Category Archives: rapid learning health systems

healthcare, policy, rapid learning health systems

The inevitable evolution of medical care delivery…

  • medicine is an information intensive industry
  • HIT uptake is growing rapidly due to policy incentives
  • Healthcare looks similar to the retail sector from the 1980s
  • Retail worker productivity grew 4% per year since 1995
  • The biggest changes are likely to come from re-imagining the role of the patient – the single most underused person in healthcare, currently considered as close to a nuisance
  • Health care will be less frustrating when the power shifts from sellers to buyers
  • The Institute of Medicine suggests that inappropriate care, lack of adequate prevention, administrative waste, and prices that are too high account for nearly one-third of medical spending. Just the billing and collection operations in health care account for 25 percent of total costs; Walmart and Amazon spend an order of magnitude less on administration. Prices have fallen across the board in the retail sector.

Source: http://www.technologyreview.com/news/518906/why-medicine-will-be-more-like-walmart/

Why Medicine Will Be More Like Walmart

What health care will look like after the information technology revolution.

The idea that technology will change medicine is as old as the electronic computer itself. Actually, even older. In 1945, Vannevar Bush, the man with the vision for the National Institutes of Health, foresaw a Memex computer program that would allow access to past books and records. A lone physician searching for a diagnosis in far-flung case histories was one of the applications Bush imagined.

Medicine is an information intensive industry. Yet there’s still no medical Memex. Even though the Internet teems with health information, study after study shows that medical care often differs greatly from what the guidelines say—when there are guidelines. Doctors frequently rely on their own experience, rather than the experience of millions of patients who have seen thousands of doctors. Not only is the past lost, the present is missing. How many times has a patient received a drug that causes an allergic reaction, just because that information is not available at the time it is needed?

Bit by bit, this situation is changing. The 2009 American Recovery and Reinvestment Act (aka the stimulus bill), created the HiTech program, which allocates billions of dollars for doctors and hospitals to buy electronic health records systems. Since the program was enacted, rates of ownership of such systems have tripled among hospitals and quadrupled among physicians. In just a few years, it is reasonable to think that the entire medical system will be wired.

What will happen then? The introduction of information technology into the core operations of hospitals and doctors’ offices is likely to make health care much more like the retail sector or financial services. Health care will be provided by big institutions, in a more standardized fashion, with less overall cost, but less of a personal touch.

medicine Walmart chart

Health care today looks a lot like the retail sector did in the early 1980s, when clothes and household products were sold by many local stores and small chains. Quality was haphazard, prices were higher, and buyers’ experiences were mixed. Consumers had only the information they could see in the store or the Sunday paper.

Retail firms got larger when information technology became widespread. Walmart replaced the corner drug store and Amazon put the local book shop out of business because large firms can use information technology better than small ones—to manage inventories, create consistency, automate routine activities, and lower prices. Output per worker grew over 4 percent annually in the retail sector since 1995. Output per worker has fallen in health care over the same time period.

When the medical Memex finally arrives, look for health care to follow the retail track. The solo practitioner is likely to be the first to go. He or she will have to decide whether to try to become an IT manager as well as a doctor, or join a larger group of doctors. For most, the choice will be easy. The chance that a doctor over 65 works alone or in a two-person practice is about 40 percent. For young doctors, it’s less than 5 percent.

Small hospitals will suffer the same fate. Already, small hospitals that have seen the price tag of medical records systems—$20 million or more to purchase, then millions to maintain—are seeking shelter in the arms of their big neighbors. I suspect most cities will go from 10 to 15 independent institutions a decade ago to three to five large health-care systems a decade hence. These systems will do everything: checkups, nursing the elderly, treating heart failure, and dispensing allergy pills.

