encrypted, two-way video conferencing between patients and Cleveland Clinic providers on a subscription basis. (more…)

#TexasHIMSS: MD Anderson’s Consumer Driven Cloud Based Solution

MD Anderson uncovered a potential problem.  Their physicians were using non-approved cloud based storage programs that they “may or may not” have been using to share PHI.  I will note that they use a pretty broad definition for “consumer driven”.  I define consumers as the target market that, in this case, a healthcare provider must engage to generate revenue that impacts the bottom line.  The inside of the organization collaborates with “consumers” outside of the organization.  That’s, perhaps, because I come from the business world where “consumer driven” is defined as “offerings, plans, or strategies motivated by customer demand or expectations.” In this case they were targeting physicians and not patients.  Yes, anyone who consumes a technology is a “consumer” of that technology, but that would basically make the entire technology world as a whole “consumer driven” because every technology is created with someone and their problem in mind.

SBEXRF-00017872-001Now that I have stepped off of my soapbox, below you will see the three steps they used to solve their problem using cloud based technology.

Step 1: Analysis and Planning

Used support of network and desktop teams.  Reached out to a few employees and received positive feedback.  Need to establish an appropriate scope.  Decided it was naïve to say that they couldn’t put the data they use in that system.  They went forward assuming it would include PHI.  Worked with desktop and network teams to identify actual target technology.  Engaged Information Security early.

Step 2: Prototype Pilot Implementation

MD Anderson used the following process to implement their pilot

  • Implement gradually and with care.
  • Evaluate surveys and usage data.
  • Pilot with a mixed user base, prototype with power users and set end user expectations

Pilot program tips were to address security concerns early, take the time to test support and administrative tools, and don’t forget about the support staff.

Step 3: Support and Marketing

Partner with key groups for support.  Advertise that these services are available.  For internal collaboration I often suggest you communicate these new tools “7 different times in 7 different ways”.  In MD Anderson’s case this included advertising the tool on their very own television station and using the help desk to document users that they knew were already using cloud based storage (perhaps inappropriately) and targeting those users.  One of the ways definitely need to be a training program that highlights any self-service functions built into the new program.

#TexasHIMSS: Mobile Health at Rockdale Medical Center

At Texas HIMSS today I was able to view a use case for Enterprise Mobile.  That’s the term I use to describe the use of mobile devices internal to a healthcare organization.  In this case, Rockdale enabled a single point of workflow across disparate data sources and care locations to enable physicians via a mobile platform.  This platform involved native mobile OS BYOD, medical device drivers, SSO, and Security.

Infographic-Doctors-Prescribing-More-Mobile-AppsWhat drove the adoption of this mobile technology?  There were three main reasons.

  1. Supports compliant workflows: They learned that doctors were using their cellphones to take pictures of images and then texting them to other physicians that were not onsite to get their opinions.  This obviously gave compliance officers a heart burn.  So, they wanted to make the right thing the easy thing by providing a high quality mobile platform that was HIPAA compliant.
  2. Improves care coordination: Data silos are a problem.  We all know this.  This mobile platform provided physicians with access to data in a single application.  They had this access no matter where they were when they needed this data.  This expedited the speed of care in emergency situations.  I’m sure it also answered the common call from physicians: “I go from room to room to room all day. If it is not on my mobile device, then I don’t care about it.”
  3. Encourages engagement: There is 91% US adult adoption of mobile technology.  As a result, these mobile platforms leverage the use of equipment that physicians are already familiar with.  This fact encouraged engagement and interest in the program.   For those of us that make implementation of technology in healthcare a habit, easy physician adoption of technology is pretty awesome.

Analytics have shown that the technology is highly utilized by Rockdale physicians.  It has also provided a competitive advantage in their provider heavy location of Atlanta.  Among other goals, Rockdale’s next steps are to partner with their local EMS and establish objectives to improve the quality of patient care in the Emergency Department.

#TexasHIMSS: Reaching Teens with Digital Health

During a breakout session at Texas HIMSS today, I attended “Reaching adolescents through electronic health portals:  Lessons from the field” by Peggy B. Smith, MA, Ph.D.

