CMS Administrator Marilyn Tavenner addressing Care Innovations Summit attendees. Image courtesy of Kaiser Health News.

“I think we would all agree that these are not ordinary times, that this is not an ordinary conference, nor is it an ordinary time in health care,” commented Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner, in her address at the first ever Care Innovations Summit Thursday. In saying so, Tavenner captured not only the essence of the problems facing our nation’s health care system and the reason that over a thousand national thought leaders, senior government officials and industry experts had gathered, but also inspiring attendees with the idea that, by being there, they had the opportunity to be a part of the solution.

Driving the day at the Care Innovations Summit, which was hosted by the Center for Medicare and Medicaid Innovation (CMMI), Health Affairs and the West Wireless Health Institute, was the notion that American innovation could solve any problem, and the thousand-plus attendees were the innovators to solve this one. Emphasizing CMMI’s founding mission of better health, better care and lower costs, speakers across sectors, industries and areas of expertise continued to echo each other’s cries that it was all possible, if people began collaborating and innovating across fields.

Even before HHS Chief Technology Officer Todd Park compared data to rocket fuel, the Summit was beginning to sound like President Kennedy’s speech to Congress announcing the Space Race. In fact, the addresses and panels were broken up by “Ignite Talks” — wherein private-sector stakeholders presented problems and issued challenges to attendees and to entrepreneurs across the country, offering not only prizes, but implementation funding for the best solutions (you can see a list with links to descriptions of the various challenges issued here).

Park best captured the sentiment of the Summit, saying, “There is no problem that Americans can’t invent themselves out of…Transformation driven by a tide of grassroots innovation mojo has already begun.”

While this sentiment and attitude towards repairing and revitalizing our nation’s health care system certainly drove the day, it is not new, nor is it exclusive to CMMI. In fact, it echoes many of the themes that motivated us to launch the Health in Place™ (HIP) initiative last month. The concept of HIP is built around the idea that, thanks to wireless communications and emerging technologies, our homes are more than ju

st houses, our offices are more than just workplaces, our schools are more than just places of learning and our cars are more than just modes of transportation — and that, for this facet of 21st century health care to achieve its full potential, a number of public policy issues are involved, cutting across multiple disciplines from health care regulations and benefit structures to tax policy and technology incentives. HIP aims to connect the dots between industries, inspire innovation and drive policy changes that accomplish CMMI’s goals of better health, better care and lower costs while simplifying things in the process.

With all of this collaboration and innovative thinking, there is no doubt that this is an exciting time in health care, but as Don Casey expressed in his closing remarks at the Summit, there are some significant obstacles to overcome to get the rockets to the moon. “I think a lot of people are skeptical about two things,” Casey said, “the American economy and do we have the ingenuity to get this stuff done, and can we actually engineer a jailbreak for health care.”

Are you planning to take part in any of the innovation challenges issued? Do you think cross-industry collaboration is really possible? And, what do you think we need to do in order to break down the barriers Casey and others at the Summit alluded to?

Millions of Americans disapprove of the Affordable Care Act without understanding what the act aims to accomplish or how it works.  Dr. Jonathan Gruber’s book “Health Care Reform:  What It Is, Why It’s Necessary, How It Works” breaks down the individual components of the act in order to give Americans a greater understanding of what all it includes and how its provisions will affect their daily lives.  Gruber discussed the book, ACA and the future of health care reform in the United States with an audience at Disruptive Women in Washington, DC last night.

Continue reading here…

By Jessie Gruman. “Buck up. You are going to feel bad for a year.”

This was my chemotherapy nurse a year ago, returning a call I made to my oncologist. I had left a message asking whether there was something he could do to help me. Should I feel this horrible following three action-packed months that included stomach cancer surgery and aggressive chemotherapy? 

The answer, at least as far as my nurse was concerned, was “Yes.” 

And she was right. It did take a year to regain my energy and feel well again.

