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Health care of the future? March 9, 2010

Posted by Hans in : opinion , add a comment

There was a very interesting series of posts at HBR Insight Center which focused on health care, specifically health care innovations. In the main post titled “Health Care of the Future“, the author presents a list of 10 innovations believed to have big impact.

  1. Checklists
  2. Behavioral Economics
  3. Patient Portals
  4. Payment Innovations
  5. Evidence-Based Decision Making
  6. Accountable Care Organizations
  7. Virtual Visits
  8. Regenerative Medicine
  9. Surgical Robots
  10. Genetic Medicine

I’ve thought about this list and I can’t really argue against any of the items listed here. I would, however, add point-of-care technologies (POCTs) and video games. In terms of video games, I’ve written about the potential to use gaming systems for health promotion (with Nintendo Wii as a great example) and also for other types of activities like teaching, interface development, simulation, and public engagement.

POCTs are poised to change the lab services market using a classic disruptive approach. Specialized knowledge is becoming more accessible as technologies advance. Individuals can now access diagnostic testing services in a matter of seconds at the point of care. I can see that treatments (based on an immediate diagnosis) can be developed to accompany the test. As an example, a blood sugar testing device could measure the sugar levels in your blood and then automatically inject the appropriate sugar/insulin based on pre-determined controls.

Do you see anything that is missed?

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The “y” in GE Healthymagination March 8, 2010

Posted by Hans in : opinion , add a comment

During the 2010 Vancouver Olympics, I noticed a series of advertisements being played repeatedly promoting GE Healthymagination. The ads themselves were fairly well done and seemed to do a good job of conveying the message that GE is serious about health care and about being an innovation leader.

Each time I watched the ad, I kept asking myself – why? Why is GE doing this type of advertisement? All of the products GE was promoting seemed geared toward hospitals or other types of health care organizations – definitely not something that a patient could buy. It’s not like a patient can go into a hospital, doctor’s office, or other health care facility and ask if they are using GE products.

I did, however, manage to check-out the website and was quite surprised by the projects they have listed (descriptions are from the website verbatim – March 2010).

As for the “why”, here’s the description from their website:

Almost everyone wants to make healthier choices, but they don’t always know how. The amount of information available on wellness, nutrition and exercise is overwhelming, to say the least. Even when we do know how to improve our health, we often try to make sweeping changes or set goals that seem too daunting to reach.

Healthymagination is about becoming healthier, through the sharing of imaginative ideas and proven solutions. It goes beyond innovations in the fields of technology and medicine, celebrating the people behind these advancements. Seeking to build stronger relationships between patients and doctors, GE created healthymagination to gather, share and discuss healthy ideas.

Because healthymagination is about becoming healthier together, it takes the form of multiple projects that you can participate in, whether you’re looking to change your lifestyle or fine-tune your approach to health. Making healthy decisions should be easy…and fun.

Guess the advertisement didn’t really match-up to the work that Healthymagination is doing (in my opinion). One project that would be great for GE to pursue is studying how to make health care more accessible (from a service perspective) and more cost-effective.

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Worlds colliding…industry vs. academia May 13, 2008

Posted by Hans in : academics, nature of ehealth, opinion , 1 comment so far

It’s interesting to see how differently ehealth is viewed by academics and industry.  To one, ehealth is the potential of using new mediums to explore ideas and possibilities, while to the other, ehealth is more of a means to an end.

For the past few years, I’ve been in the academic world exploring the limits of our existing evaluation theory as applied to ehealth innovations.  As a researcher (or perhaps more aptly, ‘would be’ researcher), I focused on the concepts of ehealth and how one could evaluate these constructs.  The pursuit was academic and intellectual, even though I tried my best to remain grounded in solving, what I perceived to be, real problems.  Perhaps that’s why much of my writing and thinking on this topic has been focused on the patient and how users of the technology (health care providers included) can be empowered by ehealth.

More recently, I’ve been exposed to the industry perspective of ehealth.  In this world, ehealth is all about programs and projects, about deployment schedules, funding options, and providing the framework to move a health care system along.  Here, there really isn’t any time for or value of the rigorous methodological approaches (and debates) surrounding randomized control trials, systematic reviews, or even articulating an epistemological viewpoint on how knowledge is constructed or derived.  Ehealth, in this context, is a business matter that requires analysis, forecast, and action.

For me, I feel somewhat stuck between two worlds, not having left the academic/research world, and yet being asked to help address some industry problems.  Discussions in the realm of industry hardly mention patients except in strategy/vision documents.  Ehealth is big business, dominated by government bodies and vendors.

