Category Archives: healthcare

facts & data points, healthcare, policy

OECD: Health at a Glance 2013

  • one of the highest life expectancies at birth of 82 years (2 years above the average)
  • top five cancer survival rates
  • top five AMI survival rates
  • 8.9% health spend on GDP (OECD average: 9.3%)
  • top three in rates of obesity – 28.3% (US – 36.5%; Mexico – 32.4%; NZ – 28.4%; UK – 24.8%)
  • comparatively high rates of adverse events in hospitals – 8.6 per 100,000 (OECD average – 5)
  • pressure on training pipeline, and eventually, health system financing

Medical Observer Summary:

  • Use of cholesterol-lowering drugs: 1st, 50% above OECD avg
  • Use of antihypertensives: 21st, 30% below OECD average
  • Fatality within 30 days of acute MI: 5th lowest, 60% below OECD avg
  • Use of antidepressants: 2nd, 59% above OECD avg
  • Antibiotic prescribing in primary care: 8th, 17% above OECD avg
  • Pharmaceutical expenditure per capita: 9th, 21% above OECD avg
  • Remuneration of specialists: 3rd, 4.3 ratio to average wage
  • Remuneration of GPs: 18th, 1.7 ratio to average wage

 

AU Media Release (PDF): Health-at-a-Glance-2013-Press-Release-Australia

OECD Report (PDF): Health-at-a-Glance-2013

Charts (PDF): Health-at-a-Glance-2013-Chart-set

OECD Source: http://www.oecd.org/health/health-systems/health-at-a-glance.htm

SMH (PDF): OECD says Australians take too many pills and must tackle nation’s obesity problem

data saving lives, entrepreneurship, healthcare, healthy habits, nutrition, policy, politics, rapid learning health systems, research methodology, technology

Katz slam dunks….

  • Used the Harvard Nurses Health Study to develop an algorithm for food healthiness as determined by health outcomes from the study – a GPS for nutrition – CLEVER!
  • Offered to do this with Government in the early 2000s but was knocked back
  • Developed a proprietary algorithm called ONQI, owned by NuVal
  • Choosing higher scoring foods correlates with a lower risk of dying prematurely.
  • “The very government agencies that regulate the food supply are extensively entangled with the entities producing our food, from farm to factory. In comparison, we mere eaters of food have very little clout. The government may be just a little too conflicted on the topic of food to be in the business of putting the truth, the whole truth and nothing but the truth on at-a-glance display.
    Certainly the big food manufacturers, the makers of glow-in-the-dark snackattackables, should NOT be in the business of nutrition guidance whatever their inclination. That approach makes the fox look like a highly qualified security officer for the henhouse.
    Which leaves independent nutrition, and public health experts and private sector innovation. And here we are.
    Private-sector innovation often involves intellectual property, trade secrets and patent applications. It involves some entity making an investment and wanting a return. That is all true of NuVal, for better or worse. It wasn’t my plan – it was just the only way to get this empowering system into the hands of shoppers. Of note, the ONQI remains under the independent control of scientists, and not the business.”
  • This is a terrific strategy – worthy of emulation.

Source: http://health.usnews.com/health-news/blogs/eat-run/2013/06/11/nutrition-guidance-who-needs-to-know-what

Nutrition Guidance: Who Needs to Know What?

  June 11, 2013 

I am writing today about nutrition guidance and who needs to know what to make it useful.

Permit me to disclose right away that I am the principal inventor of the Overall Nutritional Quality Index (ONQI) algorithm, used in NuVal – a nutritional guidance system that stratifies foods from 1 to 100 on the basis of overall nutritional quality: the higher the number, the more nutritious the food. As the Chief Science Officer for NuVal, LLC, I am compensated for my continuous and considerable allocations of time and effort. But it was never supposed to be that way – and the reasons why it is are an important part of this story.