The new year set me reflecting about what I’ve learned about being sick over the past 12 months that only the experience itself could teach me:

You know that old Supremes song, “You Can’t Hurry Love”? I learned that you can’t necessarily hurry healing either, even if you work hard at it. A week after that call to my oncologist – still feeling rocky – I joined a local gym’s “$30 for 30 days” New Year’s special to try to revive my cardiovascular fitness. For each of the next 30 days, I trudged down there, got on that Nordic Track machine and forced myself to flail about for 40 laborious minutes. On most days last year, I made myself walk at least a mile and practice yoga. I did my level best to choke down a tiny healthy snack almost every waking hour. Often, doing these simple tasks took all the energy and will I possessed. But I was committed, convinced that if I did them, I would get better faster.

And it still took a year before I felt normal again. How frustrating was that?

I have absorbed the very American notion that success results from hard work. By extension, health should be achievable if we comply with the admonitions of our employers, the media and health promotion advocates to exercise and eat right. I knew that my behavior didn’t cause my cancer and wasn’t going to cure it. But surely, I thought, I can speed up my recovery from the assault of chemotherapy and surgery if I really try. I had great expectations. So did those around me: “Why is she still so frail?” “Why isn’t she better yet?”

I might still be feeling pokey if I hadn’t worked so hard at recovering. But this experience slammed me up against the reality of physical illness and the limits of behavior in changing its course. It reminded me how a deep belief in our own efficacy makes it easy to slip into blaming ourselves (or the sick person) for not getting better. And it reminded me of how unruly, unpredictable and often uncontrollable the effects of disease and its treatment are on our bodies.

Another lesson: I expected that Health Information Technology (HIT) advances and opportunities to connect with other patients using social media would dramatically change my experience of treatment in contrast to my previous three experiences with cancer.

I was dazzled by the ease with which I was able to collect the information and evidence I needed to make good decisions about my treatment plan. And I am grateful for online access to friends and colleagues all over the world that allowed me to feel less isolated over this past year than I have during previous illnesses.

But once I started treatment, feeling ill extinguished my curiosity about my disease. It dampened all interest in second-guessing treatment decisions or seeking innovative approaches or learning about new technologies to aid my recovery. And only occasionally could I summon the energy to reach out even to close friends and family, much less to seek out people like me online for advice and support.

I see embedded in the enthusiasm about patient portals, decision aids and smart phones an attitude that being actively engaged with new technologies can somehow provide happy relief from the pain and discomfort of illness. Bright health information Websites, fun games designed to inspire adherence and smart medication reminder apps are presented as having the potential to turn the experience of illness into a series of problems that are easily solved through the acquisition of the technologies.

It’s true that HIT can help with scheduling appointments, refilling prescriptions and coordinating the disposition of test results to different clinicians, for example. (My clinicians mostly don’t use electronic health records with patient portals, so I had no respite from those tasks). And remote patient monitoring and assistive devices already make some caregiving chores easier. These are welcome contributions, especially as more responsibilities for care are shifted to patients and their families. But I return to the world of the healthy with the impression that the value of HIT is tactical, not transformative, at least for the sick person: the suffering remains.

My third insight from the past year is that most of the time I believed I was thinking clearly but in hindsight, I see that my judgment and thought processes were often clouded. Through my experience with serious illnesses, I’ve developed strategies for getting through the days. For example, regardless of how I feel, I always bathe, dress, eat breakfast and put my shoes on. The shoes were important: they serve as an optimistic signal to myself that I’m well enough to get up and go outside just like anyone else. Between the shoes and my exercise/diet routine, I could sometimes convince myself that I had returned to my former healthy state (conveniently forgetting my need to lie on the couch for hours).

But I had not recovered, and the clarity of my thinking was often – although not consistently – compromised. I scheduled events and travel that were unrealistic, given my stamina, and when I couldn’t be dissuaded from following through, I’d spend days recuperating. Again and again I disappointed myself (and others) by setting ambitious goals for commitments I couldn’t meet.

I know I am not unique in this. I watch friends and colleagues whose judgment is impaired by illness make similar, often higher-stakes errors. They make weird self-care choices, abruptly change treatment decisions, fire their physicians and refuse to seek advice about clearly serious conditions. We all believe that we are making rational choices when we do these things. But we aren’t, and the impact on our health and recovery can be serious.

