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How Biofeedback is Set to Transform the Quantified Self

During the Connected Health Symposium last week, I noticed a significant trend that I have since been calling the “next big thing for the quantified self movement”.   What is the next big thing in a world dominated by fitness trackers and mobile apps?  That next big thing is biofeedback.  I gained access to quite a few innovators while at the conference.  They note that while clinicians have been using biofeedback for eons in order to understand any number of things about a human body, most of those tools do not come in a patient-friendly package.  Thanks to these innovators, now they do.  Here are four examples quantified self devices that use biofeedback to help patients understand and manage their health.

Choose Muse

It is hard to make brain data real to a patient.  As a result, up until now there has been virtually nothing a person can do to improve Screen Shot 2014-10-28 at 12.01.25 AMtheir brain health. Psychoanalysis is highly stigmatized, which causes an even bigger drift to form between patients and cognitive health.  In order to fix this, clinicians have created a consumer friendly, clinical grade EEG to provide patients with their first real contact with their brain. The device is called Muse, and it is being dubbed “the brain sensing headband”.

By using the device, patient can improve their cognitive functions and see their outcomes in real time.  This device has also shown promising in the treatment of depression and other mental illness.  Since this treatment is wrapped in the quantitative self trend, it does not receive the same reluctance that stigmatized psychoanalysis does.  This provides promising new treatment options.

HeartMath

During the Connected Health Symposium, it was noted that 75% of physician visits are stress related.  Patients are often made to feel that they arScreen Shot 2014-10-28 at 12.02.55 AMe “stuck with it” and there is nothing that can be done.  However, a really neat connection between the heart and the brain can be used, through the power of feedback, to manage stress related illnesses such as heart disease.

I’m not sure if you knew this, but there is a “brain” in the heart that senses and responds to emotions and communicates through nerves to the brain. This heart-brain communication provides us with a way to manage our stress and  get heart healthy through the use of biofeedback.  Using biofeedback through tools like HeartMath, patients can gain windows into their hearts and brains to self manage their stress response. While this is certainly empowering for prevention of heart disease, heart disease patients have been studied, and have improved outcomes through using the HeartMath biofeedback system.

Stay tuned for an upcoming experiment that is set to merge the Muse and HeartMath technologies.

Sensoree

Screen Shot 2014-10-27 at 11.32.19 PMIf you work in healthcare technology, and you go to a Connected Health Symposium, then you will get your fair share of interesting conference performances.  In one such performance, we were introduced to Sensoree, which is a company that creates wearable technology that show visually, through light displays, what the individual wearing the technology is feeling.  This proves incredibly helpful for patients with Autism and Alzheimer’s that do not have the ability to communicate their emotional states readily.  Sensoree introduced these technologies by having circus performers wear them during an acrobatic dance routine.  As they danced, you could see their emotional states changing as a red glow of nervousness as the performers began turned into a blue glow of of focus to a purple glow of bliss.

 

BioBeats

This last bit, called BioBeats, is a platform for merging entertainment with healthcare.  In one very compelling move, BioBeats partnered with music crew Far East Movement in an attempt to connect millions of listeners to their health by way of mobile phone enabled heart beat sensors.  As Far East Movement performed, they encouraged their fans to record their hard beats.  By the time the song was over, they had collected over 1.5 million heartbeats that were, in real time, transformed into the beat that lived in the background of their performance.  Check out this “Turn Up The Love” performance below.

How to Create Habit-Forming Technology Solutions

Last week, I was at the Connected Health Symposium in Boston.  It is with great pleasure that I relay what I was taught during my favorite session by Nir Eyal author of “Hooked: How to Build Habit-Forming Products”.

shutterstock_78240940 copyWe know that mobile devices change our day-to-day behavior, but why are mobile devices so good at changing our habits?  To understand how, we must understand what habits are and how they are changed. Habits are impulses to do a behavior with little to no conscious thought.  When you think about it, social media sites like Facebook, Twitter, Instagram, Pinterest, and SnapChat get us to do some pretty bizarre behaviors as habits.  Now, over the span of just a few short years, billions are using these social platform as day-to-day habits that require little to no conscious thought.