As to why this column now, there are two recent provocations. One is our ongoing work to complete the updated algorithm, ONQI 2.0, and the window that provides into a world of weirder foods than I ever even considered possible. The other is a paper published in the Journal of the Academy of Nutrition and Dietetics a few months back and a more recent exchange of letters related to that article. The article described the advantageous novelties of a nutritional profiling system, such as weighting nutrients for their health effects rather than counting them all the same. But this was less about novelty, and more about NuVal, since the innovations described have long been included in the ONQI.

[See: Debunking Common Nutrition Myths.]

Claims about alleged novelties that were already included in NuVal prompted a letter from my colleagues and me to the journal, which was published along with a response from the original authors. In that response, they acknowledged that the NuVal system included the so-called “novelties” and acknowledged that the ONQI is, to date, the only nutritional profiling system shown to correlate directly with health outcomes. So the real concern, the letter went on, is that the ONQI algorithm is proprietary and the details are not fully in the public domain.

Which brings us back to why NuVal is a private and proprietary system in the first place and whether or not it matters that certain details of the algorithm – which populate 25 pages or so of computer code written in a language called SAS – are not on a billboard. Why isn’t the ONQI public rather than private, and who really needs to know every detail of the algorithm for it to be useful? (All of the nutrients included in it, and the basic approaches used to generate scores, have been published.)

The ONQI, and NuVal, are a private sector innovation because the public sector said: no thanks. In 2003, I was privileged to be a member of a group of 15 academics invited to Washington, D.C. by then-Secretary of Health Tommy Thompson. A Food and Drug Administration task force had been formed to guide efforts related to the control of rampant obesity and diabetes, and we were a part of that effort. We gathered in a conference room with Secretary Thompson, the FDA Commissioner (Mark McClellan) and others, including the surgeon general and the heads of the National Institutes of Health and the Centers for Disease Control and Prevention.

[See: Why Aren’t Americans Healthier?]

We were each given one three-minute turn to offer up one good idea the FDA and other federal agencies might use to help combat the ominoustrends in diabetes and obesity. I used my turn to describe, in essence, the project that later became the ONQI. I suggested that the secretary might convene a totally independent group of top-notch experts in nutrition and public health, perhaps under the auspices of the Institute of Medicine.

The group should have no political or industry entanglements and should be allowed to work for as long as it took to convert the best available nutrition science and knowledge into a guidance system anyone could understand at a glance. I was thinking, in essence, of the equivalent of GPS for nutrition, so that no one trying to identify a better food in any given category would get lost, confused or misled by Madison Avenue.

[See: 10 Things the Food Industry Doesn’t Want You to Know.]

I waited two years for the feds to do something along these lines. When they didn’t, I decided to undertake the project myself, with the backing of Griffin Hospital in Derby, Conn. – a Yale-affiliated, not-for-profit community hospital, which owns the ONQI algorithm to this day. Other than this being a private rather than federal endeavor, all other aspects of the project were just as proposed to the U.S. Secretary of Health. When we completed the algorithm, I offered it again to the FDA. A scientist at the agency recommended a private-sector approach if I hoped to live long enough to see the system do its intended good.

Why didn’t the feds take on the project? We can all conjecture. I suspect it has something to do with the story Marion Nestle told us all in Food Politics, and the stories we routinely hear about the Farm Bill from the likes of Michael Pollan, Mark Bittman and others. The very government agencies that regulate the food supply are extensively entangled with the entities producing our food, from farm to factory. In comparison, we mere eaters of food have very little clout. The government may be just a little too conflicted on the topic of food to be in the business of putting the truth, the whole truth and nothing but the truth on at-a-glance display.

[See: Seeking a More Perfect Food Supply.]

Certainly the big food manufacturers, the makers of glow-in-the-dark snackattackables, should NOT be in the business of nutrition guidance whatever their inclination. That approach makes the fox look like a highly qualified security officer for the henhouse.

Which leaves independent nutrition, and public health experts and private sector innovation. And here we are.