I’m not saying that one is better than the other.  I merely point out something that wasn’t *real* to me until recently.  I always knew that industry is different and operated differently than the research world, but perhaps I was a bit naive about how much difference there really is.

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A voice against irrational exuberance in ehealth January 23, 2008

Posted by Hans in : academics, analysis, opinion, research , 1 comment so far

For those interested in a somewhat contrarian viewpoint about ehealth, I suggest you check out Scot Silverstein.  I just recently came across his site documenting some "common examples of health care IT difficulties".  You can also listen to his interview available via the Government Health IT site – an excellent site.

In his interview, Dr. Silverstein raises some very important points:

My interest in Dr. Silverstein’s work is in our common view on technology:  that there’s great potential to make positive changes, but that success isn’t a certainty – what is commonly referred to as "technological determinism".  I’ve written as far back as 2004 about technological determinism and ehealth, namely to be skeptical about the absolute certainty that the IT professionals have about ehealth (e.g., my post about IBM building computer models to solve health care’s woes).  I think it’s important to have a balanced view on being hopeful of the possibilities, but also being realistic about the challenges (some final thoughts from a 2005 ehealth conference).

I hope to do some more reading on his website to see what other nuggets I can glean from his work.

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What can ehealth learn from Steve Jobs, Apple Inc., and Macworld? January 18, 2008

Posted by Hans in : analysis, conferences & conventions, news, opinion , 2comments

As in the past, I watched the 2008 Macworld keynote address by Steve Jobs.  This time, I was a bit surprised by some of the responses of the media and crowd.  Apple’s stock getting hammered didn’t help.  In any case, I think there are some good lessons for ehealth, and health care in general, that can be learned from Steve Jobs, Apple Inc., and Macworld.  Here are five lessons that we can learn:

1.  Focus on the user experience
This one should be a "no-brainer", as Steve Jobs always emphasizes building products that provide an excellent user experience.  You can see this in the design of Apple products.  For whatever reason, health care, and by extension ehealth, hasn’t really focused on the patient experience.  It is, however, getting better.  But, we’re still far away from anything remotely resembling a "patient-centered" system.  The system needs to change its orientation from being health care practitioner centered (i.e., physician) to putting patients first – and I don’t just mean lip-service, but real change.

An analogy of this would be the largely stereotyped caricatures of Microsoft and Apple.  Microsoft is seen as catering to the needs of business, whereas Apple promotes itself as a "consumer" oriented company.  This would translate into ehealth catering either to the existing institutional and professional powers versus patients and consumers.  FOCUS ON THE PATIENT EXPERIENCE!

2.  Demand excellence
Steve Jobs is portrayed as some tyrannical CEO who can be difficult.  However, he is known as a person who does not compromise and demands excellence from all staff and employees.  We can all learn to not compromise and give-in, but push for something better by demanding excellence.  Patients probably know this intuitively, but haven’t really had an organized voice to channel their expectations.  I know that individuals in the health care system all push to be the best they can be, but sometimes the rules, the bureaucracy, and the system just grind people down.  All of us need to demand ehealth to be excellent and not just convenient.

3.  "Think different"
This was a campaign slogan for Apple a few years ago.  I think it’s apt for ehealth of today.  Instead of succumbing to the often cited difficulties and generally accepted ways of doing things, we in the ehealth field have an amazing opportunity to push the boundaries and imagine all of the possibilities of what can be done to make things better.  Normally I hate the phrase of "thinking outside the box", but I think it fits here.  Apple Inc. is known to do things differently.  With so much more at stake, shouldn’t we also "think different"?

4.  Celebrate achievements & build excitement
I think Macworld is a great example of an event that gathers people together to celebrate the past achievements of the past year and also build excitement for the upcoming year.  eHealth needs to do more of this.  I know that there are annual conferences in the US, in Canada, and in other parts of the world, but they sure don’t get much press coverage.  If the Canadian conferences are any example, these are generally attended by industry folks with very little publicity.  A while back, I pondered the idea of having an ehealth or a health Olympics.  Maybe it’s time that we band together to create something bigger that can garner more attention and more excitement.  I don’t know about you, but whenever I talk about ehealth and the possibilities, I get excited.  We have a good chance to be important contributors in helping to make health care better for everyone.  We need to capture this excitement and inspire others.  Macworld does a great job of this for the "Apple faithful", but also generates quite a bit of buzz from non-Apple customers.

5.  Build partnerships
Apple is starting to learn how to build partnerships that are meaningful (e.g., Intel and Google).  Sure, they’re not great at it, but they’re trying.  The ehealth field can learn from this.  Instead of trying to do things on their own, we need to get together and build partnerships.  The problems and challenges are far too big for any one company or group to do it alone.  Governments and private sector groups working together is a good start.  Instead of competing with one another, we should encourage co-opetition so that more can be achieved.  But, don’t forget the patient!  The patient needs to be included in this partnership too.