While I normally lean towards the positive in providing insights from these breakout sessions, being a presenter is no easy feat, I must start with a couple of not so positive qualifiers.  “Patient portal” was not really discussed during this session.  Rather, “digital means of communication”, such as public websites and social media, is a more appropriate definition of the technologies discussed.  Fair enough on the surface.  However, not knowing the difference between public and secured technologies created a real problem when the presenter spoke of how HIPAA creates barriers to providing teens with health information via digital means.  The patient portal, used thoughtfully, can assuage these privacy concerns.  I feel that the presenter should have understood this.  Her lack of knowledge on portal was amplified when I asked a question related to the timing of the data she collected in Approach 2, mentioned below, in relation to  Meaningful Use Stage 2.  She did not know what  Meaningful Use Stage 2 was.

istock_000037708720smallWith that being said, I will carry on with insights from the session that I did find insightful.  To present these in the correct context, I will mention that digital health in adolescents presents a number of quandaries for the healthcare provider.  While most healthcare decisions and procedures can and do involve parental consent, not all can.  I involved my colleague Dr. Marcie Stoshak-Chavez in defining what decisions and procedures do not involve parental consent.  As she mentioned, although healthcare statutes vary by state, procedures for sexually transmitted diseases, pregnancy, contraception, psychiatric disorders, and drug or alcohol abuse typically do not involve parental consent and include additional privacy rules that exclude parents.  

Since teens can and do use digital technology, and technology is often used by consumers to collect information because of the anonymity involved, it is quite apropos to discuss using digital health means, such as patient portal, when providing care for teens.  This becomes a much more important conversation in those areas of care where parents should not, by law, have a seat at the table.  Of course, it must be considered that oftentimes the devices teens use are not actually owned by them.  This also must be considered.

Essentially, digital health provides the most obvious form of communication between provider and teen.  However, there are many constraints.  What follows are three areas of study that Peggy Smith provided:

Approach One: Web based platform for sexual health for at-risk youth

This method involved avatars named Tiff and Ty that were available for anonymous questions on sexual health via a clinical website (read: not portal).  This research was a qualitative assessment that evaluated the anonymous questions that were submitted via the website.  There were a total of 916 queries received.  Six major question types  were identified in order of frequency:

  • Cost (Might seem surprising at first, but makes sense in decision making that does not include parents)
  • STD testing
  • Birth control
  • Personal health concerns
  • Parental consent and confidentiality
  • Sexual health misconceptions

Some of the questions included, “Does it cost to have a regular check up and pap smear?” and  “I was wondering if yall had HIVSTD testing available and how much it would cost?”  and “Can I come in for birth control and will my insurance voer the cost for it?”

Approach Two: Evaluation of the adoption of electronic platforms by public health professionals 

This method involved studying decision makers for technology platforms within the healthcare provider industry.  This study wanted to understand to what extent public health professionals, the ones making the decisions, were familiar with electronic messaging and what their attitudes towards acceptance of these platforms were.  This is the one where I must mention that the data was collected in 2011, which predates Meaningful Use Stage 2.  I would guess that these figures would be much higher now, but it is interesting to see how failing we were in adoption of these technologies without the financial incentives.  I must also point out that it is likely that the researchers did not describe these digital care methods in the context of portal, since they did not understand the difference between web and portal.  If I were a decision maker, then that would have painted my answer in this case.

At the time of the study, only 37% of decisions makers stated that they currently had these systems in place.  Only 15% of these decision makers stated that they had future plans for implementing these technologies.  Recurrent themes in the research included a lack of confidence in the processes surrounding digital health, the depersonalization of healthcare, and the concerns for privacy.  It is also interesting to note that there was a stated difference in age cohorts.  Older decision makers were less likely to move forward in developing digital health infrastructure than their younger counterparts.

Approach Three: Global portal for information across continents

The method here was to use the upgraded website teenhealthclinic.org to provide a number of health education tools.  These included a presence in social networking, a short message service, and health education webisodes.  These webisodes targeted 16 and 17 year olds that were mostly Latino.  They used the concept of “Edutainment” (education + entertainment) to provide information on topics such as HIV testing.  Story ideas were based on real stories, contained entertainment value, provided context of audience lives, and focused on characters and their relationships.

There wasn’t much information provided on the impact of this approach other than to point to the “issues that HIPAA presented” when it came to public websites.  Again, knowing the difference between public website and portal would be helpful here.  Also, one information session participant commented that providing webisodes like this would have astronomical production costs.

Reaching Teens with Digital Health

Teen health education can oftentimes be a divisive topic, but the debates on this topic will not make these issues go away.  In fact, it has been proven via cost data that limiting healthcare to teens generates a major drain on the healthcare system.   With all of these facts in mind, do you believe technologies like patient portal can be used effectively in the area of teen health?