It goes to say, then, that creating a habit-forming technology solution of any type would require us to speak directly to the unconscious mind.  To do this, Eyal advocates what is calls the “Hook Model”.  This is defined as using experience design to connect a user’s problem to your solution with enough frequency to create a habit.  To do so, it is critical that your solution include the following four components of a hook:

  1. Trigger: A trigger is a cue to action that prompts the user to perform a habitual action.  These triggers come in two forms.  You have external triggers in the environment that tell us what to do next. Common external triggers include what we call “calls to action” in marketing, which is the “Buy Now” request.  A friend telling you to try a certain solution is also a powerful external trigger.  However, it is the internal trigger that is the most important.  Internal triggers are associations in someone’s mind that inform what to do next.  These associations come from emotions, routines, situations, people, and places. Ultimately, this requires you to have an intimate understanding of your user’s painpoints and how they respond to those painpoints.  For example, people with depression check email more. The theory behind this association states that  people suffering from bad emotions turn to their technologies to feel better. Generally speaking: Lonely = Facebook, Bored = YouTube, Confused = Google. We use these technologies to escape negative valence states. So, how do you make better products and services that help people live healthier lives?  You need to understand what internal trigger you are creating an association with.
  2. Action: An action is defined as the simplest behavior done in anticipation of reward. The reward need not be in the form of Screen Shot 2014-10-26 at 8.08.31 PMpoints and leader boards.  Want examples of the most compelling rewards used by leaders today?  Scrolling on Pinterest. Searching on Google. Play button on YouTube.  These are all “rewards” in that studies have shown they relieve enough tension in the human mind to create an addiction to our mobile phones.  There is a formula you can use to predict the power of reward found in these singular behaviors. That formula is B=M+A+T.  According to BJ Fogg, in order for any behavior to occur, we need motivation, ability, and a trigger.  Motivation is the “energy for action” (how much we want to do a behavior). Six factors to increase motivation include: seeking pleasure, avoiding pain, seeking hope, avoiding fear, seeking acceptance, and avoiding rejection. Ability is the capacity to do an action (how easy or difficult it is to do).   Six factors can increase or decrease ability: time, money, physical effort, brain cycles, social deviance, and non-routine. This is why we are more likely to do something when we see someone we know doing it. We are also more likely to do something we’ve done before . X-Y access that’s Ability (how easy) vs. Motivation
  3. Reward: To get at the heart of reward, we have to start in the brain.  More specifically we have to start in a portion of the brain called nucleus accumbens, which has some unusual properties. When they allow lab animals to trigger this portion of the brain by pushing a button, those animals will continue to do so obsessively.  In fact, the machines have to be forcibly removed.  At first it was assumed that this portion of the brain activated a pleasure center.  That was not correct.  It actually activated the “stress of desire”. The thing is, there is a way to stimulate this itch that we crave to scratch. Within the premise of “the unknown is fascinating”, variability causes us to increase focus and not let go. If a reward is given on a variable basis, then it spikes activity in the nucleus accumbens. One import variable reward system are “rewards of the tribe”, which are things that feel good that come from other people like empathetic joy, partnership, and competition. Social media is a erasure trove for rewards of the tribe.  Rewards of the hunt, like gambling, also provide the variability that we desire. The information rewards we receive from search engines like Google are good examples of a reward of the hunt. The social media activity feed works in the same way  (that’s not interesting, that’s not interesting, wait, that’s interesting!).  Then there are rewards of the self.  A search for self-achievment has an important element of variability, which is why people are happiest when they are trying to reach a goal (as opposed to having already achieved that goal).   Mastery, competency, and control are rewards of the self.  Ultimately, variable rewards are about scratching the user’s itch but leaving them with the mystery of what will happen next.  One of the ultimate examples is the email inbox.  The quest to clear your inbox can be seen as a game because the little icon signifying that you have mail told you to do something.  Making that little icon go away is an important variable reward that keeps us coming back for more.
  4. Investment: This is a variable of the hook that most companies neglect, and, therefore, presents the greatest opportunity for growth. They receive a variable reward.  What’s next?  “Investments”are defined as the load for the next trigger.  Unlike physical products that deteriorate over time, habit forming technologies appreciate and get more valuable the more they are used because of the investments in stored value. The more content that is collected in iTunes, the more value it has and the better it becomes. The more accounts I connect in Mint, the more valuable it becomes to me.   The more followers I have the more interesting Twitter becomes. Users need to be able to store their value in your technology solution.  This value is stored as a reputation that a user can “take to the bank”. How likely are you to leave a platform after you have stored value in terms of reputation?