I wanted to write about these three insights while they are still vivid for me. Standing for the past couple months on the shifting border between illness and health, I’ve experienced how (fortunately) easy it is to forget how illness eats away at the balance of one’s mind, body and spirit. As a mostly ill person glancing into the world of the healthy over the past year, I’ve marveled at the insensitivity and indifference to this imbalance by even those with the greatest love, or best intentions, training and experience.

The tools, technologies and services that constitute health care will never completely eliminate the suffering caused by illness, even if they are perfectly delivered. But that suffering might take a more modest toll if all of us – patients, professionals, caregivers, family, friends and colleagues – have clearer expectations about the arc of illness and how it affects and can be affected by each of us.

In the end, that curt directive by my chemotherapy nurse to “Buck up. You are going to feel bad for a year,” was the most helpful advice I received.

However, except for the issue of health IT’s potential to improve cross-organizational working processes, American doctors have lower expectations about these benefits than their peers who work in the 7 other nations polled in a global study from Accenture‘s Eight-Country Survey of Doctors Shows Agreement on Top Healthcare Information Technology Benefits, But a Generational Divide Exists. Accenture polled over 3,700 doctors working in Australia, Canada, England, France, Germany, Singapore, Spain and the US.

As the subtitle of the report recognizes, there is an age chasm at the age of 50: physicians under 50 years of age more likely believe in the benefits of health IT; fewer older doctors do, on a global basis. Accenture points out that younger doctors are comfortable using computers during patient interactions in the exam room, compared with older physicians who prefer face-to-face conversations without what they may perceive as a disruptive interruption of looking at a keyboard or computer screen.

Physicians that more frequently use health IT are also more likely to believe in the benefits of health IT: Accenture measured 12 functions of EMRs and HIEs and found that those who more fully interact with these features perceive the fruits of the systems. 87% of doctors who use at least 9 of the 12 applications see positive impacts in using health IT; only 64% of doctors who use 4 or fewer functions believe in the positive benefits of health IT.

Health Populi’s Hot Points: American doctors are more skeptical about the use of health information technology than their colleagues in Asia, Europe and North America. US doctors are also live subjects in the experiment that is the adoption of health care information technology as part of the HITECH Act, working hard to demonstrate meaningful use to earn financial incentives in Stage 1 this year.

Meaningful use, in fact, deals with those kinds of functions that Accenture measured, finding that the more functions a doctor uses, the more likely he/she will appreciate the fruits of health IT in terms of patient outcomes, productive workflows, reducing medical errors, and reducing the risk of litigation.

US doctors are playing catch-up with their global colleagues. This is yet another benefit of the HITECH Act that doesn’t get enough attention.

Originally posted on Health Populi on January 10th.

By Olaoluwatomi Lamikanra. Since the introduction of mobile phones in Nigeria, the number of users has increased exponentially and usage is pretty much found in both rural and urban areas.

With regards to the internet, Nigeria has about 43 million users (total population over 155 million) which far exceeds by more than double the next African country on the list-Egypt.¹

 
There are many projects associated with mobile health in Nigeria and with the exponential growth of mobile and internet users; there is an ever increasing market. Different sectors of the economy which have an impact on the health of the populace also stand to gain a lot from the introduction of mHealth initiatives. Water, Sanitation, Agriculture, Finance and Development are a few of the sectors. In Kenya, the introduction of the mPESA, a mobile phone application where moneys can be sent via mobile phones all around the country has solved the problems of money transfers. No longer do people in rural areas have to wait until someone is visiting from the city before money arrives. They receive the money as soon as it is sent from a PESA center. At a recent WaterHackathon event organised by CCHub in Lagos, one o f the tools suggested for Water development was a mobile system to facilitate the sharing of water resources in hard hit areas.²

Examples of some projects already in place include Mobile Community based Surveillance.mCBS is a mobile platform which is given to Traditional Birth Attendants to report vital maternal and child health indicators in real time using mobile phones. Using texts designed for this purpose the TBA can transmit alerts to nearby health officials who can respond immediately thus reducing delays in reaching appropriate care at a facility.³ Other mHealth projects currently being developed in Nigeria  is being collated by Ime Asangasi (@Imeasangasi- twitter handle) here.