#TexasHIMSS: “Godfather of PCMH” & the Future of Medicine

I am at Texas HIMSS this week in Dallas, Texas.  The opening keynote was provided by IBM’s Paul Grundy who has also become known as the “Godfather of the Patient Centered Medical Home”.  He provided a good overview of the history of efforts surrounding connecting data to care.  Towards the end of his chat he defined how healthcare will transform in the near future.  Here are his thoughts, and I would love to hear yours:

  1. dallas 1Healthcare will become more data driven: This is clearly at the heart of what Paul Grundy, and the patient centered medical home movement, is passionate about.  The driving question here is “Where is the data and how does it impact care at the elemental level?” with the goal of having all data available and able to act upon.
  2. Every person will have a plan: This is an interesting one for me.  My mind immediately harkened back to the Connected Health Symposium a couple of years back when Joseph Kvedar, MD spoke of using genetic data for personalized preventive medicine.  You can read my post about it here.  There is also a post by Dr. Marie Stoshak-Chavez on whether we will ever see personalized preventative medicine in the future.
  3. The delivery system will be team based:  Check out this piece on the core principles and values of team based care.  They correctly point out that care has not always been a team sport.  In the “good old days” meaning “still happening today sometimes” all care was curated by the doctor as the “all knowing sage”.  The complexity of modern healthcare provides us with a situation where the entire team needs to work together harmoniously to provide care quality.  This brings us to….
  4. Managing a population down to the person:  Here is what I hope is the “patient centered” part of PCMH. It my (not so) humble opinion, the healthcare of the future will not reach its fullest potential until it is truly patient centered.  This means that the patient needs a seat in team based care.

What are your thoughts?  Do you think he nailed it, or are there some holes in his vision of where medicine will evolve into the future?

Participatory Medicine Meets Participatory Design

Most times when the word “participatory” enters my lexicon it is closely followed by the word “medicine”.  I’m a fan of participatory medicine.  If you don’t believe me, then you can look here, or here, or here for written proof.

Participatory medicine is a care model in where the role of the patient is active, enabled, and emphasized.  Participatory medicine requires the “mindful” inclusion of the patient in the care delivery process.  When you see online patient communities forming, then you see participatory medicine at work.  You will also witness shared decision making, patient participation on the treatment team, and evidence based patient choice.  The director of the U.S. National Institutes of Health has been quoted as saying:

As opposed to the doctor-centric, curative model of the past, the future is going to be patient-centric and proactive. It must be based on education and communication.

These are the types of sentiments that make someone like me very happy.  The fact that I get to play a role, even though quite small, in this movement is the kind of intrinsic motivator that gets me up each day happy to do my work in Connected Health.

hands-raised-participateIn Connected Health we design technologies meant for patient engagement.  They are the communication lines that extend outside of the eight minute patient visit and into the lives of patients wherever they are when healthful decision making counts.  As a result, another participatory term set is beginning to exit my mouth more frequently.  That is, namely, participatory design.  Participatory design, also known as cooperative design, emphasizes active inclusion of all stakeholders, even those that do not know how to use Photoshop, in the design process.  Key to this end is the end user.  In our case that means the patient.  By using participatory design, we are able to create environments that are more responsive and appropriate to a patient’s cultural, emotional, spiritual and practical needs. User empowerment is built into the core of this process.

So, what if patients were crowd-sourced more regularly to solve all of those challenging patient engagement issues?  For example, many of the biggest challenges I see on provider websites occur because it is challenging for an employee of a health system, the ones actually making the final decisions, to release their mind from the confines of their day job.  This usually means that the content of the public website is architected in the way that employees see the organization: by department or facility.  Problem is, this gets in the way of patients trying to find the information they need to be more healthful.  Patients shouldn’t have to navigate 5 layers deep to find content specific to their condition or health concern.  Patients won’t work that hard.  Instead, the hub of digital patient engagement should have, at its core, the patient user experience.

Not being new to the public website creation rodeo, I’ve found the process and final product to be greatly improved through the addition of patient voices throughout the entire website design process.  I’ve never met two patient populations that are the same, so while there is general advice on tailoring a message to patient needs, insight should always be collected from the target market in question.  This insight informs the nuts and bolts of information architecture and the engagement of graphic design.

As a result, a one and done approach to patient feedback is good.  An iterative approach to patient feedback on site design is better.  Co-designing a site with patients?  I would love to see that on every provider website.  By using participatory design to reach out to patients in the beginning of the relationship, with the website that engenders a culture of participation, then it makes it that much easier for that participation to be embedded throughout the entire collaborative care model.