Private-sector innovation often involves intellectual property, trade secrets and patent applications. It involves some entity making an investment and wanting a return. That is all true of NuVal, for better or worse. It wasn’t my plan – it was just the only way to get this empowering system into the hands of shoppers. Of note, the ONQI remains under the independent control of scientists, and not the business.

[See: Mastering the Art of Food Shopping.]

Which leads us back to the second question: Is it a problem for a system like this to be a private-sector innovation? Who, really, needs to know every detail of such an algorithm?

Consider that if you are shopping for a car, you do need to know if it comes with anti-lock brakes or all-wheel drive. But to decide if these are working for you, you don’t need engineering blueprints; you just need to drive in the snow. When shopping for a smartphone, you may want to know if it has GPS. But you don’t need the trigonometry equations on which the GPS is based to determine if it works; you just have to see if it helps you get where you want to go.

Nutrition guidance in general, and NuVal in particular, are just the same. What are the exact formula details? Who cares. We routinely rely on tools based on math and engineering most of us don’t understand – but we don’t need all that input to know if the tools are working for us. We just need the output. We need to be able to use them. People using NuVal have lost more than 100 pounds, and even over 200 pounds. Choosing higher scoring foods correlates with a lower risk of dying prematurely. More than 100,000 scores are on public display in 1,700 supermarkets nationwide. The ONQI is at least as transparent as any car or smartphone or computer.

[See: The No. 1 Skill for Weight Management.]

Let’s acknowledge: If you are reading this on a computer screen, neither of us truly understands the engineering involved in me writing it, using word processing software, attaching it to an email and sending it to my editor at U.S. News & World Report so she could post it in cyberspace, where you found it. But we do know it worked.

We rely on private-sector innovation for a lot of important jobs, and even many that put our safety on the line. The private sector makes our cars and planes. We seem to be comfortable using these without scrutinizing patent applications. The private sector makes our computers, and smartphones and GPS systems, and we can tell whether or not these work, even if we don’t know how.

Why, then, is nutrition guidance different? The answer, I believe, is politics, profits and the inertia of the status quo. We are accustomed to vague nutrition guidance from conflicted sources, and those same sources are apt to imply there is something wrong with private-sector innovation and the intellectual property issues that come along with it. But if those issues don’t undermine the cars, and planes and navigation systems that get us from city to city and coast to coast, it’s not at all clear why they should be a problem when navigating among choices in a supermarket aisle.

[See: The Government’s MyPlate Celebrates Second Birthday.]

As a scientist, and not a businessperson, my preference would be to put the ONQI on a billboard for all the good it would do. But on this, I must defer to the businesspeople who have made the relevant investments and are entitled to safeguard potential returns. As for the scrutiny that all advanced systems should get, the ONQI has been shared with scientists at leading universities and health agencies around the world – but for private assessment and use rather than public display. Others like them who want to review the program need only ask.

We should all care that the military-industrial establishment seems opposed to putting the blunt truth about nutritional quality, as best we know it, on at-a-glance display. We should care that federal authorities responsible for nutrition guidance are also responsible, if only indirectly, for food politics and supply-side profits. That story may lack novelty. It may be old news. But it is nonetheless something everyone who eats does need to know – engineering blueprints not required.

data saving lives, entrepreneurship, facts & data points, healthcare, quantified self, rapid learning health systems, technology

Medical Body Area Network

  • The FCC has proposed the allocation of spectrum for Medical Body Area Network (MBAN) devices.
  • Deloitte expects the wireless health device market to triple in the next few years

From: http://www.fool.com/investing/general/2013/11/17/3-technologies-that-will-change-the-face-of-medici.aspx#!

3. Wireless body monitoring
We need only to listen to the words of FCC chairman Julius Genachowski to get a feel for the potential for wireless body monitoring. Genachowski noted last year that “a monitored hospital patient has a 48% chance of surviving a cardiac arrest,” compared with only 6% for an unmonitored patient.

