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March-3-2015

9:22

candice-apple-watch.0

The Apple Watch is on the cover of the March issue of women’s health and fitness magazine, Self, worn by Victoria’s Secret model Candice Swanepoel. There is also a 12-page marketing spread for Apple Watch in Vogue.

While Apple Watch hopes to be the “it” fashion accessory of 2015, many are anticipating its release as a hub for health. News is coming March 9, as Apple schedules a “special event” in San Francisco.

Health Monitoring Features You Won’t Find on Apple Watch

The WSJ says Apple will not include some health monitoring features originally explored for the first Apple Watch. Many of the sensors failed to function according to expectations.  (UPDATE: MobiHealth says Apple never announced those monitoring features in September anyway.)

While you won’t be able to measure blood pressure or stress levels, the NYT says Apple Watch will include a heart rate sensor and a tracker for movement.

Interpreting patient-generated health data for users was also a regulatory concern. But new FDA guidance allows devices that display, but not interpret data, to bypass regulatory approval, according to Politico. It also reports Apple, Intel and others were part of a sustained lobbying effort for more relaxed FDA regulations.

Would Steve Jobs have waited on Apple Watch?

Should Apple Watch have been unveiled last September, before it was ready? In the past, new Apple product launches were a surprise. Steve Jobs only revealed the form factor for an Apple product after he considered it a winner for both form and function. And Apple didn’t need to be first, just better. For example, Apple was not the first to come up with an MP3 player, but when it launched the iPod, it was unquestionably – cool.

Cool can’t be measured like the wealth of Apple shareholders, but you know it when you see it. While I have been an Apple fan girl for … a long time, I can’t say that I am taken by the Watch’s boxy design. It is unfortunate that we don’t see more of Marc Newson‘s signature curves in the Apple Watch.

Five million Watch devices were ordered for the launch. And while Apple Watch will probably set smartwatch sales records, will it deliver form and function? Time will tell.

One functional flaw affecting smartwatches is battery life. With a projected one-day battery life, some predict the timing is not right, and  Apple Watch will flop. Pebble Time recently set funding records on Kickstarter and boasts a ten-day battery life.

With the rise in wearables, health is cooler than ever

Apple wants to bridge consumer wellness and healthcare, and empower individuals to manage their own health. Salesforce reports millennials want to do just that. In fact, 63 percent say they would be interested in proactively providing their health data from wearable devices to their physician. But physicians are concerned about managing patient-generated health data, according to hospital pilots for Apple’s HealthKit.

Companies that make watch apps will probably play an important role in defining the purpose of the Apple Watch, similar to the app developers for the iPhone and the iPad. – NYT

Apple Health most popular self-tracking iPhone app

Apple Watch will need to coordinate with Apple iPhone. BetaWorks recently conducted a study of over 40,000 iPhone users to see which apps people kept on their homescreens. These are the apps people supposedly use the most.

In the self-tracking category, Apple Health app topped the list by far at 23.45 percent, according to Ernesto Ramirez of QuantifiedSelf.com.

 

homescreenfreq_WHealth

If you take out Apple Health and outliers, Ramirez shows these fourteen apps appeared most often: Coach.me, Day One, Fitbit, Health Mate (Withings), Moves, MyFitnessPal, Nike+, Pedometer++, Runkeeper, Runtastic Pro, Sleep Better, Sleep Cycle, Strava, and UP (Jawbone).  Read more on wearables and apps.

News for developers

More smartwatch news comes from the Mobile World Congress, running through March 5 in Barcelona. The Huawei, running Android Wear, is attracting a lot of attention, and the LG Watch Urbane LTE version is experimenting with bringing back a WebOS to a mobile device.

A future where a mobile device is not tied to one or another behemoth OS would be welcome, and this is where true innovation lies.

Also in March:

  • Philips is hosting a Healthsuite Hackathon on March 6, where developers will work on pulling data from trackers, remote monitoring devices for the home, and hospitals.
  • Developers will convene at  Wearable TechCon in Santa Clara, March 9-11, to talk about Apple WatchKit, and fitness apps for the Apple Store and Google Play.

The rise in wearables is also improving the design of functional devices for chronic disease. Below is the Embrace epilepsy tracker.

Embrace epilepsy tracker

 

 

 

 

 

 

 

 

An attractive twist to an analog design is the minimal Minuteman One-Hand

Minuteman One-Hand

Minuteman One-Hand

 

 

February-26-2015

11:50

Can 10 successful entrepreneurs come up with solutions to 10 of healthcare’s most “wicked” problems in 10 days?