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Peering into the (ehealth) fog of war … January 16, 2008

Posted by Hans in : analysis, opinion , add a comment

At one point in time, a long time ago (around 2000), I wondered if centralized, government maintained electronic health records was the way to go.  In defense of this position, my arguments revolved around the notions of efficiency and control, in that it was easier for systems to be monitored, maintained, and updated if they were all in one place.  But, as anyone with a technical background could point out, there are significant technical issues behind such a strategy.  It would seem that some people agree: "German doctors say no to centrally stored patient records".

What I find interesting is the proposed "counter" solution:

As an alternative, the German private doctors’ body is suggesting the use of encrypted USB-sticks. These could be handed over to patients and would carry all relevant patient data, including digital images such as radiographs or CT-scans

Wow.  I haven’t heard a call for the use of physical based media in quite some time.  Personally, I thought that this line of thinking was disappearing as the feasibility of cloud computing increases and slowly becomes a realistic option.  In all fairness, there are a few other very interesting points raised by the group representing the German physicians.

After reading this article, I get the distinct feeling that as of 2008, we’re staring into the "fog of war" as no-one is certain as to what strategies or solutions will ultimately prove successful.  Might be interesting to start documenting what ideas people think will work or not work.

From my involvement in this industry in North America, I got the distinct impression that a strategy that mixes personal and public records was emerging.  Basically, health care organizations and governments (depending on their level of involvement in the delivery of care) would maintain an electronic record that is stored and available to authorized parties of the "system" (be it regional or otherwise).  Patients would then maintain some sort of "personal health record" that they can control.  The organizational records are often deemed to be the "electronic health record".  Maybe it’s me, but the title, "electronic health record" seems to have a more legitimate or official connotation than "personal health record".

It will be interesting to see what strategy(s) emerges.

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ehealth election madness September 26, 2007

Posted by Hans in : analysis, news, opinion , add a comment

Here in Ontario, we’re in the midst of a provincial election. Voting day is October 10, 2007 and I suspect that the level of attacks will increase as voting day approaches.

I’m not writing about political parties, but I am somewhat surprised with some of the debate regarding ehealth. The former government (Ontario Liberal Party led by Dalton McGuinty) has an election promise regarding the development of electronic health records and other health care related issues in their platform piece titled “Power to Patients”.

Create an electronic health record by 2015 and give Ontarians control over the information contained in it

What was interesting, however, was the response by one of the parties titled “Dalton McGuinty’s three ‘e’ approach to e-health”. They criticize McGuinty’s e-health strategy for being evasive, expensive, and election oriented for promising an electronic health record by 2015.

In all honesty, I’m not sure that I can disagree with any of the statements made in the press piece. On the other hand, having been on the “inside” during my brief stint on the Ontario Hospital eHealth Council, I know that things aren’t as easy as they appear. 2015 is far enough away that achieving a working electronic health record should be achievable. People compare Ontario’s progress with Alberta’s, but we have to understand that Alberta is unique (I briefly explained some of that in a previous post).

In any case, what was interesting is that when I searched the other major political parties’ websites, I couldn’t find any mention of a strategy or promise regarding e-health or electronic health records. Yup, the incumbent government hasn’t been perfect, but it would seem that they at least have a plan for e-health in Ontario, which seems more than what the other candidates seem to have. But then again, this could all be hype because of the election.

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Podcasting in healthcare – 2007 update August 30, 2007

Posted by Hans in : analysis, opinion, podcasting , 1 comment so far

As some of my readers might remember, I ran a series of posts on examining the potential role of podcasting in healthcare. At the time, I wasn’t too keen on podcasting in healthcare:

Recently, I came across a post titled “Will Podcasting Survive?” on a blog that I follow (Read/WriteWeb). In this article, the author, Alex Iskold, examines podcasting as the evolution of radio. Even though the technologies available to create and distribute podcasts are more widely available than ever, this medium of podcasts seems to have stagnated. He presents some data/graphs to highlight and support the idea that podcasting is stagnating. He gives four main reasons for this trend:

  1. Competition with video and blogs
  2. Limited applicability
  3. Monetization is a challenge
  4. Competition from big media

He concludes with:

It appears that podcasts are not picking up steam, and rather, podcasting is actually slowing down. There is not enough incentive for people to jump exclusively into podcasting because of tight competition from video, blogs, big media and a lack of clear monetization methods. However, it does not mean that podcasts are not here to stay.