With the tremendous opportunity for improving health care in mind, the FCC proposed allocating spectrum for Medical Body Area Network, or MBAN, devices. Such devices will record vital signs and other important physical information through sensors attached to a person’s body, with the data transmitted to a local wireless hub. The information can then be monitored remotely by clinical professionals, with alerts sent to let these experts know when medical intervention could be needed.

GE Healthcare (NYSE: GE  ) is one company already developing MBAN devices. The giant company plans to introduce technology using sensors that monitor heart and breathing rates, temperature, and pulse oximetry within the next few years. Deloitte predicts that the wireless body monitoring market could more than triple in just the next couple of years. Within the next decade, this technology could be key in helping control overall medical costs.

facts & data points, healthcare, policy

China’s plans universal health care by 2020

China is expanding its health care system and aiming for universal coverage for its 1.35 billion citizens by 2020. The report estimates that the country alone will make up 34% of the global growth in medication spending over the next five years.

Source: http://healthland.time.com/2013/11/19/why-were-spending-1-trillion-on-health-medications/

Report PDF: IIHI_Global_Use_of_Meds_Report_2013

complex adaptive systems, data saving lives, entrepreneurship, healthcare, healthy habits, musings, nutrition, policy, quantified self, rapid learning health systems

Because in health, less is more…

When we look back at contemporary health systems 50 years from now, we will consider them to be an technologically indulgent folly of grand proportions, driven by an imperative to deliver more and more complex care in order to justify higher and higher costs.

In a fee-for-service context, elaborate technologies justify higher costs. An elective angiogram costs $25,000. If this had to be paid by individuals, there would be no interest in conducting them with the frequency that they are performed today.

Perhaps this is why Singapore, with its health savings accounts with health costing around 4% of GDP (achieving the same high outcomes of Australia), lacks the excesses of more universal health systems?

The use of bariatric surgery for obesity is perhaps the most egregious example of this phenomenon. A AU$20,000 – 30,000 procedure is now introducing moral hazard that will undermine attempts to introduce behavioural and lifestyle change i.e. “Why bother changing my lifestyle when I can simply get a lap band to fix me later?”

Pharmaceutical companies are also using this play book with the introduction of their new, highly-specialised, so-called “biologics” to the market, particularly in the cancer area. They are often protein based and extremely difficult to manufacture, but are also very targeted. Funders are responding to this threat with value-based payment schemes where by the drug company only gets paid if the treatment succeeds.

Current health market settings establish this perverse incentive. Moves to value/outcomes-based care will remedy these perversities, providing incentives for activities that reduce care costs. In such an environment, the cheapest interventions also become the most profitable.

Home delivered broccoli instead of lap-bands.

CBT SMS’s instead of SSRIs and psychotherapy.

A rapid learning health system instead of a profit yearning sickness market.

 

healthcare, nutrition, policy, rapid learning health systems, research methodology

Forbes: Curing Type 2 Diabetes with Surgery: It Works — Now Let’s Figure Out Why

  • Insulin resistance stabilises ahead of weight loss in gastric bypass surgery
  • Insulin resistance tracks with weight loss in lap band surgery
  • No one knows why, though some pharma start ups are looking for a molecule
  • A great example of empiricism triumphing over reductionism

PN: This still leaves the door open to the solid food hypothesis

http://www.forbes.com/sites/davidshaywitz/2012/03/26/curing-diabetes-with-surgery-it-works-now-lets-figure-out-why/

3/26/2012 @ 11:59PM |29,806 views

Curing Type 2 Diabetes with Surgery: It Works — Now Let’s Figure Out Why

During my endocrinology training, I was captivated by a phenomenon I’d seen on the wards, and had just started to read about in the literature: type 2 diabetic patients receiving bariatric surgery exhibiting rapid, seemingly instantaneous improvements in their glycemic control, apparently related to profoundly reduced insulin resistance as a consequence of the surgery.

The first teaching seminar I gave as a fellow, at Endocrinology Grand Rounds, asked the distinguished medical faculty who gathered in the Ether Dome, “Is Diabetes a Surgical Disease?”