Who treats us, and where, will change as well. With an electronic backbone in place, one doesn’t need to see a doctor for every issue. There is little the primary care doctor does that can’t—and increasingly isn’t—being done by a nurse practitioner, perhaps at a clinic in a Walmart or CVS. Routine prescriptions for medication refills can be handled online, with an electronic doctor watching. Even high-end services can be spread widely, with specialized centers coördinating the treatment of patients far from its walls.

medicine Walmart chart

The biggest changes are likely to come from reimagining the role of the patient—the single most underused person in health care. Today, patients are thought of as close to a nuisance (“I told him to take his pills …”). But imagine that the patient was a participant and contributor to the medical Memex. Blood-pressure cuffs can be in the house of every person with high blood pressure; the daily pressure would be transmitted to the doctor’s electronic record and monitored by a computer for outlying values. Decision-support software might allow people with localized cancer to choose between surgery, radiation, and watchful waiting—decisions which are, today, heavily influenced by doctors (and none too objectively).

Information technology is going to change the game because it will affect how people view themselves, their illness, and the people who care for them. Amazon’s loyalty comes in no small part because it uses our past searches and the searches of people like us to predict what we will want. The customer is part of Amazon’s Memex. Health care will be less frustrating when the power shifts from sellers to buyers, and when patients are more in charge.

Some worry that a health-care system that’s concentrated like retail will drive up costs. But it’s also true that organizational changes are easier when more doctors work together in one system. According to the Institute of Medicine, inappropriate care, lack of adequate prevention, administrative waste, and prices that are too high account for nearly one-third of medical spending. Just the billing and collection operations in health care account for 25 percent of total costs; Walmart and Amazon spend an order of magnitude less on administration. Prices have fallen across the board in the retail sector.

Norman Rockwell’s classic painting, “Doctor and the Doll,” is memorable for how the doctor is comforting the little girl by listening to her doll’s heart. Norman Rockwell’s doctor knew everything about the girl and her family. The doctor of the future will not. Rather than being a living electronic record consulting an internal Memex, tomorrow’s doctor will be there to direct patients to the right specialized resources, to reassure those in need, and to comfort the terminally ill. This life may not be as exciting as the surgeons or diagnostic sleuths one sees on TV, but it is a noble calling nonetheless.

David Cutler is the Otto Eckstein Professor of Applied Economics at Harvard University and author of the forthcoming, The Quality Cure: How Focusing on Health Care Quality Can Save Your Life and Lower Spending Too.

data saving lives, entrepreneurship, healthcare, healthy habits, quantified self, rapid learning health systems, research methodology

sharing drives behaviour change

http://medcitynews.com/2013/10/calico-communities-legislation-tech-drive-new-era-health/

  • peer support is a powerful model to support behaviour change
  • social media-backed sharing of progress reinforces achievements
  • Stevens is the CEO of KEAS > workplace health interventions

Calico, communities, legislation and tech drive a new era of health

October 14, 2013 12:45 pm by  | 0 Comments

America’s healthcare system has historically taken only baby steps to empower individual health and wellness ownership – until now. Recent events are about to alter existing healthcare paradigms and I believe this to be the most pivotal of moments. With Google’s Calico, the Affordable Care Act (ACA), Penn State’s wellness debacle and the rise of health-oriented social, healthcare entities are now taking a microscope to existing practices and infrastructures. What will they find? An industry destined for a radical makeover that will result in a prevention-based and consumer-driven healthcare network.

 Let’s take a look at the players involved, from the good (social networking and technology), the bad (Penn State’s wellness initiative) and the TBD (Calico and the ACA).

The Emerging Models
Legislation, technology, communities, and social networking are forcing a healthcare overhaul. Consider Google’s Calico: It has the opportunity to create the largest online community to share health information, turning personal health on its head. With a greater global consumer reach than any other organization, Google has the access and resources to throw at this opportunity, making it the ideal company to coordinate this effort – and being led by Art Levinson, the Bill Gates of biotech, doesn’t hurt.

Addressing the issue of aging in a share- and prevention-oriented effort is a response to the growing presence of the “empowered patient.” Calico could finally deliver on the promise for people to have the ability to seize proactive command over their health with a full understanding of their health data and risk factors. Previously constrained by outdated regulations and a healthcare system that doesn’t prioritize prevention, the tables are finally turning. The potential can live up to the hype.