This is how customer attitudes change and habits are formed. If you are building a technology that requires habits, then you need to ask these five questions to know if you have been successful:

  • What internal trigger is the solution addressing?
  • What external trigger gets the user to your solution?
  • What is the simplest behavior in anticipation of reward?
  • Is the reward fulfilling yet leaves the user wanting more?
  • What “bit of work” is done to increase the likelihood of returning?

Eyal ended his talk with a discussion on the morality of manipulation.  Designing habit-forming products is a form of manipulation. As a result, engineers of these solutions need to be careful. We need to be responsible for the impact we have on changing user behavior by using this power for the force of good by fixing one of the world’s problems.

Sure, it’s huge, but this is my favorite new iPhone feature

I’m having a good laugh at all of the memes floating through social on the “hugeness” that is the new iPhone 6.  Apple even wisely predicted the size sentiment (℅ super user research) and landed a spot featuring Jimmy Fallon and Justin Timberlake that provides a few laughs.

So, while size-by-size comparisons are even a thing in my household (husband has the new phone while I’m skipping a version), I’ve found that my favorite features of the new release are actually a part of iOS8, and, therefore, I don’t need to get the new phone, and the extra inch of screen size that provides, to have them.

So what new iPhone feature has me all giddy and excited?  Safety.  FOSgNia

Let me explain.  I’m a big fan of the Quantified Self, and, as a runner and biking enthusiast, I like apps that help me track my progress.  I especially like when those apps are extensible and connect to provide an entire Quantified Self experience.  I’m not here to talk about HealthKit, though.   I’m here to talk about a lack of functionality I have found in these apps when it comes to safety.  I’m a woman running or cycling alone, and sometimes, if my work day creeps into the evening, the sun goes down before I get started.  I’ve combed the app store trying to find an answer, and there really aren’t good answers out there.  What I need is:

  • A way to alert loved ones passively if I run into trouble while I’m running or riding my bike.  It’s not really reasonable to expect that I can reach for my phone and make a call if I’m, for whatever reason, not able to complete those steps in the process.
  • A way to inform an EMT that may arrive on a scene when I am unable to communicate.

The iOS answers to these problems:

  • Share my Location: When I’m ready for a run, iOS lets me set up a window for when and who I want my whereabouts shared with.  I can set up the time parameters I have for my run, say 7:00 p.m. – 8:00 p.m., and share my location with my husband and best friend until I alert them that I am home.  If they don’t hear from me when they are supposed to, then they not only know something is up, but they know where I am as well. What I’d love for iOS to add is a way to send an alert if I fall during a run or ride.  I know, because of the ActivBeacon app, that this is possible.  The downside of ActivBeacon is that, for whatever reason, the app malfunctions and turns my volume up to full blast when I have both music and the app running at the same time.  Eye of the Tiger loses its motivational effectiveness at that volume.  Trust me, I know.
  • Medical ID:  The Medical ID, part of the Health App can be used by medical responders to know of any allergies or medical conditions I have and who to contact without unlocking my phone.   To do so, open the Health App and click on “Create Medical ID” that you see in red.  In the Medical ID you can add our name, birthday, height, weight, medical conditions, medical notes, allergies, medications, blood type, and organ donor status.  You can also add your emergency contact.   You will also want to make sure that you have the “Show When Locked” feature on.

So, there you have it.  If you know of any alternative options for exercise safety, then I’d love to hear about them!

The Meaningful Use Marketing Fail Keeping VPs up at Night

In a recent chat with the VP of a large health system, I learned what keeps him up at night.  His organization, like many across the nation, has invested mountains of time and money in Meaningful Use Stage 2.  Like most health systems (all but 11% says research groups like KLAS) they chose to invest in the patient portal modules available through the EHR vendor.  This Blog_What-Keeps-You-Up-at-Night2is largely because most Meaningful Use patient portal decisions are being made by IT, as opposed to business.  At the top of the list in IT decision making criteria is integration with EHR.  So, VPs like my new friend at this large health system are able to cross off the features required via Meaningful Use quite easy.  All except one…

They are having a heck of a time getting patients to actually adopt the patient portal technology.