That’s the question Denver’s Tom Higley started asking himself three years ago. Tom, a successful entrepreneur himself and tireless Colorado startup advocate, is the brainchild and chief organizer of an event, dubbed 10.10.10, happening right now in Denver that aims to learn what’s possible.

In a first of it’s kind event, 10 entrepreneurs have been brought together to create products and companies to solve 10 of health care’s wicked problems. Day 10 is today Thursday, Feb. 26th, where we’ll find out what things the CEOs will be working on in the months to come.

Think of it as an executive-level healthcare startup hackathon that lasts 10 days. If it works, it’s going to be taken on the road and into other industries such as food, water, energy and education. With 80% of outcomes linked to things such as nutrition and education, I suspect some of these future events may have an impact on health care as well!

To be sure, coming up with solutions to such problems on short order, in an area where even Apple is apparently struggling to innovate, may seem like a tall order to many on the front lines of digital health, but the expectations are appropriately muted. Higley will measure success by having at least a few solid, fundable companies in the next nine to 18 months.

Perhaps an even bigger story is the dedicated community of people are working to make Colorado a major player in digital health, with 10.10.10 as a showcase. The event and the entrepreneurs are supported by over 100 volunteers and as well as the Colorado Health Foundation, Kaiser, and many others. Bryan Sivak, the U.S. Department of Health and Human Services’ chief technology officer and entrepreneur-in-residence, sent a video in support of the event that was played at the kickoff last week.

There’s also a distrinctly consumer-centric perspective on solutions here as well. Esther Dyson, VC Brad Feld and SomaLogic CEO Larry Gold discussed as much yesterday on a panel, challenging the CEOs to come up with products and business models related to health, not health care, and providing access to data for consumer. If someone’s a patient, it’s often too late for intervention, according to Dyson.

You might want to keep Colorado on your map if you are thinking of starting a digital health company. A new state-of-the-art digital health campus called Stride, set to open in the coming year, will focus on creating a hub of digital health companies. Several major players in health care are rumored to be setting up a presence (more on this in the months to come). Places like Stride, events like 10.10.10, and the dedicated community that supports them, along with success stories like iTriage, are starting to put Colorado on the digital health map.

A cornerstone to the environment I see growing is the willingness of pitch in and help. Local VC Brad Feld talks about that helpful ethos of the Boulder startup community in his book “Startup Communities,” and it seems to have caught on among the digital health people throughout the front range.

Each element of the 10.10.10 event has a “coopetition” aspect to it, even the problems. Individuals and organizations pitched in and submitted problems and the final list was selected based value, difficulty and market opportunity.

The event so far

The first public-facing event was the kickoff where the problems and entrepreneurs were announced. The wicked 10 problems will be familiar to many in involved in digital health and certainly reflect the new realities of non-Fee-for Service (nFFS), quality-based care, public health and a few oldies but goodies:

The 10 Wicked Health Problems are:

  • Alzheimer’s
  • Childhood Obesity
  • Patient Engagement
  • Antibiotic Resistance
  • End of Life Care
  • Pandemic Weapons and Bioterrorism
  • Patient and Data Matching
  • Health Guide Maps
  • Health Data
  • Patient Mobility and Independence

Depending on how you categorize, the wicked problems are pretty evenly divided between public health, patient-empowerment, health IT, and science-focused. Now matter how you organize them, they are big, wicked and broad. It will be interesting to see how the entrepreneurs hone them down to problems to areas that are manageable.

At the midway point event, February 20, the entrepreneurs seemed to be leaning toward some solutions, but no decisions had been made. We’ll have to find out on Thursday where things are headed, I’ll tweet-report back this Thursday, so follow #101010health to find out more.

I hope the midway panel offered some insight to where things are headed. There was an excellent panel with Kaiser’s Dr. Jandel Allen-Davis, SomaLogic (Proteomics company) CEO Larry Gold and Peter Sheahan of ChangeLabs. The dynamic was great, had some great one-liners and made a few things pretty clear. I hope the 10 entrepreneurs, who were sitting in the front row during the session, use some of these takeaways as a guide:

  1. New payment models are happening, we need to reallocate that money to behavior change.
  2. People will be in charge of their health more and more, people need the power to make better decisions.
  3. Longitudinal tracking of everything will happen, but how?
  4. We need to balance security and access of all this info.
  5. There’s still too much harm that can come from the lack of security on health data.
  6. We understand what drives sickness, but not what drives health. How do we move upstream in predicting (beyond stepping on a scale?).
  7. It’s the interaction, not the visit.
  8. Make the healthy choice the easy choice.
  9. Bricks and mortar care will change, but coexist in new ways with the digital.
  10. Many of the changes needed in our health care system are social, not rational.