The October 1 launch of ACA-mandated healthcare exchanges is another step toward preventative care and information sharing. While the ACA is polarizing on both sides, (the outcome of its execution remains yet to be seen) the core of the ACA will impact the resulting healthcare industry in a way that empowers individuals to own their well-being and fosters collaboration with all patient caregivers.

The Anti-Model 
Pennsylvania State University recently (and wisely) repealed a recent decision that established apunitive-based health and wellness program. Love or hate it, even the ACA agrees with the ‘carrot’ versus the ‘stick’ (companies can offer a reward of up to 30 percent of health costs for employees who participate in programs like risk assessment). Given the backlash and media attention Penn state received, it was an unfortunate way to learn what not to do.

Additionally, HIPAA is about to be a relic. Designed in a bygone era, HIPAA will be rendered obsolete thanks to the ACA. Because the ACA will provide benefits to those with pre-existing conditions, HIPAA’s privacy laws will only exist as roadblocks to individual health and wellness. The future of healthcare is driven by information sharing. It’s time for HIPAA to die

The Proven Models
Peer support in healthcare is proving to be wildly successful. As consumers, we increasingly seek the wisdom of crowds to create and sustain meaningful behavior change. El Camino Hospital in Mountain View, CA, recently launched a healthcare program for its employees in which social networking was a one of the tent poles in the program. During an 8-week time frame, over 1,000 participants lost over 1,000 pounds and began eating more fruits and vegetables. What was the number one motivating factor? Sharing progress updates with colleagues.

Today, 80 percent of healthcare costs are associated with preventable illnesses such as obesity, diabetes, hypertension and high cholesterol. It’s no wonder people are demanding to take back ownership of their health. Social networking, communities, technology and legislation are propelling old school healthcare into a consumer-driven and preventative-based model. I say bring it on — it’s about time.

complex adaptive systems, healthcare, healthy habits, nutrition, policy, rapid learning health systems, research methodology

NYT: The Challenge of Diabetes for Doctor and Patient

..or why managing diabetes doesn’t fit with how doctors have been taught, and therefore generally like, to treat patients >>> we need a radically new approach not involving doctors, busy doing other things – see Iora Health post re. health coaches.

The good news: lifestyle change for the obese or those with prediabetes may have lower progression to diabetes
http://archinte.jamanetwork.com/article.aspx?articleid=1485081

The average news: childhood obesity is plateauing [PN: ??from a scandalously high base]
http://www.nytimes.com/2012/12/11/health/childhood-obesity-drops-in-new-york-and-philadelphia.html?_r=0

The bad news: Intensive lifestyle change for diabetics did not reduce the risk of stroke or heart attack, even though these patients were able to lose weight, improve their overall quality of life, take fewer medications and even decrease costs.

Lifestyle changes — diet and exercise — require huge and ongoing investment efforts for patients; we’d like to think it pays off for the big-ticket clinical outcomes. Hopefully future studies will show benefits.

 

OCTOBER 17, 2013, 3:43 PM

The Challenge of Diabetes for Doctor and Patient

By DANIELLE OFRI, M.D.

My patient was miserable — parched with thirst, exhausted and jumping up to go to the bathroom every few minutes. His vision was blurry and he’d been losing weight the last few weeks, despite eating voraciously. I’d only just met him, but I was able to diagnose diabetes in about a minute. What was unusual was that this was a scheduled office visit; usually, patients with such overwhelming symptoms are the provenance of emergency departments and urgent care centers.

A quick shot of insulin and five glasses of water and my patient felt like a new man, with no need to go to the E.R. But now, of course, the hard work would begin. A new diagnosis of diabetes is an enormous undertaking — lots to explain, major life changes to contemplate, myths to dispel, consultations with a nutritionist and a diabetes nurse.

