Sorry to all those that think I’m beating a dead horse with this topic, but I think a lot has gone unwritten. Thanks to Trey Lauderdale of Voalte for his guest post last week on the subject. I also want to extend the invite to anybody else that has an opinion on the topic. Please e-mail me with you post (or thoughts for a post) on pagers and smart phone communications for healthcare.
Let’s start with a poll. I found this nifty company called Quipol that creates embeddable surveys. It’s free, easy, and allows for social connections to Facebook and Twitter. It only allows for "Yes"/"No" surveys so it’s slightly limited in robustness as a polling tool, but the simplicity makes it great. Give it a try. I’m curious how the results turn out.
I wanted to follow-up on Trey’s post and take a more holistic — as well as enterprise and administrative — view of smart phone apps meant to replace pagers. Trey is clearly of the opinion that healthcare communications, whether pager or smart phone, need to be driven by workflows and not technologies. That’s a good point.
Trey also hit on the fact that my question, pagers vs. smart phone apps, is really too broad. He broke pagers down into four categories: 1) in-house, 2) wide-area, 3) shared, and 4) personal.
I’m slightly confused about the categories. I imagine a shared or personal pager can be wide area or in-house, right? I guess these are really characteristics of pagers, or functions of pagers. In-house and wide-area are mutually exclusive. Shared and personal are mutually exclusive.
With that in mind, I’m going to flip it around and categorize pagers — and more generally, healthcare communications — into critical vs. non-critical. To me, this is the dividing line between whether a phone using Wi-Fi and a carrier network can be a pager. Sending a thank you for a referral or asking a quick question (curb-siding) about a patient who has already left an office is not critical. Sending a code/cor page is critical. Everybody gets this.
For each category above — and somebody please tell me if these categories / characteristics aren’t exhaustive — both critical and non-critical functions exist. If that’s the case, and assuming smart phones can’t be the only form of communication for critical messages, can we really replace any of these pager categories? Or can we just limit the usage to certain types of messages, remaining weighed down with an overcrowded waistline?
I’ve found data on my own, and seen data sent to me from others, that show results of trials or studies of smart phones in place of pagers. The results generally find users prefer smart phones, but not that smart phones were found to provide 100% of critical communications. Are there any hospitals that have 100% replaced pagers?
The power of phones over pagers is the ability to provide a richer communication experience. Phones and apps allow you to move a high percentage of communications off pagers. That’s good.
Are there solutions that determine if communications are critical or not, routing them accordingly? I think this is what Trey was touching on when he addressed clinical workflows. I think this is what PerfectServe does, though pagers are a node or preference and not replaced. PerfectServe is not replacing pagers, just trying to limit the use of them to when they are preferred by clinicians.
One other issue I wanted to bring up is the issue of administrative or enterprise tools for clinician communications. I realize that SMS and in-person communications aren’t really auditable, but don’t hospitals want secure clinical message access for audit purposes? If a physician downloads an app and gets the rest of the medical team to use it for team communication, what happens if an order discussed using the app doesn’t get entered and an adverse event results? I assume at that point the legal teams have an expensive fight over user agreements and terms.
I also wanted to follow-up on this series of posts with something on proper smart phone etiquette. One of the points raised in the comments — one I hadn’t thought of — is that a smart phone is more interrupting to a clinician than a pager. This is really an interesting paradigm. As we do more on our personal smart phones, both personally and professionally, we’re more distracted, less engaged, and seemingly less interested. I’ll post more about this growing problem next time.
Two players pushing hard for a major role in shifting the way healthcare is delivered, Verizon and NantWorks (Patrick Soon-Shiong’s technology and health company), announced a partnership at the World Health Care Congress earlier this week. The first initiative is an "integrated information infrastructure" targeting cancer treatment called the Cancer Knowledge Action Network (CKAN). My interpretation is that the CKAN will combine, analyze, and make actionable scientific data on cancer treatment so that clinicians at the point of care can deliver the most up to date, tailored treatment possible. Speeding the process from bench-to-bedside would be fantastic and I don’t doubt that NantWorks and Verizon have the technology and resources to do it. The question is how does it happen practically in our health system. Maybe some hand-picked pilots will show what’s possible.
Sotera Wireless receives FDA clearance for its mobile, wireless patient vital signs monitor. The device is meant to provide real-time, constant monitoring of patients outside the ICU. It monitors heart rate, 3 or 5 lead EKG, O2 saturation, BP, respiratory rate, and temp. This definitely extends the reach of hospital monitors to other settings, I’m thinking homes in particular. Seeing as both Sotera and AirStrip are funded partially by Qualcomm, it would be interesting to see Sotera as another data partner for AirStrip.