It appears as though the “if we build it they will come” concept hasn’t quite held true in the case of patient portal.  In fact, the statistics are rather staggering.  Recent research discussed in the HealthData Management article entitled “Patient Portals Not Yet Go-To Platform for Patients” reveals:

  • Almost half of patients don’t even know if their physician has a patient portal
  • 11 percent are confident their physician “does not” offer one

And here is the kicker for a recovering marketer like myself:

  • Less than half of those surveyed–49.2 percent–report actually being shown a patient portal by their primary care physician either during a visit or outside a visit

And why is this keeping folks like my VP friend awake at night?  Well, first and foremost it is because healthcare providers like him are fans of patient engagement and want to provide patients with the tools they need to stay healthy.  Taking it a step further, Meaningful Use Stage 2 is a financial incentive.  The criteria for getting those incentive dollars are not met when you build a patient portal.  They are met when a critical population of patients adopts the technology. Early results are in, and patients are not adopting.

So, what’s the the underlying problem here?  Well, it’s multifaceted, but much of the error falls in building patient portals that are not user centric.  he user, the patient, is and should be the center of our universe.  However, it is oftentimes not the department of IT, the department largely in charge of Meaningful Use, that invests in stores of knowledge like user experience.   I’ve also been met with many blank stares across conference room tables when I ask healthcare provider portal teams about campaigns their marketing team have created to drive attention to the portal and journey maps that have been created across their patient digital experience to drive patients into the portal.  In my opinion, Meaningful Use is one of the biggest marketing fails I’ve seen in my career thus far.  There is not alignment between IT and the rest of the organization on the measures needed to drive patient engagement.  In my opinion, which has now been validated by this research, a campaign that does not also consider physician adoption of portal technology is a campaign waiting to fail.  If the physicians are not using it, then their patients will not either.

This is why I began the dialogue a few of months back on what the market says you need in your patient portal.  The market, which in reality is simply cumulative actions of patient populations, is the most important input into the creation of a successful patient portal.  You can see some of the components of a user centric patient portal in that series:

 

 

 

 

Market Driven Patient Portal: Avatars for Personalized Coaching

In our next installation from the “What the market says you need in your patient portal” series we bring you avatars. These avatars are closely related to our last post on gamification and serious games, but their real value proposition is in what I like to call “high touch digital healthcare.” Many may think that “high touch” and Market Driven Patient Portal - Avatars“digital” cannot exist in the same concept, but oh they can.  We are actually beginning to see that in some cases patients prefer high touch digital to face-to-face care.

Here are some examples:

  • Patient Education: In the realm of patient education, we had a study that used digital avatars with human characteristics to help women through preconception health.  In this case human interaction was not replaced.  Rather, the avatar augmented and furthered the patient experience through the use of digital technology.  The avatar asked initial questions and then triaged the more difficult interactions to clinicians.  This allows clinicians to have more time to deal with complex issues. Add this to a patient portal and you begin to see how patient health concerns can be triaged remotely with the requisite education embedded throughout.
  • Appointment Registration: I love that more and more healthcare organizations are making online pre-registration an option.  Going even a step further many hospitals and ambulatory care centers are digitizing the in person appointment registration, which I mentioned in an earlier post of this series. Let’s add avatars to this process, which adds a “human” touch to an otherwise clinical process (pardon the pun).
  • Patient Discharge: The discharge process is ripe for errors and omissions.  All too many times patients arrive home without having absorbed the right data they need to maintain their health.  The result is often costly readmission.  Even a couple years back I was able to witness a demonstration of the use of avatars during the discharge process.  Through an automated touch display, patients were able to navigate through their discharge instructions in an interactive way.  The avatar even threw in fun questions like whether or not the patient preferred the Red Sox or Yankees (read: the hospital was in Boston).  Patients provided rave reviews for their avatar led discharge experience.  In fact, the experience was rated higher than in person discharge by a wide margin. Now, let’s add this functionality into the patient portal as well to continue that interaction remotely to ensure that those discharge instructions are followed. I’d suspect that you would see a marked improvement in readmissions rates simply because discharge instructions are adhered to.