REFERENCES:

1. http://www.internetworldstats.com/stats.htm (accessed 26th December 2011)
2. http://www.cchubnigeria.com/watermeetup (accessed 26th December 2011)
3. http://ehealthnigeria.org/where-we-work/list-of-implementations/mobile-community-based-surveillance-mcbs/

WawaRed (wawa means baby in Quechua language) is a pilot project of Cayetano Heredia Peruvian University that provides pregnant women with access to health information through a cell-phone-based interactive system. Women can access for free information about what to do if they have warning signs during their pregnancy such as vaginal bleeding or severe vomiting. The system also provides them with SMS reminders for their clinical appointments and with motivational messages.

The project will soon develop an electronic medical record that will interact with a mobile phone platform. Initially, the project was focused only on health information before the delivery. Given that women expressed their desire to continuing receiving messages to remind them about clinical appointments for their newborn, vaccinations, and nutritional tips, the project is being extended to cover one year after the delivery.

The project is being conducted under the leadership of Dr. García and Dr. Curioso and it is financed by the Mobile Citizen Program of the Science and Technology Division of the Inter-American Development Bank.

Wawared has established strategic alliances with the Regional Government, through the Callao Health Division, and with Telefónica Movistar of Peru. The project has now additional support from UNICEF to include an Electronic medical record for the baby`s first year of life.

Video of the project: WaWaRed: Getting connected for a better maternal and child health in Peru by IDB’s Mobile Citizen

“My daughter took a self-defense class,” Jill explained, “And she was taught the ‘fight or flight’ response to escape harm. I’m 60 years old. I’m not good at fighting and not very fast at fleeing. So what’s my third option?” Jill created the WatchMe 911 app to provide the solution.

“I first started thinking about a personal alarm system before smart phones even existed. I saw that there were car alarms and house alarms, and wondered why there weren’t personal alarms. At the time I imagined that the personal alarm would go through an answering service system, but since smart phones were created, it can all be tied together in an app format.”

Jill demonstrated the WatchMe 911 app to me during our interview. It contains features such as a panic button that can be armed in advance. Two taps on the smart phone screen and a circle of friends and 9-1-1 are contacted immediately with your GPS location and an alert message. The panic button is a favorite for women who are concerned for their safety when walking late at night or in dimly lit parking lots or alleys.

The “Monitor Me” feature allows the user to schedule messages to friends in advance of a potentially dangerous situation. The message will be sent at a specific time unless disarmed by the user. This is helpful in situations where, for example, a user is out for a run without their phone and might become injured or threatened. They can set the alarm to send out a call for help to friends, with a pre-programmed description of the trail that they’re on. This feature is also popular during blind dates when users would like their friends to check in with them at a certain time.

WatchMe 911 also contains a simple “call 9-1-1″ button, a check-in button (that reminds me of a combination of  FourSquare and Twitter), and allows select groups of people to join a “neighborhood watch” type network to support friends who might need help. There is a campus version of WatchMe 911, called OnWatch that is modified for college students, allowing them to connect with campus police, for example.

Although the WatchMe 911 app only launched in September of this year, its sister program (OnWatch) has already won the Apps Against Abuse Technology Challenge, sponsored by the Office of the Vice President, the White House Office of Science and Technology, and the Department of Health and Human Services.

Jill told me that WatchMe 911 is available for free download on iTunes now, with in-app purchase fees ranging from $5.99/month to $99.99/year. Call 911 feature is always free. Users are offered a 30-day FREE trial of the entire app.

Although my one concern about these apps is the potential for false alarms (I can imagine how annoying it could be for forgetful joggers to send out unintentional, automated alerts to friends), I believe that version 2.0 of WatchMe 911 could provide revolutionary real-time aggregated data to law enforcement. Nation-wide and local crime hot-spots could be identified easily from users who opt-in to share their alerts, allowing police to allocate resources more effectively – deterring violent crimes before they even occur.