A new study of in-home telemonitoring of 205 elderly patients (average age 80.3) with multiple health issues finds no difference in ED visits and hospitalizations between the telemonitoring group and control group. An unexplained finding was that mortality was higher in the telemonitoring group. The results are certainly interesting and don’t paint a picture of home monitoring as a means to decrease expensive healthcare utilization.
Payer Highmark announces a pilot with 10,000 members to provide them virtual visits using Teladoc. The cost for a virtual consultation is $38. I’m assuming this is a discounted rate for Highmark members, right?
Allscripts CEO Glen Tullman recently wrote an articleForbes about the changes coming to healthcare and the power of devices we already have (iPhone, Wii, Fitbit, XBox, Skype, etc) to transform the delivery of care. The two things that stick with me from the article are: 1) Glenn Tullman and Steve Ballmer have good relationships with their doctors, and 2) who was the first to find the quote by William Gibson: "The future is here, it’s just not evenly distributed" (I heard Todd Park use it at the Healthbox demo day a couple weeks ago and liked it).
More good news for health IT entrepreneurs looking for funding. A new report finds that VC funding in health IT was the highest ever recorded in Q1 2012. The total invested was $187 million across 27 deals. I hadn’t heard of the two biggest deals(Kinnser Software and Healthx) but I’m fairly familiar with the next three (Sharecare, DocuTAP, and PerfectServe).
A new report by PwC finds that consumers increasingly turn to social network to find and share health-related information. This is more evidence why I think providers need to at least have a presence on social networks. Some of the highlights:
A third of those surveyed use social media to find and share medical information
90% of those in the 18-24 age bracket trust health information found on social networks
72% said they would use social networks for scheduling appointments (how about a ZocDoc Facebook app?)
34% said social media would affect whether they take a particular med (no reminder apps to fix that problem)
82% of health organizations have their marketing departments manage their social media efforts
Mobile app startup Alt12 Apps announces the release of a new app and associated social network Kidfolio. The company also raised $1.26 million in seed funding. Alt12, which is creating apps and communities targeting women, had two previous apps with good uptake – one a lifestyle app for women and the other for pregnancy. The theme (which I think is a good one) is to target women with apps and give them access to small, meaningful communities. The apps are a bit like a targeted, themed version of Path. Starting with menstrual period tracking and ovulation, then on to pregnancy, and now Kidfolio, which is a like a mobile, interactive, collaborative scrapbook for moms, Alt12 is positioning itself well with an engaged group – expectant, new, or young moms. Alt12 charges for membership to its networks. Who knows, up next maybe we’ll see Alt12 apps for wives to track marital issues or for adult daughters to track the health of elderly parents. It fits the company focus.
Humana is piloting Stanford Chronic Disease Self-Management workshops for 100 members. How many members does Humana have, anyway? Either way, the lucky 100 members participate in six-week workshops, conducted online, to help them better self-manage chronic diseases.
The White House announces the winners of the Apps Against Abuse Challenge. Both apps enable users to press a button to connect to family and friends, send location information, and get access to abuse hotlines and services. I’ve heard the statistics before, but I’m always astounded that one in five women in college will be a victim of sexual assault.
In what sounds exactly like text4baby but for developing countries, the Mobile Alliance for Maternal Action is using SMS — as well as short audio messages over mobile devices — to deliver tailored education and instruction to pregnant women. Just like text4baby, Johnson & Johnson is a partner. Does anybody know what company is providing the technology? I didn’t see Voxiva (the text4baby tech partner) listed anywhere.
Why is the concept of pager replacement such a hot topic?
It’s really quite simple. The expectations of our users have changed significantly over the past five years. Physicians, nurses, and other caregivers have access to various means of personal communication and the expectation is to AT LEAST have similar functionality in their day-to-day jobs.
The good news? This problem will be fixed. The bad news? No pager replacement vendor seems to really understand the concept of how consumer communication needs to be tied into clinical workflow to improve communication.
“Pager replacement,” as it’s currently described, makes me sick to my stomach. It is the result of unimaginative vendors forcing a “Band-Aid” approach to a problem they understand at a superficial level.
Removing a physical pager and replacing it with a virtual pager on a smart phone simply removes a device. It does not actually improve workflow. It just removes a slight cost. Or, more likely, transfers a cost to another vendor … because we all know that software isn’t free.
Asking a pager company to fix a communication problem is like asking a typewriter company to develop the first personal computer. What was true then, is still true today. Technology should enable entirely new workflows that benefit the end user — in the case of clinical communication — the care provider. Taking an obsolete workflow centered on paging and replicating it on smart phones misses the point entirely.
When looking at a pager replacement strategy, the first thing a hospital must do is understand that not all pages are created equal. It is important to begin segmenting pagers into different categories of use. For example:
Once the segmentation of pagers is completed, a holistic strategy of pager replacement can begin. A hospital must look beyond the physical pager and dive into the workflow associated with a pager.