Overall, avatars and other forms of digital high touch are a win-win-win.  They are low cost (win), add a sense of fun to otherwise lackluster processes (win), and increase quality all at the same time (win). Stay tuned for our final posts in the series where we start to discuss the importance of health information exchange and interoperability as they relate to the patient portal.

Market Driven Patient Portal: Gamification and Serious Games

More than half way through our “What the market says you need in your patient portal” series I bring to you one of my favorite topics: healthcare gamification and serious games.   Games are great at explaining complex systems.  There are fewer places one can find complex systems than in the micro and macro worlds of Market Driven Patient Portal - Gamification and Serious Gameshealthcare.  In healthcare we’ve seen games of multiple types.  Here are some of my favorite examples:

  • Games that help modify user behavior: Humana took a pioneer stance in the world of serious games in healthcare with their Horsepower Challenge.  Using the craze the followed games like Dance, Dance, Revolution, Humana used “exergaming” in 2009 to challenge 20 members of Congress and 2,000 5th and 6th graders nationwide as they “raced” across the country by taking steps with a pedometer.  She also harkened back to a healthcare game I mentioned in a post back in 2011, namely Re-Mission.
  • Games that train wellness behaviors: In the game Re-Mission, a nanobot named Roxxi is injected into the human body to fight particular types of cancer at the cellular level. Those playing the game are also asked to monitor the patient’s health and report any symptoms to the fictional Dr. West.  Each level of the game informs the player on a variety of treatments and on the importance of staying compliant with medical protocol.  HopeLab trial studies, that were published in peer-reviewed journals, revealed that playing Re-Mission led to more consistent treatment adherence, faster rate of increase in cancer knowledge, and faster rate of increase in self-efficacy. Most notably are blood test results, that showed the measured level of chemotherapy drugs in blood to be higher in players versus the control group.
  • Clinical learning labs: These are the types of gaming environments where practitioners can train in virtual learning labs on an avatar.  A great one is foldit: Solving Puzzles for Science.  foldit, funded through a University of Washington grant, is an attempt by game developers to crowdsource scientific research.  Within a few paragraphs of texts, the gamer is educated on what proteins and amino acids are and why their shapes, and what those shapes fold into, are important.  The goal is to have human “protein folders” work on proteins that do not have a known structure.  Scientists can then take folding strategies that human players have come up with while playing the game and automate those strategies to make protein-predicting software that can fight HIV and cancer more effective.  Beyond protein prediction, protein design has even more direct implications to disable a virus.  Thus far there are not many automated approaches to protein design, so foldit’s human folders are a great source of research.

Gamification is the term we use to describe serious games that go beyond strictly trying to entertain.  They have a “higher purpose”, so to speak.  Designers use game techniques to get players to do something not game-like at all.  The possibilities for embedding serious games into patient portals are seemingly endless, but my favorite is in the realm of personalized prevention. The patient portal is a powerful repositiory of patient data and can also function as an empowerment tool. Similar to the build of the patient portal itself, if you want to develop a serious game that works, you must, better than anyone else, understand the purpose of your game.  You must know to whom your game is targeted.  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 game should be designed.  Document, in detail, what your experience needs to communicate with the gamer.  What kinds of puzzles best match this experience? Then consider what type of game genre matches these puzzles.  Lastly, consider what platform would need to be used to help the gamer bring action to play.

Building a game that is based on what motivates your audience is what makes a serious game a game.  The market will continue to push this functionality onto the patient portal.

Market-Driven Patient Portal: Social Collaboration

Next in our lineup of “What the market says you need in your patient portal” series is social collaboration.   This topic brings us to the core of a term that we hear a lot in the industry: patient engagement. What is that, really? Any form of engagement requires communication. Right now communication between provider and patient Market Driven Patient Portal - Social Collaborationis getting better, but I’d still say that the relationship is in its “healing” phase. The best way to speed that healing is through creating mechanisms that support healthy communication between the healthcare provider and the patient.

Traditional methods of communication focused on the brick and mortar. There has been noticeable resistance to the idea of email, and far fewer providers offer social capabilities. So why will the market push for it? Because patients are accustomed to using social collaboration and they know it is far more convenient to use that tool over, say, picking up a phone or driving to the office. Providers will find that it is also much more cost effective than standing firm on the old way of doing things.