I hope this app gets the traction it deserves, because the potential for benefit is incredibly large. And for all the other women and grandmas out there who are looking for an alternative to “fight or flight” this may well be your ticket.

Originally published on Better Health on December 9th.

Before we address that question, let’s be transparent about the fact that there are several definitions of just what ‘mHealth’ is: purists may conceive it as covering only those health tools and applications that ‘go’ mobile–that is, that are deployed via mobile phones and devices like tablet computers. Then there’s the other end of the spectrum (pardon the tech-pun) embodied by the West Wireless Health Institute‘s concept of infrastructure-independent health care. My friend and long-time colleague Matthew Holt, co-founder of the Health 2.0 Conference, addresses this idea with his paradigm of “un-platforms.”

Wherever your own idea about “mhealth” sits on this continuum, it’s crucial to recognize that mHealth does not equal only mobile phone apps. There is a lot of hype around health apps for smartphones, but the traction is already with text messaging on simple phones in developing countries, doctors accessing prescription drug information on their beloved iPhones, and a growing number of people quantifying themselves through wearable devices that provide health-promoting nudges throughout the day.

What’s driving the adoption behind these programs? First, it’s about the value that the program offers the health system, health provider, and individual health consumer. Cash-strapped developing countries have leapfrogged over developed nations’ health systems– where health capital is sunk into hospital beds, legacy IT systems, and incentives that aren’t well-aligned with providers to deliver health care at the most appropriate, efficient site. In the developed world, providers deliver care based on how to maximize reimbursement — often in higher-cost-than-necessary settings — but paid-for by both public and private payers. In poorer countries, necessity is indeed the mother of invention — read “adoption” — of mobile health.

For doctors, mHealth adoption is rooted in being productive - another kind of profit maximization based on doing more in less time. For patients, growing co-pays and coinsurance sharing can motivate the patient-as-consumer to opt into self-care through tools like the FitBit and Withings scale that I personally use, or Fooducate for making healthy food buying decisions at the grocery store (which I also regularly use).

So, value becomes an underlying driver of mHealth adoption, where there is transparency of transaction costs in health care, and flexibility for stakeholders to make choices.

What of “values” driving the adoption of mHealth? That’s a softer issue, but no less potent than “value.” We’ve learned through the Great Recession of 2008 (ongoing in much of the U.S. and world economies) that individuals want to engage with organizations and institutions that embody their values. One of the big consumer shifts in the post-recession is DIY – the emergence of the creative economy, where people want to do more for themselves, from home improvement to self-improvement and cooking. People have lost more than a little faith in institutions – business and government – being hard-hit in the stock market seeing retirement funds fall, witnessing home values plummet, losing jobs, or losing faith in public institutions.

For health providers, autonomy and self-determination continue to be a value in practice. So adopting tools that bolster practice productivity and empowerment can delight the health practitioner. Those organizations who enable that garner trust, appreciation and brand loyalty. We’ve seen this, for example, with Epocrates, which continues to enjoy high take-up by physicians for its growing portfolio of mobile applications.

Whatever analyst forecast you read on the mHealth market — and you have your pick of many these days — remember that value + values will drive adoption.

Health Populi’s Hot Points: While there’s a go-go mood about mHealth adoption, a few significant barriers remain to be addressed: building out broadband to people who especially need it and don’t have it, aligning payment for health care so that providers will adopt the right tools for value-based and connected health; and patient engagement with their own health.

While a cadre of pioneering doctors, providers and patients have begun to engage with mobile health tools and apps, 2012 could be the year when we may begin to stop using the “m” and see mobile as just another infrastructure option for delivering health to engaged, activated patients.

Originally posted on Health Populi on December 6th.

By Jessie Gruman. Did you know that every nursing home resident in the U.S. must be asked every quarter whether she wants to go home, regardless of her health or mental status? And if she says yes, there is a local agency that must spring into action to make that happen.