Pager replacement is not a big bang approach. With thousands of devices and dozens of workflow scenarios, it is important to look for low-hanging fruit and early wins that require small amounts of work, yet can have a significant impact on communication and patient care.
In some scenarios, a simple pager replacement application might make sense for a short-term approach. However, such “pager replacement app” solutions should be treated just as that — a short-term solution to bridge over to the desired end state.
Trey Lauderdale is chief innovation officer of Voalté of Sarasota, FL.
Thanks for the comments on my last post about pagers vs. smart phone apps for clinical communications. I’m working on a follow-up on the subject.
Allscripts formally announces the release of Wand, its native iPad app for Allscripts professional and Enterprise. The idea is to offer easy access to the tasks clinicians do most in EMRs. Also part of the value Allscripts is touting is data displays that can help clinicians have discussions with patients. I haven’t tested it yet, so I’d be curious to hear feedback from clinician users not included in the press release.
In May, the VA is very likely to eliminate one of the barriers to veterans receiving telecare at home – co-payments for the virtual service. This hopefully will spur increased usage of home-based telecare by veterans and save the VA some money.
I’ve grown to be a fan of GreatCall, the mobile company focused on solutions for the elderly. I’m not really sure why, especially as I still describe it as mobile phones with big buttons. Maybe simple phones with big buttons — and some other specialty connected devices — have grown on me. GreatCall just announced LiveNurse for iPhone. The app and service ($3.99/month) enables users to access nurses 24 hours a day. It also includes the A.D.A.M medical education content. The $3.99 has to just be the subscription with additional cost for usage, right? I can’t see that anywhere on the website.
I’ve written before about mobile device management and bring-your-own-device (BYOD) policies for health systems. This article, while not specific to healthcare, is a much more informed opinion about the “unstoppable momentum” of BYOD that will cause mobile to be the transformative force in enterprise IT over the next decade.
US physicians lag behind physicians in other parts of the world in terms of using social media to engage colleagues and patients. On the surface, I imagine payment models and medical-legal reasons hold the US back.
The New York Times has a story outlining five companies “pushing” transformation in healthcare in the US. Each company is broken down by idea, how it works, and business model. AirStrip and ZocDoc are the most obvious choices, but Telcare, Avado, and ClickCare are also included.
The Microsoft HealthBlog has a story about a sponsored pilot using Kinect games and HealthVault to improve the health of seniors. It’s an interesting concept and I’m excited to see more programs like this. Who doesn’t love the idea of bowling on Kinect or Wii to improve health?
More games for health news, which I love. This article has a lot of good examples of how payers are using games to engage members and improve health. Some, like Cigna’s deal with DailyFeats, I hadn’t heard about.
I admit I haven’t always been the biggest fan of Fooducate (or apps like it) for nutrition tracking. I personally would never use them but thankfully for Fooducate, I’m the not the target audience –75% of users are female. Fooducate scans barcodes, grades the scanned foods, and offers alternatives, all based on the nutritional content and ingredients. Basically it makes ingredient lists meaningful. Fooducate has over a million downloads of its mobile app and 500,000 people use its mobile or web apps every week. It’s not Instagram growth, but very impressive for a health app. I’m curious how Fooducate does monetizing this with mobile ads.
Surgeons at Henry Ford Hospital (MI) are using iPads and FaceTime for “telerounding.” That’s a new term for me and I sort of like it. Patients are given iPads and, with the assistance of a medical team member at the bedside, can do live video chat with surgeons using FaceTime. I assume surgeons could use an iPhone, iPad, or Mac computer, but the story says iPad. I think this would make docs happy, especially those that have traditionally had to round at different places and also see patients at an outpatient clinic.
The California Telehealth Network (CTN) gets a donation of $700,000 from UnitedHealthcare. United previously donated $600,000 to CTN. The grant is meant to improve CTN’s technical and programmatic support. Interestingly, and maybe not surprisingly, only 20% of CTN locations have on-site IT.
With the Instagram purchase this week, I felt compelled to include one of the many articles about the new power and value of mobile. This is one of the better ones that I read and it outlines business models built solely on mobile.
I read this article a few weeks ago about Apple clawing back market share lost to Android over the last year. The reasons: 1) iPhones for Sprint and Verizon; 2) low-priced iPhones (old models); 3) broadened distribution for Apple (Walmart, Amazon, Best Buy); and 4) Apple’s costs are now the same as alternatives.
In related good news for Apple, a survey of over 5,000 high school students finds that 34% of them now own an iPhone, up from 17% last year. I haven’t been in high school for a while, but this seems incredibly high to me based on the cost of data plans for iPhones. The same survey found that 34% of high school students own a tablet and 70% of those tablets are iPads
I got some very good responses to my post earlier this week about free apps and services in healthcare. Several of the points in the comments were spot on, articulated better than my post, and required me to write this follow-up to better explain my thoughts on free services and revenue models.