Patients use social to gather information. The healthy byproduct of this dynamic is a greater emphasis on managing wellness. Every social communication does not require direct communication between patient and physician. Instead, social relies on content to navigate a user towards answers and provides readily available mechanisms to find answers to questions. These “conversations” have the power to personalize experiences on an individual level, as well as deliver rapidly consumable healthcare information that can be personalized to the individual and their health needs. A social collaboration strategy is a success when you are able to engage and interact with the patient in a way that drives them towards the overriding goal of wellness. Everything that you do, or want to accomplish, on the patient portal should support that experience. This not only guides your content and communication objectives, but it can also result in lasting interactions that elevate consumer experience.

To make social collaboration effective, it is important to present content in a fashion and format that makes the most sense to the user. Let’s be honest, social collaboration can be a bit nerve wracking in a HIPAA regulated environment. As such, it is crucial that every social collaboration initiative include a formal governance program. This program will ensure that patient communications stay relevant to the overall goal of wellness. However, with the right strategy, you can embrace the power of social to influence the conversation and amplify the health of your population.

Market Driven Patient Portal: Dynamic Scheduling

Taking our “What the market says you need in your patient portal” series a step further, today we are going to address the market demand for dynamic scheduling.   When it comes to the marketing work of drawing patients into the brick and mortar, I often tell clients that, where their website and patient portal are concerned, if Market Driven Patient Portal - Dynamic Schedulingthey get the Find a Provider tool wrong, then they have gotten everything wrong. It’s an extreme statement, but it is meant to highlight a few key market dynamics:

  • The fact that there are four primary “conversion” tools that transform unknown consumers into patients. They are: Find a Provider, Find a Location, Schedule a Class, and Make an Appointment. The value of these tools is that they allow us to finally put a name to that unknown consumer that is interested in interacting with your organization in some way. It also gets them to the most important step, which is scheduling an appointment.
  • The dramatically high use of the Find a Provider tool by users of provider websites and patient portals. Go ahead and check your web and portal analytics (I’ll wait). Find a Provider is the most often visited page, right? Thought so. This is, by far, the most popular conversion tool that a healthcare provider has. It is the ultimate gateway towards getting that appointment scheduled.
  • Our ultimate goal is to get that unknown consumer, or a current patient, in for an appointment for highly important service line X. To do so we need to reduce as many barriers as possible that could be in their way.

Enter the new world of scheduling embedded into a market driven patient portal. In this world we allow patients to schedule appointments online by providing them with calendar capabilities. Yes, this is very different from the way that business is currently done. Why? Clinicians work in a very dynamic environment that makes it challenging to manage schedules. Even though it is dramatically different from the way business is currently done, the market is making existing scheduling systems obsolete. Why? It’s surprisingly due to that very same dynamic nature of clinician schedules. The healthcare environment provides a seemingly endless supply of tasks for the clinician. Trying to overlay that dynamic environment over the traditional scheduling system is fraught with the well known long wait times, and poor consumer experience, that patients currently experience. Dynamic scheduling makes appointments easier for both the provider and the patient. Here’s how:

  • Predicting Clinician Scheduling Chaos: Making sense of the chaos of a clinician schedule is no easy task. Dynamic scheduling embeds the power of mobile and analytics to exploiting knowledge of planned and emerging tasks. Ever hear of the butterfly effect? The premise there is that even seemingly chaotic events have a rhythm, but that rhythm is largely undetectable by we mere humans. With dynamic scheduling, mobile devices and wifi signals can triangulate location and analytics can span a number of different factors to make sense of a clinician schedule. This technology can be taken even further when you consider the life of emergency room clinicians. The dynamic scheduling application can sort data in real time to keep the clinician moving towards the patients with the highest needs.
  • Patient Self Service Appointment Scheduling: On the portal, a patient can then interact, in real time, with a clinician’s dynamic schedule and securely book their appointments online. In that way, scheduling an appointment takes on user processes similar to online shopping in retail. Once a date and time are selected, the dynamic scheduling system can automatically confirm the appointment and record it in the EHR system. No staff action required. Secure automated email and text message reminders can also be used to decrease the number of no shows.