At the time, the answer was, “Yes?”  Now, two recent reports presented today at the ACC, and simultaneously published in the NEJM (here and here), seem to upgrade this answer to “Yes!”

Both reports conclude that bariatric surgery surpasses medical therapy as a treatment for type 2 diabetes, and are fascinating not only because of the immediate clinical implications (as discussed by Matt Herper here, and in anNEJM editorial comment here), but also because there’s some really cool underlying science that nobody seems to understand.

The fundamental paradox is the same mysterious clinical phenomenon that so intrigued me years ago: the drastic improvement in diabetic function that occurs significantly before most of the weight is lost.

The authors of the first study note, “Reductions in the use of diabetes medications occurred before achievement of maximal weight loss, which supports the concept that the mechanisms of improvement in diabetes involve physiologic effects in addition to weight loss, probably related to alterations in gut hormones.”

The authors of the second study were also struck by the rapid improvement in glycemic control they observed, reporting that all patients treated surgically were able to discontinue all their diabetes medicines within fifteen days of their operation – a remarkable result (and entirely consistent with my own clinical experience).  Almost all of the surgically-treated patients remained free of diabetes after two years, while none of the medically-treated patients were as fortunate.

As the authors write, “there was no correlation between normalization of fasting glucose levels and weight loss after gastric bypass and biliopancreatic diversion, findings that are consistent with results of previous studies, which suggests that such surgeries may exert effects on diabetes that are independent of weight.”

The authors also point out this result is in contrast with gastric banding procedures (which constrict the stomach but don’t otherwise alter the anatomy); the improvement in diabetes seen in those patients does appear to correlate more directly with weight loss.

The intriguing scientific question is how can bariatric surgery result in an almost immediate improvement in the insulin resistance profile of diabetic patients?  To my mind, this is among the most important unanswered questions in endocrinology, and medical science more generally.  While the effect is generally attributed to “gut hormones” (as the authors of the first study write), the biology beyond that gets a bit murky.

To be sure, some companies are working on it – the example that springs first to mind is NGM Biopharmaceuticals, a small Bay-area biotech (with which I have no personal nor professional connection) founded in 2008 as an ambitious science play by The Column Group, Rho Ventures, and Prospect Venture Partners.  I’m sure others are working on this challenge as well.

A final point – as attracted as we are to the view of basic science driving clinical medicine, the experience with gastric bypass surgery arguably exemplifies the reverse, and represents a triumph of empiricism, as well as a reminder of the value of human physiology (see here), and more generally, the importance of studying people (and not just parts of people).

It also would not be the first (nor will it be the last) time that medical sophisticates learned a valuable lessons from those laboring – often, as in the case of many bariatric surgeons, with inadequate respect – on the front lines of patient care.

This article is available online at: 
healthcare, policy

The brutal view from medicine’s front line…

  • despite the noise regarding safety, quality and health reform, and in particular payment reform from fee-for-service to value-based-payment, the truth is that practically all providers and provider organisations are simply focused on one thing: MAXIMIZING REVENUE
  • It’s fun to read about cool technology, big data, and innovation incentives, but the reality is that in the trenches, many (I’d say most) providers and provider groups feel that they are locked in a deadly battle with payors (and increasingly, other providers) for their livelihoods; many feel they are having to work harder and harder to bring in the same (or less) money then doctors a generation ago. 
  • Many feel that the profession has lost the autonomy and respect it used to enjoy, and that providers are now viewed as mechanized assembly line workers, held to strict quantitative “quality” metrics that rarely capture the complexity, or essence, of the patient experience.