Two days later I had another new patient for a scheduled visit — thirsty, tired, losing weight, eating and drinking like mad, eyes so blurred he could hardly see. We’d barely gotten past the introductions before I’d made another new diagnosis of diabetes. Another shot of insulin, another five glasses of water, and then the plunge into the thicket of diabetes education.

Most of my regular office visits with diabetic patients — even newly diagnosed patients — don’t involve such dramatic presentations. More often the disease is found when we screen patients who have risk factors like obesity or a family history of the disease, or who have commonly co-occurring illnesses like hypertension, heart disease or elevated cholesterol.

These two patients highlighted the outsized role that diabetes plays in the primary care setting. The tidal wave of diabetes over the last two decades has made it one of the most common diseases that internists and family doctors treat. Right now feels like a good-news-bad-news time on the diabetes front, which in a general medical clinic can sometimes feel like the only front there is.

The good news is that childhood obesity rates have begun to inch downward in some cities, including among poor children, the first positive sign in the obesity epidemic in years. Obese children are potential future diabetic patients, so even incremental progress is a public health victory to celebrate.

Also good news is a study in which adults with obesity and pre-diabetes were able to lose weight with sensible lifestyle changes and coaching. This took place in a primary care setting, not a research setting, so this also suggests that we might be able to bend the curve of new diagnoses of diabetes.

But there’s also bad news. Intensive lifestyle changes for patients with diabetes, disappointingly, did not reduce the risk of stroke or heart attack, even though these patients were able to lose weight, improve their overall quality of life, take fewer medications and even decrease costs. Lifestyle changes — diet and exercise — require huge and ongoing investment efforts for patients; we’d like to think it pays off for the big-ticket clinical outcomes. Hopefully future studies will show benefits.

Even with all the research and new treatments available, combating diabetes can feel like a Sisyphean task. The bizarre contradiction of junk food being cheaper than healthy food, combined with a bombardment of advertising — especially toward children — make it a challenge even for motivated people to eat healthfully. Sugary drinks in monster-size containers abound. And our fixation with screens large and small keeps us increasingly sedentary.

But even with all the uphill challenges, there are successes, even if not perfect ones. Both of my patients who came to my office with florid diabetes that week have improved. Perhaps it was the concreteness of their symptoms that motivated them, but they have both made steady progress getting their diabetes under control.

Over the past few months they’ve been eating more moderately, and exercising more regularly. We’ve been calibrating their medications so that their blood sugars have left the stratospheric levels and are now only moderately elevated. Medication side effects, cost of glucose meter supplies, real-life logistics, and concomitant issues of blood pressure and cholesterol control have made it a challenge to get to normal. We’d still be dinged as “failures” in the quality-measures department for not achieving the recommended clinical goals, but both patients feel vastly better and are much healthier now.

So there’s bad news and good news. But the real news for these two patients – and for many, many more like them — is that diabetes is a marathon, not a sprint. Although there have been a flurry of life changes right now, diabetes is something they will live with for the rest of their lives. They will always have to be cognizant of what they eat. They will have to keep track of medications, glucose levels, carbohydrate intake, doctors’ appointments, exercise, and weight.  They will have to be on the lookout for the many complications that diabetes can bring. This of course is not news to anyone who has diabetes or treats diabetes, but for these two patients this was news.

Now, we gear up for the long haul, the messy, complicated, occasionally gratifying business of living with a lifelong chronic illness.

Dr. Danielle Ofri’s newest book is “What Doctors Feel: How Emotions Affect the Practice of Medicine.” She is an associate professor of medicine at NYU School of Medicine and editor in chief of the Bellevue Literary Review.

http://well.blogs.nytimes.com/2013/10/17/the-challenge-of-diabetes-for-doctor-and-patient

data saving lives, healthcare, rapid learning health systems, research methodology