What do you think of the market drive towards dynamic scheduling?

Market-Driven Patient Portal: Telehealth Beyond the Virtual Visit

Last month I published a post entitled “What the market says you need in your patient portal” that garnered a lot of interest. In that post I addressed the balancing act that healthcare executives face when market based initiatives are sidelined in order to drive focus to regulatory requirements such as Meaningful Use. Sometimes the market and regulatory requirements are in sync. However, when those regulatory initiatives get delayed things get complicated. My advice is that, beyond Meaningful Use, ultimately the market will determine what true patient engagement means, and I highlighted seven features that a market driven portal should have. I will spend time during this series going into detail on those features. They include:google-smart-contact-lens-glucose-sensor-640x353

  • 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

Today we will begin with telehealth. The topic has been in the news quite a bit recently – mostly in terms of telehealth reimbursement. The world of telehealth is not only in a state of transition currently, telehealth is also one of the major net deltas that we will see between healthcare of today and the healthcare of ten years from now. So, what does telehealth look like beyond the virtual visit? We are pushing towards a world where technological innovations will make the brick and mortar less and less relevant even in the world of healthcare. One of the more interesting developments in this area is a push by X Prize, by way of multiple multimillion-dollar prizes, to innovate technologies in such a way to diagnose common medical conditions with no intervention from a health care professional. With this drive in the marketplace in mind, telehealth in a market-driven patient portal you would find:

  • Socially Enabled Patient Portals: In a socially enabled patient portal, physicians and patients can work together toward their combined goals of better health using tactics like dynamic messaging, activity feeds, blogging, and open question forums.  These technologies are particularly effective in rural and low-income areas and are being used to enhance the quality of care for diabetic populations in low-income areas, for example.  These technologies show great promise for providers and health plans interested in managing chronic disease in a cost-effective fashion, especially for the uninsured.
  • Robotics:  Children’s hospitals have been the early adopters of telehealth technologies. Some innovations of interest are in the realm of robotics. Boston Children’s Hospital has an impressive telehealth program with a video-monitoring robot. These 4-foot-6, 17-pound, two wheel robots help with post-operative consultations and care primarily as a means of videoconferencing, giving the families of hospital patients a way to keep in touch with doctors and nurses in between post-surgical appointments. Equipped with cameras, audio gear and a video screen for a “face,” the robots are operated remotely by Children’s Hospital staff. In addition to facilitating communication, they can take video and close-up photos of surgical scars or other key areas of interest to help medical staff monitor recovery.
  • The Smart House: When it comes to uncovering issues early, the tracking of vitals, combined with analytics that readily alert clinicians when those vitals show potential for problem, have been crucial to telehealth outside the virtual visit. We are seeing innovations that embedded fiberoptics into carpeting that can track the activity of patients in and out of their bed while at at home. There is also an innovation called the Health-e-Chair that incorporates a vast array of biosensors to measure vital signs including weight, blood pressure, temperature, ECG, auscultation of heart and lung sounds, blood oxygen saturation, motion analysis and reflex response time. The chair incorporates a communication unit with a remotely controlled camera.
  • Nanosensors: Taking the tracking of remote patient monitoring microscopic is no longer just something we will get to eventually. There are innovations on the market now that can make a big difference in population health. Diabetes is a serious issue in the world of healthcare (understatement of the year award nomination). One of the leading causes of blindness in the world, diabetes patients have a risk of developing retinopathy, which could ultimately lead to blindness. Nanotatoos have already proven out in diagnostic efforts to track blood glucose levels, for example. Google and friends are also innovating around embedded camera functionality into contact lenses to find early signs of diabetic retinopathy.

One in five Medicare patients are readmitted to a hospital within 30 days of discharge, and one in three are readmitted within 90 days. It’s estimated that 75% of all hospital readmissions are preventable. Telehealth provides many benefits as a virtual visit. However, it is taking telehealth beyond the virtual visit that the market will push towards as we work to bring down the cost of care and reduce readmissions. Stay tuned for a future post on how the integration of all of this data takes this effort a giant leap forward.

Anything you think I’m missing? I’d love to hear your thoughts in the comments below.

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.

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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.