I also looked at user agreements and privacy statements for several of the companies I listed. The wording seemed vague enough to not really be restrictive in terms of use of data, though almost all restricted the sale of data to third parties. I’m not an attorney, but I imagine almost all of these agreements are written to assure flexibility for the companies. Why not, right? Just out of curiosity, do any readers actually go through these agreements when they register for services?
After going back and re-reading my post, I realized the main message that I wanted to come across was that there needs to be transparency in how companies are going to use personal health data. Both for the user and, in certain instances, for the people they invite to the service or app (doctors inviting patients, patients inviting doctors, doctors inviting doctors, patients inviting patients.) Several of the comments touched on transparency as the key factor in personal data usage.
I agree with reader Margalit Gur-Arie, who wrote, "My current assumption is that wherever you enter any data in an Internet application, sooner or later, it will find its way out of the company servers, with very few exceptions." That mapped well to this post by Fred Wilson about online privacy and current attempts by legislation to address online privacy. Fred makes some very good points about profiling and tracking, including that it can provide real value to users. I personally love Amazon recommendations, but I’m getting annoyed with Amazon’s listing of links to relevant external sites. Fred, being a VC with a much better understanding of the issues in my post about startup investors and returns, also writes about online profiling and tracking as "the economic underpinning of the Internet." He warns about privacy regulations undercutting this significant Internet driver.
That leads to part of reader HIT Project Mgr‘s well-stated comment. "Unlike Travis, I’m not ready to throw out a promising start-up company who has a business model of creating a user base before figuring out how to make money with it, because innovation is often done at the initial investors (Venture Capitalists, Angel Investors, etc.) expense and thus their risk financially not mine. My only investment is my time to upload, learn and use the app. If the start-up never makes it, the investor who knew the risk loses out for the most part. Those who got the product for “free” only have the trouble of finding a new ‘free’ app to use." I definitely understand developing something is never free and companies operate to at least cover their costs. I also understand that investors take on risk when they invest in new companies in order to hopefully get a good return. This risk is higher with earlier-stage companies, especially those that are building networks or acquiring users with a less well-defined strategy to monetize that network or those users.
The second part of the above comment, about the risk and investment on the the part of a user, is something that I think is dependent on the app or service itself. While I agree there is no real risk to users of free services for something like logging blood pressure or linking patients with similar health conditions, these were not the services I had in mind. I probably should have been more clear about this as I was writing. The services I was thinking about as I was writing involved providers inviting patients, and to a lesser extent other providers, to join or connect to them.
In the instance of providers inviting patients, providers are implicitly vouching for the startup service by inviting patients to it. If that service shuts down, well that’s one thing and likely not a major loss to the provider or patient. But, if the startup survives, it now sits between provider and patient. In this place, it can offer things (goods, services, etc.) directly (or indirectly through partners and affiliates), to patients based on interactions with providers. These targeted offerings might be accurate and they might not be accurate. This represents a risk to providers. I realize this is a very specific example, but it’s the one that really motivated my last post. Am I over-thinking this scenario?
I also realized as I was thinking about personal health privacy, especially as it relates to tracking and profiling, that most people already have data about their personal health floating around today, even if they haven’t used any free startup health services that I mentioned. Most consumers search and browse the Web for health information. If people have searched for erectile dysfunction, depression care, fertility treatment, diabetes products, cosmetic procedures, or any number of other health-related topics or products, those are likely linked to that user in some way. This tracking might not be truly personal identification, but it goes a long way to painting a profile of health and tailoring content to a user. As an extreme example, I can’t imagine what online profiles look like for clinicians that search the web for health-related information for patients.
One other point that I wanted to clarify is about intent and motives. It’s not that I don’t trust free services because I think they are malicious in intent (was that a double negative?) It’s more that I realize they will do everything possible, within the confines of the law and user agreements, to increase revenue and value for the company. This makes sense for the company and its investors.
That goal to maximize share value has to be ideally balanced with doing things that don’t harm the company in the long run. I don’t think this is always the case, as different stakeholders can have different short- and long-term motivations. I suppose the counter argument to the above example, since I’m debating myself, would be that a service using its position between provider and patient could harm the company by upsetting providers and having them stop using it. This might be true of providers knew what was happening, though I don’t think this is usually the case with online profiling.
I’m not sure if this post clarified anything. If anybody out there wants to write a guest post about online privacy and free services in healthcare, please let me know. With my last post, I did not intend to play the role of Luddite to the digital destruction of medicine. My point was to bring up potential issues with free services, especially those that target specific interactions, ideally generating a dialogue in the process. Thanks again for the thoughtful responses.