What doctors can learn from each other – value based healthcare

http://www.ted.com/talks/stefan_larsson_what_doctors_can_learn_from_each_other.html

http://www.ichom.org

  • 17-fold difference in outcomes for prostate surgery in Germany (5% vs 50%)
  • Continuous improvement not only improves quality of care over time, but also improves the quality of care for all who participate in it
  • Agents of change are the clinicians
  • Physicians are always very competitive – “always best in class”
  • They are extremely motivated to improve if they are shown not to be the best.
  • Physicians also thrive from peer recognition – “if one cardiologist calls another cardiologist at a competing [lagging] hospital and asks how they can improve, the leading cardiologist will share”
  • These qualities and dynamics establish an environment supportive of continuous cycle improvement
  • BCG have formed the International Consortium for Health Outcomes Measurement (ICHOM) with Michael Porter (Harvard Business School) and Karolinska Institute (Sweden) but reps from UK, USA, HK, BEL, SWE, NO, DK, DE, NL, AU, SG, Switzerland
  • They will establish data sets providing international outcome comparisons: 4 (2013), 8 (2014), 16 (2015) – 40% of disease burden in 4 years.
  • measuring value (vs costs) in healthcare – the things that matter to patients – will make clinicians part of the solution, not the problem

ContinuousCycleImprovement

 

entrepreneurship, healthcare, rapid learning health systems

Is a Health Coach Better Than an Overworked Doctor?

Going back to first principles to examine what really matters in a therapeutic relationship and discovering its the relationship. That a health coach previously working at Dunkin’ Donuts might be more effective than a Harvard trained doctor might be difficult to compute, but makes complete sense.

Iora Health seem to be limit testing this idea.

 

Is a Health Coach Better Than an Overworked Doctor?

Iora Health CEO Rushika Fernandopulle at the WIRED Data | Life Conference in New York City. Photo: Christopher Farber.
Suzanne Koven was walking in the rain when she slipped, fell and fractured her right shoulder. It took surgery and months of physical therapy to heal. 

“The recovery was miserable,” she said. But it came with a silver lining.

Koven is a primary care doctor at Massachusetts General Hospital, and the hospital insisted that for her first three weeks back she had to take twice as long to do her job. Suddenly, she had the luxury to actually spend time with her patients, to talk with them about what was wrong and how she could help.

“It was the happiest time in my career,” she said. “It completely transformed the nature of the interaction [with patients].”

That wouldn’t last. When her three weeks were up, Koven had to rejoin a system that rewards quantity over quality. She was back to seeing 20 patients a day.

But just a mile away from her office, at Iora Health’s main offices in Cambridge, Rushika Fernandopulle was busy brewing just the kind of medicine that inspired Koven to go into primary care more than 20 years earlier — a practice that, at its core, is about building relationships. At Iora Health’s clinics, teams of doctors, nurses and health coaches work together to take care of patients holistically, bundling together mental health services, peer support groups and nutrition counseling with more traditional primary care services like physical exams.

This model builds on a team-based approach to medicine known as patient-centered care, itself part of a larger movement to cut costs and improve health by upping the quality of primary care. The idea behind it is if people’s baseline health is better, the system will have to spend less money paying for expensive emergency procedures later.

What’s key to our model is to build a team around the patient — Rushika Fernandopulle

 

Large healthcare outfits, university systems and Silicon Valley upstarts have tried this approach with varying results before. But Iora wants to take this concept a step further by actively going after the most expensive, high-risk patients, spending more time and resources on each one, and investing in building in-house data analytics and IT tools. Along the way, the company is killing the standard model, in which doctors are paid for each service they provide, and redefining what a health provider is.

“What’s key to our model is to build a team around the patient” in a data-centric way, said Fernandopulle at the WIRED Data|Life conference in New York City yesterday. They take data from hospitals, pharmacy benefits companies and patients to monitor how patients are doing and to identify what patients to treat in the first place.

So far, he says, this approach has met impressive results. The company has been able to reduce emergency room visits by 48 percent and hospitalizations by 41 percent, resulting in an overall 15 percent reduction in healthcare costs in pilot studies at its four practices in New Hampshire, Nevada, New York and Massachusetts. Plus, the physicians in his clinics tend to be happier.