Peter Sheahan related the story of a meeting where a fresh-faced twenty-something told the Joint Chiefs of the U.S. military that social media would help foment geopolitical unrest. Of course, they snickered and dismissed him out of hand. This was six months before the Arab Spring.

That story makes me hope that we have some of those kinds of thinkers at 10.10.10. I wonder who will be laughed at, but keeps on building, and is eventually proven right in health care? Will it be one of these?

Craig Misrach

Founder and CEO of medical device company Freedom Meditech.

Cheryl Kellond

Co-founder and CEO of Bia Sport, a sports watch company.

Joy Randels

Seasoned executive with a long string of successful companies and an IPO.

Monique Giggy

Monique has started and grown several companies, including Swing by Swing Golf.

Lizelle van Vuuren, Denver, Colorado

Founder and CEO of marketing company Effectively.

Kelly O’Neill Dwight, Denver, Colorado

Principal consultant of KMD Consulting Services.

Zackary Lewis

Founder of Liquid Compass, a radio streaming company.

Lincoln Powers, Billings, Montana

CEO and chief data architect of Rocky Mountain Technology Group.

Best wishes to all to fix some of these wicked problems! It won’t be easy, but we’re rooting for you! Looking forward to tonight to see where things are headed!

February-24-2015

9:47

On January 21, the Office of the National Coordinator for Health IT announced that Michael James McCoy, MD, would be the department’s Chief Health Information Officer, a newly created position. According to the announcement, Dr. McCoy will serve as the lead clinical subject matter expert on interoperability, and he has a background perfectly tailored to the task with experience both as a practicing physician and as a leader at the IHE for more than a decade.

Thanks to Dr. McCoy for answering the following questions about the new position and his vision for a learning health system.

Q. First, congratulations on the new appointment with the ONC. You previously practiced medicine and held various leadership positions in the private sector, what attracted you to working with the ONC and what vision do you hope to bring to the department as the industry moves into stage 3 of Meaningful Use?

Dr. Michael James McCoy

Dr. Michael James McCoy

ONC is at a crossroads, coming through a period where significant funding was applied to incentivize the adoption and use of basic electronic health information technology to one where the information can flow to help achieve better care, smarter spending of health care dollars, and healthier people. Now we need to make sure that the infrastructure we have established through the supports created in the HITECH Act can provide returns, with data and analytics capabilities that progress us, as a nation, toward a Learning Health System.

I had the good fortune to be in the right place at the right time to be able to join ONC and the great team of people here to further the goals of improving health, health care, and reducing costs of health care delivery with a person-centric view. Dr. Karen DeSalvo, the National Coordinator for Health IT – my boss – continues to be supportive about the importance of health information technology as the tool to support achieving better health (not as an end unto itself).

I hope that my experience as a practicing clinician with early EMR use in the office, as someone with vendor and implementation experiences, and with system-level knowledge of the challenges for adoption and utilization of the data available, can provide a balanced perspective across ONC.  There are many offices within ONC that have huge impacts on policies, procedures, rules, and regulations – way more than I realized before joining the team here!  There is significant coordination required between the various teams, and Dr. DeSalvo has been working to ensure the views are balanced with senior clinical and legal/legislative perspectives applied.

My vision is that I may be impactful in advancing the notion of person-centric health, and in some small way, help influence the direction that our advancement to a Learning Health System takes. I fully embrace a person-centric concept, and think announced initiatives, including Precision Medicine, will continue taking our nation’s health system down that path.

Q. Karen DeSalvo was quoted as saying you would serve as the ‘lead clinical subject matter expert on interoperability.’ This brings to mind the inclusion of patient-generated health data into the medical record. How do you think the big questions about responsibility for the PGHD (e.g., Is the physician legally responsible to monitor the data? Are patients responsible for accuracy of reported data? etc.) will be resolved? 