This is the result of a 2010 Center for Medicaid/Medicare Services regulation aimed at helping keep older people in their (less expensive) homes rather than institutional settings. A New York Times article notes that the nursing home exodus, while modest to date, is building. This means the number of people with serious chronic conditions like congestive heart failure, diabetes and chronic obstructive pulmonary disease who draw heavily on community-based primary care services will grow. These returnees are joining their peers and the blossoming crowd of us Baby Boomers who intend to resist living in nursing homes with as much spirit as our parents did, while the consequences of our plump and sedentary lifestyles arrange themselves into a constellation of diabetes, congestive heart failure and COPD similar to the one that plagues our elders.

Much has been written about the overwhelming demand that caring for our collective chronic conditions will place on the primary care clinicians in our communities in the coming days. And many of the provisions of health care reform anticipate those demands: Accountable Care Organizations, Electronic Health Records, Patient-Centered Medical Homes. As each of these innovations staggers haltingly forward, the developers of patient-facing self-care technologies yap and nip at patient’s, health providers’ and payers’ heels, claiming the effectiveness of devices and apps that could easily today help older people with serious chronic conditions care for themselves and lower the cost of care.

We have the Veteran’s Health Administration (VHA) to look to for the feasibility of those claims. The VHA has been using telehealth to support self care for veterans with serious chronic conditions since the late ‘70s. In a 2010 interview, physician Adam Darkins, Chief Consultant for Care Coordination Services at the U.S. Department of Veterans Affairs, said: “Much of the technology capability that is needed to support older adults in improving their health is already available; the pressing issue is how to increase the adoption and usage of these technologies.” The VHA currently supports more than 46,000 vets using simple phone-based technologies like the Health Buddy, a device that lives near your phone into which you enter your blood sugar, weight, or blood pressure with the understanding that your nurse and doctor are looking for changes that signal trouble and will call to discuss them if they see any. And the agency will vastly expand the scope of its investment in remote patient monitoring approaches in the coming years.

But remote patient monitoring for chronic illness self care that is integrated into non-veteran primary care hasn’t really caught on. Group and staff-model health plans such as Kaiser Permanente and Group Health Cooperative and other closed systems have piloted such programs with promising results but they have yet to take those pilots to scale. And while home health agencies have also experimented (and occasionally implemented) programs for two-way video conversations, for example, adoption has been modest.

Despite the VHA’s confident move into using remote patient monitoring technology to help veterans care for a host of chronic conditions beyond COPD, CHF and diabetes…despite the large number of pilot studies demonstrating that well-defined remote patient monitoring programs integrated into primary care produce better outcomes and save money…(and most importantly, from my perspective) despite the reports that participants in the trials and veterans say those technologies help them take better care of themselves, most older people with serious chronic conditions don’t have the option of receiving this kind of support to care for themselves.

Why? Molly Coye and her colleagues in a 2009 Health Affairs article ticked off the barriers:

• “…The principal barriers to innovation in chronic care (are) the effects of benefit design and reimbursement mechanisms;
• …Most providers and delivery systems have little experience with remote clinical technologies. They are poorly prepared to evaluate the technologies or to make decisions about their acquisition or deployment…
• …The financial models and assumptions needed to calculate costs and return on investment do not exist.
• …Although most remote patient monitoring products on the market today have a functional interface with one or more electronic medical records (EMRs), installation and maintenance are an additional burden on delivery systems’ information technology (IT) staff.”

These barriers are almost as insurmountable today.

OK. Maybe the solution is for individuals to seek out and contract with providers of such services on their own. After all, free-standing services such as Life Call (of “I’ve fallen and I can’t get up” fame) and otherpersonalemergency response systems have long been popular among older people (and their children). There are undoubtedly some people for whom corresponding free-standing devices and programs to help them monitor their symptoms are both affordable and preferable. It’s likely, however, that their price, requirements for technical competence and enthusiasm for self-monitoring exceed those of most chronically ill older people.