It’s the type of effect that Koven noticed during her three-week stint working at half her normal pace. She doesn’t have hard data to back this up, but she noticed that it took her patients roughly 15 minutes to start confiding in her. During a normal 15 minute visit, the patient would never get to that point. More open communication, she says, also made her less likely to order unnecessary expensive tests and medications.

At Iora, that’s standard partly because of the way the payment system works.

A provider pays a lump sum of money, usually between $150 and $200 a month, for each patient instead of forking over money per service. Then it’s up to the team to decide how to best treat the communities they serve. The system only works if the clinic keeps patients healthy. It behooves Iora to figure out exactly what’s wrong and tailor treatment to its patient population.

Sometimes that means cutting back on medications or the number of specialists patients see. It can also involve phone calls, text messages, video conferencing through Skype, or group sessions like Diabetes Clubs during which patients socialize and teach themselves how to best manage their disease.

To do this in a data-driven way, the team surveys patients for feedback and uses that information to tweak how care is delivered. It actively collects blood pressure, blood sugar and prescription refilling data to make sure patients are sticking to their health plan. If they don’t refill a prescription, for example, the system creates a task for a health coach to follow up with the patient.

Fernandopulle recounted the story of “Mr. Edwin,” a patient with end-stage renal disease and anxiety. His panic attacks sometimes prevented him from getting the dialysis that was keeping him alive, which resulted in 17 emergency room visits and $280,000 in healthcare costs.

His health coach asked him what calmed him down and he said listening to music. She used Iora’s discretionary budget to buy him a $45 iPod onto which the health coach loaded merengue music, Mr. Edwin’s favorite. Mr. Edwin took his merengue music with him to dialysis, and, Fernandopulle says, that quelled his anxiety and prevented expensive ER visits. This would have never happened in a traditional healthcare setting, he said.

Because that hinges on having a good rapport with patients, the company puts a premium on social skills. A background in health isn’t even necessary to get hired as a health coach. For example, before joining the company, some of Iora’s best health coaches worked as cashiers at Target and Dunkin’ Donuts, possibly the last place a traditional healthcare system would look for talent.

“It’s one of the most innovative models out there. What they’re doing is trying to start to think outside the traditional confines of who can provide care,” said Ashish Jha, a professor of health policy at the Harvard School of Public Health. “You don’t need to go to medical school to be a great health coach, to connect with people and motivate them. Those skills exist much more broadly.”

But, he says, that’s not an approach the healthcare establishment is necessarily ready to adopt in its entirety. The concept of building practices around team-oriented care might be scalable, but a strong leader is critical to make this model successful. “It would take a very special, very large healthcare provider to tolerate this approach. The idea that you’re going to get a health coach from Dunkin’ Donuts just seems hard to tolerate.”

Then, there’s the question of whether small companies like Iora can really make a dent in the country’s $2.7 trillion healthcare bill. There are hundreds of experiments and pilots around the country trying to redefine primary care, and it’s still unclear what will work, says Kevin Tabb, the CEO of Beth Israel Deaconess Medical Center in Boston. ”It’s not clear that a small company has the resources to really develop sophisticated systems on their own. Google couldn’t pull it off.”

I don’t think of talking with patients and getting to know more about them as some warm and fluffy add-on. It’s what medicine is — Suzanne Koven

 

Still, Tabb says, if one or several of these works out, it could still have a big impact.

And it wouldn’t have to be as scalable as you might think. “Five percent of the sickest patients are responsible for more than 50 percent of the healthcare spend,” Tabb said. “It may be that we only need to provide intensive care to a small percentage of the population.” What Tabb means by “intensive care” is not the intensive care unit of a hospital, but the type of personalized, regular care experimental primary care practices like Iora provide.

What all this says to Koven is that healthcare is very much a service industry. And what sets a good service apart is the ability to listen to customers well and to make them feel like what they say matters. That builds trust.

“Primary care — or my idealized version of primary care — actually allows for much more of that storytelling,” Koven said. “I don’t think of talking with patients and getting to know more about them as some warm and fluffy add-on. To me, it’s what medicine is.”