The subject of patient-generated health data (PGHD) has many complexities, but in reality, some of the biggest questions relate to similar concerns expressed by clinicians in reviewing “data dumps” from Transitions of Care (TOC) documents, or receiving old records from other physicians. Those concerns relate to the (receiving) physician missing some critical data element in the old record (whether paper or electronic) and their liability as a result of missing that information. There have been lawsuits on this with paper records, and now with electronic records, there is even more data (potentially) for a clinician (or attorney) to review. Whether the data comes from another EHR or from PGHD, there is some obligation for the clinician to review the information received. To what extent and how much data validation must occur (the trust or provenance of the data source) are not yet defined clearly. The legal requirements, the ethical requirements, and the practical requirements for that “minimum level of review” have not been fully established, nor has a consensus view been achieved on what is “right.” ONC is certainly not, in my view, the arbiter of such, though it could, through outreach and coordination and/or through its advisory committees, convene such discussions.

To me, the concerns, about PGHD misses the bigger picture: individuals are now beginning to drive their own health care decisions in a big, and growing exponentially bigger, way. If physicians do not choose to engage with the increased consumer demands, they may find themselves increasingly marginalized in the care delivery system.

This presents opportunities for developers and other technically savvy entrepreneurs to look at the challenge of filtering signals from the noise.  Everyone is busy these days; finding the important e-mail amongst all the other e-mails and spam received is a great thing. Physicians want the same thing from the PGHD received, and from all of the other interactions with their health information technology (rules and alerts that make sense).  Usability, and good (actionable) information, not just data or noise.

Q. A person-centered health system seems to make perfect sense when it’s talked about at the water cooler, yet I sense there is a large chasm that exists between the goings ons in the health care system and the majority of patients in the U.S. How can we be sure that patients really want to be engaged with the health care system?

Not every “patient” wants to be engaged. That is the reality. Sometimes it is exactly those patients, though, that need to be engaged.

However, looking at the opportunity from a different perspective, the way to a better, healthier country is to engage people before they become patients. Witness the growth of wearable devices, connected to the Internet of Things. The FTC report forecasts 25 billion devices communicating over the network this year and 50 billion by 2020.

Further, assuming it is just a patient that wants to engage is another fallacy. Many of us have roles as caregivers, whether for spouses, children, or parents.  Many of us live remotely from the person receiving care. Having access to be able to assist in understanding the care received, ensuring good communications with care providers, and being actively and proactively engaged is possible only through application of health information technology.

There are so many opportunities to improve the relationships between people (whether a patient, caregiver, or healthy individual) and clinicians (in hospital settings, offices, long-term care settings), and technology can help. Many physicians still seem to view patients coming in with externally garnered information (“Dr. Google”) as problematic, instead of as interested and engaged in their health.

The whole care delivery system is in the midst of transformation (even disruption), and embracing and adopting the change is a better approach than becoming obsolete.

Q. As a former board member, you obviously have a lot of interest in IHE’s activities. Where you surprised there was no mention or talk about IHE in the most recent JASON report? What role do you think IHE will play as HL7 FHIR progresses?

The November 2014 JASON report did not reference IHE, but I don’t find that too surprising given the constituency of the advising body. As in many other circumstances, one approach may be favored by those in office at one time and less so by subsequent office holders. IHE references and use was quite prominent in the HITSP days, less so until recently. One may note that in the 2015 Interoperability Standards Advisory draft, IHE is mentioned multiple times, with XDR, XDS, PIX/PDQ, XCA, XCPD, CSD, and HPD all called out.

There are many technically savvy people (aka “geeks”) that work in and with both HL7 and IHE, and harmonization and collaboration between the two groups can only help the overall advancement of health information technology. Perhaps in my simplistic (? naive ?) way, I view the constructs as HL7 and others (SNOMED, LOINC, RXNORM) providing the “ingredients” to IHE’s recipe (e.g., IHE PCC’s APS, LDS for obstetrics) on utilizing in a meaningful way the constituent parts. Much as a cake recipe calls for sugar, eggs, and flour as ingredients, the “how much sugar,” “how to mix,” “how long to bake and at what temperature,” etc. define the end product (the cake). Many different cake recipes exist, just as many different use cases for health data exists….

Q. What do you hope the health care system will look like in 5 years? 

In 5 years, I hope we are well on our way to the Learning Health System, with little or no thought required to get my health data into or out of any part of the care delivery system I am interacting with. I want to be able to take my personally derived data (from exercise on my bicycle or from monitoring my weight with my WiFi-connected scale) and have it available for those with whom I wish to share. I want to be in a health care system that is focused on wellness and general health as much as it has been focused on episodic care and illness.