 

Source: http://www.forbes.com/sites/davidshaywitz/2013/11/12/the-brutal-view-from-medicines-front-lines/

The Brutal View From Medicine’s Front Lines

Health policy discussion these days focuses extensively on the idea that medicine is changing, moving (maybe slowly, maybe rapidly) from a fee-for-service to a fee-for-value world, where providers and hospitals own risk, and are incentivized to reduce costs and improve care, a win-win situation for all.
It’s possible such change is happening – somewhere, or in some parts of some organizations.Yet, most providers with whom I’ve been speaking tell a starkly different story.  The view from the front lines suggests that hospitals and care delivery systems are obsessing like never before on doing whatever they possibly can to maximize their revenue.  They are consumed, utterly consumed, by this objective.

It’s touching to read accounts from Ashish Jha and others describing benevolent CEOs concerned about patient care and safety; the hospital executives I’ve been hearing about tend to talk a good game about safety, and may even genuinely care about quality, but they are focused on, driven by, and hired for their skill at maximizing revenue – a prime directive that quickly percolates its way through the entire care system.

I know of examples at non-academic centers where doctors are refusing to see patients who don’t carry “good” insurance, citing miserable rates of reimbursement – rates they point out can be lower (sometime much lower) than what professional trainers often make.

At academic centers, publishing papers is certainly encouraged, but making your “RVUs” (i.e. seeing enough patients) is prioritized – and failing to do so can get you canned.

Hospital records are routinely reviewed in detail to ensure every opportunity for “revenue capture” has been identified.

The reason to highlight what seems to me the current state of medicine (and yes, this is anecdotal, but I suspect that if anything, this description understates the magnitude of the situation) isn’t so much to critique it as to surface it, and remind readers what healthcare actually looks like today — a reality that seems far more Hobbesian than what’s often imagined, presented, and discussed.

It’s fun to read about cool technology, big data, and innovation incentives, but the reality is that in the trenches, many (I’d say most) providers and provider groups feel that they are locked in a deadly battle with payors (and increasingly, other providers) for their livelihoods; many feel they are having to work harder and harder to bring in the same (or less) money then doctors a generation ago.  Many feel that the profession has lost the autonomy and respect it used to enjoy, and that providers are now viewed as mechanized assembly line workers, held to strict quantitative “quality” metrics that rarely capture the complexity, or essence, of the patient experience.

It’s hard to envision this is sustainable – you can only increase the speed of the treadmill so much.

Rather, the question is what comes next for medicine – how will care be delivered, and who will be delivering it?

healthcare

BEACH: Diabetics spend an extra hour and visit 8 more times

  • Type 2 diabetics (vs normals) spend 2.6hrs (1.6hrs) and  visited 8 (5.6) times per year
  • Diabetics also utilised allied health more frequently and intensively
  • Only accounted for 8% of GPs current work load

Source: http://www.medicalobserver.com.au/news/patients-with-diabetes-visit-gps-eight-times-a-year

Patients with diabetes visit GPs eight times a year

19th Nov 2013

Andrew Bracey

PATIENTS with type 2 diabetes spend an extra hour a year with their GP compared to other patients, according to new data which has prompted renewed calls for an improved approach to funding for management of the condition.

The findings, from the latest Bettering the Evaluation and Care of Health (BEACH) study, published this week, showed the average patient spent 1.6 hours a year with their GP, while those with diabetes spent an average of 2.6 hours.

The report, General practice activity in Australia 2012–13,  noted those with diabetes also spent time with a range of allied health professionals as well as practice nurses.

With the management rate of the condition increasing by 33% over the past decade, the authors said type 2 diabetes was “very resource intensive” and was “bound to increase in future”.

BEACH director Associate Professor Helena Britt said type 2 diabetes now accounted for 8% of GPs’ workload and that patients with the condition visited their doctor an average of eight times a year compared to the national average of 5.6 annual visits.

Patients with diabetes had their condition managed at half of their GP consultations, according to the report.?

Brisbane GP Dr Gary Deed said the data confirmed the need to improve funding models for the management of diabetes in general practice.

Dr Deed, who is a director of Diabetes Australia’s Queensland arm and chairs the RACGP’s National Faculty of Special Interests Diabetes Network, said he hoped the Coalition government would undertake a consultation with GPs “at the coalface” as part of efforts to develop a long-term approach to diabetes management. ?