And that’s the type of medicine Iora Health is trying to kickstart.

Source: http://www.wired.com/wiredscience/2013/11/wired-data-life-iora-health/#!

complex adaptive systems, data saving lives, healthcare, meaning, musings, policy, politics, rapid learning health systems

The gist of my concerns…

Post-change makers festival closing event, here’s a first go at capturing my main beefs with the health system – a little rough around the edges but captures the gist:

 

  Appearance Reality Vision
Mission Brittle health system Bankrupt sickness market Sustainable learning wellness market
Universality Universal healthcare Safety net + PHI Universal
Payment Fee for care Fee for activity Fee for outcomes
Leadership Run by experts Run by amateurs Run by the finest minds
Levers Doctors in hospitals prescribing pharmaceuticals and performing procedures Unmanaged social determinants with doctors spruiking pills and procedures Actively managed social determinants featuring broccoli magnates

That said, and given the issues and concerns we discussed, I suspect some (if not all) of what needs to happen, has to happen alongside or entirely outside the existing system. Hmm.

I just returned from the closing event for this: http://changemakersfestival.org/

I didn’t have a chance to properly speak with Jenny about our discussion, but got the impression that there simply wasn’t the kind of support for think tanks here that existed overseas.

That said, I did have a reasonable chat with Nicholas Gruen – an very interesting economist and thinker – and suspect there may be an alternate angle to pursue… will keep you posted.

data saving lives, entrepreneurship, healthcare, rapid learning health systems, research methodology, technology

Jointly Health – analytics for remote monitoring

Jointly Health is the first Big Data Analytics and Closed-Loop Decision Support Platform for Remote Patient Monitoring

From their website:

Company Overview

Jointly Health is a venture-backed company headquartered in Orange County, CA. In collaboration with Qualcomm Life, Jointly Health provides a very disruptive, end-to-end Remote Patient Monitoring and Analytics Platform that can detect changes in health states much earlier and with greater specificity. Jointly Health also makes this information actionable by healthcare professionals inside their existing workflow.

First Application

The first application of Jointly Health is to reduce preventable hospital admissions in patients with complex chronic disease. In the U.S. there are 4 million preventable hospitalizations resulting in $88 billion in preventable costs and unquantifiable amounts of human   suffering. Remote patient monitoring has the potential to reduce these hospitalizations but is plagued by missed intervention opportunities, false alarms and inefficiencies. Jointly Health solves these problems.

Uniqueness

Jointly’s proprietary platform utilizes a number of advanced technologies including Predictive Analytics, Complex-Event Processing, Real-Time Analytics, Signal Processing and Machine Learning and has four distinct advantages.

1. Can collect a wide variety of remote health data at high velocity and volume. This includes multiple types of physiological data, human observational, environmental, contextual, and other meta data.

2. Has an adaptable ecosystem that enables our customers to build complex disease models which we can then execute.

3. Can remotely detect changes in health states much earlier and with greater specificity.

4. Provides healthcare professionals with a closed-loop decision support system for intervention optimization.

————-

From: http://www.medgadget.com/2013/11/futuremed-day-4-the-end-of-the-beginning.html

Kreindler elaborated on the value of high speed data for applications including remote patient monitoring and analytics to proactively detect deteriorating health states before they being to detract from quality of life. The energetic talk concluded by touching on how Jointly Health, in collaboration with Qualcomm Life, harnesses big data and analytics to make “information actionable.”

 

cool, data saving lives, entrepreneurship, healthcare, rapid learning health systems, research methodology

His Brother’s Keeper – The PatientsLikeMe story

Heyworth is the founder and former CEO of the ALS Therapy Development Institute (ALS TDI), a non-profit biotechnology organization driven to developing treatments for amyotrophic lateral sclerosis (ALS). The first half of Heyworth’s talk focused on his emotional motivation for ALS TDI, which began when his younger brother Stephen was diagnosed with ALS. Heyworth’s investigation into the options available for managing his brother’s disease revealed a disturbing fact: as much as 80% of ALS research outcomes could not be replicated, making much of the support for ALS clinical trials statistically unsubstantiated.