The draft Interoperability Roadmap (open to public comment until April 3rd) provides the proper vision towards a Learning Health System that will achieve those goals. It may be an aggressive timeline to some. It certainly is reflective that ONC cannot carry the burden alone. Public, private, state, and federal cooperation and collaboration is essential to achieving success. Our nation’s health depends on it. I think it is the most worthy goal one could have as a health care professional. I certainly am proud to be associated with the dedicated and brilliant team here at ONC working to achieve the goal!

Special thanks to Peter Ashkenaz and Brett Coughlin from the ONC for their help facilitating this post.  

February-17-2015

11:44

oliver“Please, sir, I want some more.” – Oliver Twist

In this super-sized world, we tend to believe that “more” is better than “less.” I personally believe more trumps less in many areas:

  • All things being equal, I’d rather have more money than less. Most providers seem to agree, which is likely one reason for today’s hot market for applications and services that maximize reimbursements and help providers qualify for more financial incentives.
  • I am always wishing for more time. Providers, vendors, and payors are seemingly obsessed with wanting more time. Why else would we see so much lobbying for extending Meaningful Use deadlines or the transition to ICD-10?
  • The world would be a better place with more dark chocolate.

Of course more isn’t always better. Quite often – especially in the health IT world – less is actually “more.” Consider the following:

  • MGMA recently asked CMS to consolidate its reporting programs and eliminate its use of multiple Web portals for Medicare Part B reporting. Fewer portals means fewer registrations, user names, passwords, and the like, as well as less confusion as to which portal to access for what task. Fewer portals equates to increased efficiencies and fewer administrative hassles.
  • As EMR adoption has grown, so too has the length of a typical chart note. Clinical documentation is no longer just a means for tracking a patient’s condition. Instead the chart note has become the primary tool for meeting billing requirements and justifying reimbursement. The chart note has fallen victim to “note bloat;” that is, with EMRs it’s too easy for users to paste in non-essential data, making it difficult to narrow in on the most critical elements. The American College of Physicians and other professional organizations are now calling for the redesign of EMR-generated documentation to make it is more concise and reflective of the information gather to develop an impression, diagnostic and/or treatment plan, and recommended follow-up.
  • Healthcare generates a wealth of patient data that can be analyzed during the care process, or on a larger scale to measure everything from internal quality metrics to population health trends for predictive analytics. Some may argue that more data is better, but a case can also be made that all data is not equally good/relevant/of value. When it comes to big data, perhaps more data is okay as long as we have plenty of “spam” filters to eliminate the irrelevant.
  • In terms of hardware technology, what’s not to love about less? We embrace devices that are increasingly smaller; we seek components with produce less noise and use less energy; and we’re spending less capital as more applications migrate to the cloud.
  • And of course in the general healthcare world, stakeholders often criticize the over-use of healthcare services in U.S., which not only wastes dollars and resources, but may harm the health of patients, according to a Health Affairs report. Ten to 30 percent of total healthcare spending is considered unnecessary and the waste includes everything from overprescribed antibiotics, excess testing, and unnecessary surgeries.

Oliver Twist and chocoholics may disagree, but sometimes less can be the best way to go.

February-11-2015

10:29

At this week’s HIMSS Patient Engagement Summit, getting patients actively involved in their care will be explored as “the blockbuster drug of the 21st Century.”

Healthcare, once defined mainly by technology and quality of care, is suddenly being redefined by this patient-first approach.

To put it simply, patient engagement is the new hard currency in healthcare. And the effect it will have on our industry will be vast.

heart of patient engagement

This means measurable patient-first approaches that are value-based, reliable and sustainable.

Including new business models that rely upon delivering better service and a better patient experience.

To make it happen, providers must focus on the patient, namely, what they think and how they feel.

Changing mindsets. Focusing on communication and collaboration.

The result? Happier patients. Compliant patients. Engaged and productive healthcare teams. Dramatically improved outcomes all around.

cycle of patient engagement

Patient engagement delivers better health and healthcare.

I invite readers of this blog to explore this topic with me at this week’s #HITsm TweetChat. I hope to bring the unique perspective of an artist who is dedicated to culture change. What changes need to occur in healthcare to effect needed culture changes that will foster an environment where patients want to be engaged in their care?

I look forward to your views on Friday’s chat.

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