With the majority of patients also having at least two other comorbidities, he said a block funded model, such as the one being trialled under the Diabetes Care Project, created problems with regard to funding of the patient’s whole care.?

Meanwhile, the report found GPs made 7.6 million more referrals in 2012–13 than they did a decade ago with the increase split almost evenly between referrals to medical specialists and allied health services. A total of 126.7 million GP services were claimed through Medicare in 2012-13.?

The report also stated that despite spending on average three hours less per week providing direct clinical care than a decade ago, GPs were dealing with an increasing number of health problems during each consultation.

entrepreneurship, healthcare

MIT’s Hacking Medicine Program on Health Entrepreneurship

  • MIT’s Hacking Medicine program believes that entrepreneurship is best suited to tackle health’s largest problems
  • he best healthcare solutions alleviate suffering at scale, often via technology to de-skill medicine, increase quality and lower costs, thus broadening access
  • Clinicians often get in habits and practices that are hard to change
  • Be a missionary, not a mercenary. Find a mission and customer with whom you truly empathize. The rest will come if you use that as your compass.
  • Entrepreneurship is not academic, though one should try to be strategic you don’t need an MBA.
  • The most important aspect of entrepreneurship is the entrepreneur’s mindset: to have a mission, clear use case and the persistence to solve it creatively.
  • Broad realization that technology can be used to scale medicine at a broader systems + population health
  • Changing healthcare reforms in the US is aligning incentives for better systemic healthcare
  • Large entrenched healthcare institutions are having a tough time adapting versus more agile startups
  • Start up costs have plummeted, so it’s more capital efficient than ever
  • The ubiquity of mobile computing and low cost diagnostics and sensors make health data liquidity and tracking easier than ever
  • Rising middle classes and health infrastructure in emerging economies are expanding access and demand globally

Source: http://rockhealth.com/2013/11/hackingmedicine-founder-now-best-time-history-world-entrepreneur/

Why it’s the best time to be a healthcare entrepreneur

We caught up with Zen Chu, the founder of HackingMedicine and the current Entrepreneur in Residence at MIT to ask him some burning questions about digital health and entrepreneurship. Hear more from Chu at our sold out Healthcare Bootcamp in Boston tomorrow, along with thought leaders from athenahealth, MC10, IDEO and others.

What was the impetus for starting HackingMedicine?

We started MIT’s HackingMedicine program to push a philosophy that entrepreneurship is best suited to tackle healthcare’s largest problems. Housed within the Trust Center for MIT Entrepreneurship, it serves as a place to welcome non-healthcare engineers and entrepreneurs and connect them to Harvard Medical School and connect them to Harvard Medical School, the Health Sciences & Technology joint graduate program between MIT and Harvard, and Boston’s wonderful teaching hospitals. Our content and most programs are open to everyone and the mission is to infect more entrepreneurs to tackle healthcare problems.

How do we better engage clinicians in technology innovation in healthcare?

The best healthcare solutions alleviate suffering at scale, often via technology to de-skill medicine, increase quality and lower costs, thus broadening access for more people around the world. Clinicians often get in habits and practices that are hard to change. Our Healthcare Hackathons have brought hundreds of clinicians and health professionals together with entrepreneurs, engineers and hackers. We have now moved over 1500 participants through hackathons on 4 continents and we believe the process we have developed and freely teach is one of the best ways to identify unmet healthcare needs and bring diverse perspectives together to create high impact and creative solutions.

What is the number one piece advice you have for entrepreneurs?

Be a missionary, not a mercenary. Find a mission and customer with whom you truly empathize. The rest will come if you use that as your compass.

How do you ‘teach’ entrepreneurship?