Iskold’s conclusions seem to support my thoughts about podcasting in health care, albeit his conclusions are a bit more general in nature. Specifically, podcasts are “something you need to specifically listen to. They typically consist of a discussion you need to be able to focus on to follow”, making podcasts much like listening to a lecture. For some, it will be great, but for others (the vast majority, in my opinion), podcasts will not have much value, other than to be another resource that can be accessed.

Well, a year has passed, and I ran an update using Apple’s iTunes media software (v7.3.2.6) and was surprised at some of the results.

Table 1: Podcasts by topic using Apple’s iTunes on Aug. 30, 2007 (1200 EST) from Canada

Topic/ Keyword 2006 2007 Notes
health 105 150 Mostly health and fitness offerings and a few educational offerings. E-health Insider has a podcast.
medicine 105 150 Seems like a hodge-podge of podcasts focusing on specific conditions. From the descriptions, I get a sense that these are styled like “talk-shows” or something like the CNN offering “Your Health with Dr. Sanjay Gupta” (he has a podcast available from the CNN’s health page)
healthcare 84 141 A wide variety of topics covering improvement, education, self-help, and business. An interesting podcast by CDW talks about technology/IT management issues in healthcare.
doctor 105 150 Not really health focused, as the search returns anything using “doctor” in its name.
e-health/ehealth 1 6 Some very focused and interesting offerings including conference proceedings, e-health insider podcasts, an Australian industry publication podcast, and an individual podcast focusing on issues for Latin Americans.
telemedicine 1 3 Recordings from symposia.
telehealth 0 1 Weekly podcast from Canadian Society of Telehealth
informatics 5 139 Wow – what a surprise! I haven’t had a chance to go through everything, but there seems to be quite a range of podcasts here ranging from comedy, education, careers, and topical listings
cancer 105 147 A good variety of podcasts, mostly related to education and self-help with a few personal accounts of living with cancer. I was a bit surprised by the small increase in numbers, as I expected this section to grow much more than the other topics.
patient 105 150 Again, a wide variety of topics focusing on self-help, education, and general health.
cardiovascular 20 39 Some very focused topics.

I was very much surprised by the significant jump in informatics and the few new ehealth podcasts. I didn’t expect those numbers at all. My expectation was to see more health topics (i.e., health, ancer or cardiovascular), when in fact there wasn’t quite as many – granted 40–50% increases are significant.

Given Iskold’s comments about the slowing trend of podcasting and increasing video content, I wonder if video will supplant podcasting in healthcare. Granted, there may be considerably more podcast offerings on the Internet that are not hooked-up with Apple’s iTunes software.

In my own personal experience, I stopped listening to podcasts on a regular basis. I can’t say exactly why I stopped. All I know is that I didn’t find listening to podcasts to neither particularly enjoyable (even for purely entertainment podcasts) nor efficient. I was always irritated at the slow pace of the discussion, or irritated at the difficulty in jumping to the topic of interest. In the end, I decided to stop altogether.

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Now coming to a theatre near you: Capital Health is recruiting… August 26, 2007

Posted by Hans in : opinion , 1 comment so far

I don’t know about you, but I generally don’t like to watch advertisements, especially the 10–20 minutes of paid advertisements just before the start of show at the movie theatre. Normally I pay little attention to the ads, but I almost fell out of my seat when I saw a recruiting ad for Capital Health, “one of the largest integrated health regions in Canada” (it’s located in Edmonton, Alberta). I don’t know about you, but I don’t expect to see recruiting ads for “health care careers” when watching the late showing of actions movies like “The Bourne Ultimatum”.

I was curious about the ad, and so I did a quick check of the Careers & Training section of the Capital Health site. For those interested, there are some interesting postings ranging from clinical, corporate, and even academic/research.

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A prescription for Google Health? August 21, 2007

Posted by Hans in : analysis, opinion , 11comments

About a year ago, Google indicated that “health care information matters”, with little to report since then. Google seemed to have formed a health board comprised of physicians and some patients to guide its efforts. Recently, I’ve read a few pieces speculating about Google’s efforts toward building a health care product/service (here and here).

In 2005, I had an idea for how Google could potentially disrupt health care. I even shared it with my supervisor, who thought it was an interesting idea and mentioned he would mention it during a meeting he had set-up with some senior execs at Google. Unfortunately, the meeting never took place, and I sort of forgot about it because of my studies.

My idea was that Google develop a personal health record using basic Web2.0 technologies already in its portfolio. Google has several services that could potentially be re-organized into a functional health information product:

This idea of Google developing a consumer oriented electronic health record was based on the theory of disruptive innovations described by Clayton Christensen.

