Thanks for the clarifications and comments on my last post about telemedicine and evidence. As I said in the post, the more data we collect, the more we’re learning what questions we really need to ask and answer. Hopefully we’ll see more good data being published to address these new questions.
One issue that was highlighted by reader C. Gresham Bayne in his comment pertains to house call patients, an area that fascinates me. I need to write a post about physicians delivering care in the home and the associated technology that enables it. This comment motivated me to do the research and get it done. It’s not for today, but it’s coming.
For today I was motivated by the picture above. I had the unfortunate experience of being in the hospital last week with one of my kids. It was only day surgery and all went well, thankfully. The experience wasn’t unfortunate because of the treatment we received but, let’s be honest, being in a hospital as a patient or family member is not pleasant. The center was an academic center, if that matters to anybody.
In the recovery room, I glanced next to the bed and found the tape deck in the picture above chained to the wall. I can’t really imagine what it is used for today, but maybe there are still tapes on the recovery floor that patients can rent out, sort of like borrowing a DVD to play in your room. I love that it was chained to the wall, either to prevent it from being stolen or from being thrown across the room out of anger, frustration, or maybe psychosis.
[As a side note related to physical media, doesn't it make sense to eliminate all of it – including DVDs -- from hospitals ASAP? Bringing them from room to room probably brings unneeded contamination. I know they are cleaned with wipes, but still. The technology to replace the media certainly exists today, although I realize it is not at the top of the priority list or fires-to-be-put-out list for hospitals.]
Back to the original reason for the post. My initial thought in seeing the radio was that a lot of the stuff I write about and read about in health IT is not standard operating procedure. We have an extremely long way to go. All the companies with cool ideas and services that people like me report on have a lot of executing to do to become a part of our health system. It was a good reminder to me how far certain aspects of medicine — on both the patient and doctor side — are from today’s technology. It’s also good news for investors and innovators, because opportunities abound.
My next thought was how poorly we engage patient when we actually have them sitting in front of us or lying in beds in our facilities. iPads and smart phones are a long way from tape decks, but as we push to give people ownership over their own health and wellness, doesn’t it make sense to start that ownership in the hospital or office?
What would giving somebody ownership and engaging them at the point of care really look like? I think it can take many forms and I think we’re starting to see people trying it.
From a totally low-tech point of view and in the inpatient setting, why don’t we give patients printed daily information about what the medical team is doing for them and how there care is progressing? The information could be high level and not specific, and it could also include targeted educational material.
The paper forms could also include daily medication lists, with nurses helping patients check off each med as they are given or taken. This gets them used to monitoring adherence and practicing what they should be doing at home. Also, include a way for patient to document questions they have, and even encourage it. I’m sure you could gamify this if you wanted to encourage the behavior.
Smart TVs or tablet devices could make that paper process high tech. I’m not sure if GetWellNetwork or LodgeNet are doing this, but it certainly makes sense. GetWellNetwork is extending services to post-acute care and that is a step in the right direction.
In the case of the VA pilot, in which iPads are issued to family caregivers, why not build apps and tools to make appointments and hospital stays more meaningful and care seemingly continuous, not episodic? Or why not start patients using the mCare platform for health communications when they are still at the VA?
You could do the same thing with office appointments. Require patients to document — along with MAs and nurses — their weight, blood pressure, and any other biometric data. Obviously both paper and apps could do this. The idea is to get patients used to having some responsibilities and ownership of their own health and health data.
I’m interested to learn who is doing these things. Maybe this is something that has been tried and doesn’t work, or something that is working swimmingly.
In my next post, I’ll discuss similar concepts that are more socially enabled.
Travis Good is an MD/MBA involved with health IT startups. More about me.
I read and referenced a very good article recently that stated there’s no such thing as a healthcare consumer. The article used this as the basis for a pretty convincing argument about the failure of Google Health.