Learn through doing. Entrepreneurship is not academic, though one should try to be strategic you don’t need an MBA. Classes and books can only go so far and every startup or technology is it’s own beast depending on the team and challenge. I think the most important aspect of entrepreneurship is the entrepreneur’s mindset: to have a mission, clear use case and the persistence to solve it creatively.

You’ve said it’s the most exciting time to be an entrepreneur? Why now?

This is truly the best time in the history of the world to be a healthcare entrepreneur:

  • Broad realization that technology can be used to scale medicine at a broader systems + population health
  • Changing healthcare reforms in the US is aligning incentives for better systemic healthcare
  • Large entrenched healthcare institutions are having a tough time adapting versus more agile startups
  • Start up costs have plummeted, so it’s more capital efficient than ever
  • The ubiquity of mobile computing and low cost diagnostics and sensors make health data liquidity and tracking easier than ever
  • Rising middle classes and health infrastructure in emerging economies are expanding access and demand globally
healthcare, healthy habits, quantified self, rapid learning health systems, research methodology

mHealth mediated exercise prescriptions work

  • mobile technologies improve outcome measures associated with exercise interventions when compared to those interventions alone
  • not definitive, but certainly encouraging

Source: http://www.fiercemobilehealthcare.com/story/mhealth-improves-risk-profile-cardiovascular-disease-type-2-diabetes-patien/2013-11-08

Abstract: http://www.biomedcentral.com/1471-2458/13/1051/abstract

Provisional paper (PDF): Lifestyle interventions

mHealth improves risk profile in cardiovascular disease, type 2 diabetes patients

November 8, 2013 | By 

A provisional article published in the peer-reviewed journal BMC Public Health suggests that mHealth technology supporting exercise prescription interventions can be effective.

The findings are based on a Canadian study of 149 adults with at least two metabolic syndrome risk factors, one group using the intervention and one control group.

“Mobile health technologies have proved to be a beneficial tool to achieve blood pressure and blood glucose control in patients with diabetes,” argue the authors, who are currently completing their analyses‎ and will be submitting their data for publication in the next few weeks. “These technologies may address the limited access to health interventions in rural and remote regions. However, the potential as a tool to support exercise-based prevention activities is not well understood.”

The study was undertaken to “investigate the effects of a tailored exercise prescription alone or supported by mobile health technologies to improve metabolic syndrome and related cardiometabolic risk factors in rural community-dwelling adults at risk for cardiovascular disease and type 2 diabetes,” states the article. The authors hypothesized that the primary outcome, systolic blood pressure, and secondary outcomes would be improved in both groups, but to a greater extent in the mobile health intervention group at 12 weeks and that these changes would be better maintained at 24 and 52 weeks in the intervention group with mobile health support, compared with the active control group.

The results of the study “will contribute to the current literature by investigating the utility of mobile health technology support for exercise prescription interventions to improve cardiometabolic risk status and maintain improvements over time, particularly in rural communities,” concludes the provisional article, which serves as a protocol paper.

Study participants were recruited from rural communities in Ontario, Canada. Participants were randomized to either: an intervention group receiving an exercise prescription and devices for monitoring of risk factors with a smartphone data portal equipped with a mobile health application; or an active control group receiving only an exercise prescription.

In addition to the exercise prescription, the intervention group received a mobile health technology kit for self-monitoring of biometrics and physical activity. The kit included a smartphone (Blackberry Curve 8300 or 8530) equipped with Healthanywhere health monitoring app (Biosign Technologies), a Bluetooth-enabled blood pressure monitor (A & D Medical), a glucometer (Lifescan One Touch Ultra2) with Bluetooth adapter (Polymap Wireless) and a pedometer (Omron).

Nevertheless, a recent study in the Journal of Medical Internet Research found that although mobile health interventions are effective in promoting physical activity, their degree of validity reported in studies is unclear.

Using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, the review revealed a recent increase in studies conducted to determine the effectiveness of mHealth interventions for the promotion of physical activity. Yet, quantity, not quality, seems to prevail, the authors argued.

To learn more:
– read the article in BMC Public Health