Currently, efforts are underway to develop electronic health records (EHRs) by governments, regional authorities, hospitals, health information companies, and pretty much everyone else in health care. EHRs have been somewhat of a “holy grail” in the health informatics community since the 1970s, promising an assortment of benefits. Currently, there is no standard EHR product available, and so vendors have been pitching integrated solutions for the last little while. In recent years, hospitals (at least in Canada) have been examining the possibility of assembling EHRs based on “best of breed” technologies – basically taking one component from company A and another component from company B etc. With more governments getting involved in setting an agenda for ehealth/eletronic health records, the vendors seem to be more open towards adopting standards for sharing information between systems and with other organizations (a push for a more regionalized model). Needless to say, these efforts are quite costly in terms of purchasing hardware, building-up an infrastructure, training, and licensing costs. Physicians and other smaller medical groups have been largely left alone to purchase products from vendors – which isn’t necessarily a bad thing.

So where does Google fit in? Well, Google could release a “free to use” personal electronic health record – here are some reported “screen shots” of the would-be Google product (looks like my suggestion might be pretty close). How would it work?

For patients
This product would be a central place that a patient could record and store health information. Information could be found on the web and then recorded for future reference (search). Patients could record some thoughts and questions about the information they found (blog or docs). Alternatively, patients could keep a “health diary” recording responses to medications, daily activities, food eaten, difficulties with activities, etc (blog). Some specialists have mentioned that patients don’t remember enough detail about past events to be helpful when first noticing symptoms, leading to delays in diagnosis/treatment and additional tests. Basically, all of the functions of a personal health record freely available to patients. The “home page” (or “about page”) could list pertinant information (age, existing conditions, allergies, etc). Basically, the patient version is an easy way for patients to view their own information, add additional information, and link to family members (social networking), and share with health professionals.

For providers
While patients can create large quantities of data (usually in text format), this isn’t so great for busy health professionals. Health professionals could be provided a “dashboard” that summarizes the information contained in electronic health record – things like charting medications taken with responses. Obviously some development of appropriate applications would need to take place. Ideally, lab data could be either imported or linked to provide a full picture of the patient. The best thing would be for Google to pitch this type of service to small physician offices who don’t have the expertise to set-up and maintain their own systems. All a physician would need is an internet connection and a few computer terminals. Scheduling could be handled either by the patient using the calendar service and monitored by some administrative staff. No more lost charts!

But wait…
Some will mention that this Google health product will not be “good enough” to meet everyone’s needs. You’re right. But it doesn’t need to be. Google can simply release this product and develop it by adding new features and functions along the way and go “up-market” (following the classic disruptive innovation curve). Of course, Google would need to insure security and privacy and be cognizant of any reglations and laws.

Others might point out that the existing vendors will not sit still. True, but most vendors are interested in making money, and thus they focus on selling to hospitals, HMOs, or other health care groups. Patients aren’t a lucrative market (yet). Vendors might release a product aimed at patients, but that’s more to ensure that hospitals will keep buying their products. Google has an inherent cost advantage here because its services are free to the users because it’s paid for (presumably) by advertisements. Google stays happy because it maintains its user base, and thus increasing its potential ad revenue. At first, the product might not have all the features, but new ones can be added quickly by opening up APIs so that developers can add new features, putting pressure on existing vendors to provide services at Google’s price points and pace (yikes – how do you compete against free?).

Another potential snag is that hospitals and lab companies will not want to share their data with Google. Yeah, that’s true. But, as more standards emerge and governments push for sharing of information, getting other players involved (like Google, Microsoft, or another firm) should be easier. It’s not a question of whether existing players want to, but more a question of when will they be forced to start sharing information.

As Christensen predicts, we’ll soon enter a stage of “commoditization and modularization” where standards allow for components to be swapped interchangeably (we may be closer than we think). If that’s the case, then vendors will need to switch their efforts at providing integrated products to focusing on specialized components like decision support modules, data visualization, or other applications that can “plug” into a larger framework.

I’m interested to see just what Google has up it’s sleeves. The idea that I’ve just described would also follow in Google’s current practice of releasing “beta” products, getting feedback and gaining market share, and then monetizing the product with new releases (see their history with their office products). In one scenario, Google could provide a suite of EHR products for physician offices for free, or with some basic support for an annual cost, slowly moving up the value chain. It’s unlikely that large hospital corporations will ditch the investments they’ve made in the near future. Besides, large corporations have much more demanding needs that Google probably can’t match initially. But, things may change. If enough patients start using Google’s services for Health, maybe there could be a radical shift in power from the health professionals to patients.

I don’t know about you, but I’m very curious to see what Google releases.

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