While I agree with most of the article, the definition of “consumer” is too narrow: "someone who uses personal dollars to buy goods and services for his or her own use." I agree that individuals in the healthcare system are insulated from most of the spending, but, with high-deductible rate plans and increasing premiums, individuals are getting closer to the transaction itself.
This is why we are seeing the launch of services like 2nd.md and CarePilot. Their success remains to be seen, but they are targeting the consumer in the definition above.
I have taken to using the term healthcare consumer. Within the US healthcare system, there are massive differences in the amounts of services (dollars) consumed by different individuals and groups. The challenge is targeting solutions at the big — or potentially big — consumers of healthcare, those with chronic diseases and those at the end of life.
End-of-life care is a policy/legal battle without an app, device, or service, other than those that already exist, such as hospice. That leaves chronic disease as the biggest potential bang for the buck.
How do you target chronic disease? Recent information shows that people with chronic disease (and their caregivers) are motivated and even willing to pay for connected health devices and services. But it’s not easy, or else we would be seeing more success in this arena.
IBM did a good job in its recent report on connected health devices by breaking the population into:
- Chronically Monitored – chronic disease patients with ongoing (and typically covered) needs,
- Motivated Health – younger and proactive people who are interested in ways and tools to help them stay healthy.
- Information Seeker – people with chronic needs that are not yet life threatening.
Segmenting the market this way makes a lot of sense. The needs and the associated functionality, partners, and payers are very different across the three segments.
The report then went on to outline strategies to target Information Seekers, who it describes as "underserved" by device makers. I see Information Seekers much like the examples given in the report. I’d describe them as your typical middle-aged American — gaining a few pounds every year, maybe with high blood pressure or cholesterol, pre-diabetic or non-insulin dependent diabetic, basically somebody with metabolic syndrome.
This population will very likely develop diabetes, heart disease, and/or have a stroke at some point. Any of these would acutely worsen quality of life — both for them and those around them — and significantly increase their consumption and cost of care. It would also likely move them from Information Seeker to Chronically Monitored and make any interventions more difficult.
This segment of the population is massive. Thirty-four percent of all adults over age 20 meet the criteria for metabolic syndrome. About 210 million people in the US are between 15 and 64, so using some approximation, that’s about 80 million people with metabolic syndrome that desperately need some effective intervention before it is too late. Blacks and Hispanics are more likely than non-white Hispanics to meet the criteria for metabolic syndrome.
How do you target this large and growing group? The good news, compared to over 65 and Chronically Monitored, this group is more likely to own and be able to use a mobile device, more likely to use Facebook, and more likely to be paying for at least some part of their healthcare.
The bad news (or good news, depending on your perspective) is that members of this group have not yet experienced a catastrophic health event. Talking to them about losing weight, eating less salt, or taking their meds as prescribed can be exceptionally frustrating. They nod in agreement and then come back the following year eight pounds heavier.
I’m not quite sure if it is a matter of motivation, lack of insight, or both. Either way, they are hard to target because they don’t necessarily HAVE to think about their poor health every day. They don’t (yet) carry a glucometer, walk with a cane, or experience chest pain or shortness of breath walking to the mailbox.
I’ve hopefully set up a case for why healthcare consumers do exist and matter, especially those sliding down the slippery slope of metabolic syndrome. I want to write a series of posts examining efforts to target consumers with health tools. I want to discover who has been successful in offering consumer-facing health products, demonstrating adoption and impact on chronic disease.
I’ll keep the list of companies and offerings as broad as possible for now. From there, I’d like to explore the impact of mobile on these offerings and link it to the success of mobile in other industries.
The success stories in the consumer health market that come to my mind are below. Leave a comment or shoot me an e-mail with any suggestions.
- WebMD
- Walgreens Mobile
- MyHumana
- Epic MyChart
- RunKeeper
- Zeo
- iTriage
- text4baby
- ZocDoc
- WellDoc
Stay tuned for more analysis and again, please drop me a line if you’ve got any suggestions on companies or products to profile.
Travis Good is an MD/MBA and is involved with health IT startups.