Heyworth raised the question of how we can move forward when there are faults in the data at the heart of our assumptions. The fact that ALS, considered one of the best-researched medical conditions, might have no real supportable data drove Heyworth to establish ALS TDI in 1999 with the aim to champion a new model of disease research based outside of academia and for-profit organizations. Heyworth’s story was captured by author Jonathan Weiner in His Brother’s Keeper and by the PBS documentary So Much So Fast.  Heywood’s discussion also touched on his work as co-founder of PatientsLikeMe, an online resource for disease-specific medical information. The tool allows patients to track their diseases and share this information with others dealing with the same conditions. PatientsLikeMe disrupts the current system of clinical trials with patient-driven databases that provide insight into the efficacy of specific treatments.

Taken from: http://www.medgadget.com/2013/11/futuremed-day-4-the-end-of-the-beginning.html

complex adaptive systems, data saving lives, entrepreneurship, healthcare, healthy habits, meaning, musings, nutrition, policy, quotes & aphorisms, rapid learning health systems, research methodology

The behaviour change arms race…

Behavior change is difficult, but to date it has dominated by industries, such as the processed food industry, who have mastered the art of mass market behaviour change through a withering combination of product research, development and engineering, marketing, advertising and promotion, all founded on an unstoppable and lucrative business model. At this moment in history, industry is the unopposed, global behaviour change super power. Serious capital investment with serious returns but with the unfortunate side-effect of producing a global epidemic of non-communicable disease.

The institutions charged with protecting the public’s health have been caught flat footed. Rather than trying to neutralise industry’s behaviour change efforts, medically-dominated health systems have instead chosen to layer their own lucrative pharmaceutical and surgical business model on top.

Doctors quite legitimately pay lip service to the “diet and exercise” mantra because they know it doesn’t work. And why doesn’t it work? Because anyone can say eat healthier food and exercise, thus making it difficult to justify their years of training and high fees. It’s much better for doctors to note “diet and exercise”, but then pump the drug and surgery options.

So what needs to happen?

A countervailing super power must be established. Not one founded around a powerful business model, but rather a movement of interested citizens, concerned by the grotesque monentization of the population’s health. In effect, a competing super power in the behaviour change arms race.

Key characteristics:

  • protect the children
  • use evidence, but don’t wait for conclusive results
  • empower with data
  • apply political dark arts

Funding sources:

  • social impact bonds
  • crowd sourcing
  • private health insurers
  • government (not a good time for this)

Inspirations

  • Purpose.com
  • GetUp.org.au

 

healthcare, healthy habits, policy, rapid learning health systems, research methodology, technology

Cth Fund on health management apps

  • 40,000 to 60,000 health and wellness apps
  • health app market estimated to be work $700M in 2012, doubling by end of 2013
  • 52% of smartphone owners have used their device to gather health information
  • 19% have at least one health app on their phone
  • safety-net populations have better-than-expected access to mobile devices and are more likely to use their phones to access health information
  • chronic disease (diabetes and asthma) management apps are often extensions of proven interventions that yield clinical benefits and/or financial savings
  • User’s (particularly older users) most popular features: diagnoses, monitoring BP, BSLs
  • User’s least popular features: medication and exercise reminders
  • Providing feedback on progress supports sustained use
  • 30 – 60% of melanomas screened via a teledermatology app were diagnosed as benign!!!!
  • Asthmapolis is an asthma app that is fully integrated with the rescue inhaler to indicate where and when the inhaler is used, correlate that with weather etc.
  • FDA differentiates between lifestyle apps and apps which send data to clinicians – the latter are considered medical devices and will be regulated.

 

PDF: 1713_SilowCarroll_clinical_mgmt_apps_ib

Source: http://www.commonwealthfund.org/Publications/Issue-Briefs/2013/Nov/Clinical-Management-Apps.aspx?omnicid=20