Further, there is reason to believe that part of the effectiveness of the VHA approach and most other pilot programs is related to the technology’s close connection to the individual’s primary care clinicians. Brown geriatrician Richard Besdine told me: “It’s important to remember that the quality of the communicators, especially on the professional end, matters. Remote patient monitoring is only as good as what is on the other end.” David Lindeman, director of the Center for Technology and Aging agrees: “The barrier is not the hardware. It’s the current system and the lack of care management programs. Individuals and family members can find a device or monitoring technology but there isn’t a connection with the provider. And without a formal link to the primary care clinician or practice, the benefit is slim.”

Jeremy Rich, MD, who directed a pilot of a telephone-based monitoring system for older people with COPD in the staff-model HealthCare Partners Medical Group, told me about an older patient who desperately wanted to remain in his home to care for his two giant Macaws. The man said that not only did the monitoring give him confidence that he was doing OK and offer reassurance that his familiar medical team was looking out for him, but that he tried to do a little better because he knew they were watching.

Psychologist Richard Birkel of NCOA (formerly of the Carter Center) has considerable experience implementing patient and caregiver support programs that include technology. He talked about hearing from patients in a short-term post-surgical care program that they didn’t want to give up the monitoring once the program ended. “They loved the relationship with the team and the certainty of having back-up if something were to go wrong.”

By no means is every older person with a serious chronic condition amenable to remote monitoring and support. Many are just fine on their own. Some of them have declines in vision, hearing, cognition and manual dexterity that make it difficult to make use of the technology. Some would rather meet their clinician face-to-face in their home or make the trip every couple weeks to see her at her office. But the desire to remain independent and at home is powerful for many, and knowledge that there are effective, affordable technologies that may help people do so safely has the potential to elicit robust demand – and willingness – to engage more fully in their care.

It is frustrating to wait for professionals to carefully renegotiate their roles and learn to work as a team, use the new electronic health record (EHR) and adjust to new lines of authority and accountability. It’s excruciating to watch the majestic consolidation of practices and hospitals into Accountable Care Organizations that will eventually use payment models that can support remote patient monitoring. It’s exasperating to observe the fits and starts and resistance to implementation of EHRs. How long will it take for the “back end” of the clinical enterprise to be configured so our clinicians can work with us and our parents and our neighbors to help us care for ourselves using these new technologies?

While I understand the tremendous effort these changes require, it breaks my heart a little to think of all of those whose independence and lives at home could be supported with the technology that exists today.

Today, you can receive text messages, voice mail, or email reminders for just about anything from medications, to testing, to health tips, or appointments.  Information and help where you want it, when you want it, and how you want it are transforming the relationship between you and your providers.  Teens get help with diet and smoking cessation as well as disease management.  Elders and their care givers get live follow up and real time transmission of important vital signs through remote patient monitoring that can alert providers to developing problems at home.  Ambient assisted living systems that track movement at home, and personal emergency response systems help elders stay at home but alert others when a condition changes over time or in an emergency.

Mobile personal monitoring is getting a boost from other companies who recognize people want to be on the go, and are not held back by the need to monitor or address health needs in traditional ways.  In the next several years, Ford Motor company plans to provide “First Assist” emergency health care instruction through its OnStar system. They will provide allergy alerts based on day-to-day location indices of allergens, and glucose level monitoring alerts via dashboard applications.  Future plans also include voice requests for health information and updates, seat sensors to detect electrical heart rhythms/problems, and stress reduction responses.  Leveraging existing technologies such as GPS, telecommunications, and internet access is catapulting us into an age of ubiquitous computing where our environment is instantaneously and unobtrusively enabled by computer assisted functions.

Electronic medication reminder boxes and vials already offer services to remind people what to take, and when to take it with flashing lights and compartments that release.  Failure to respond on schedule triggers follow up to the consumer and family members. Simple transmission of daily weight and other vital signs is easily performed through a variety of economical products including one scale that will post your weight on Twitter.  Edible computer chips are being tested to report proper drug ingestion. 

Thousands of cell phone applications provide tools to receive and send health information as data points, documents, and static as well as moving images.  With 24/7 expectations, we now have 24/7 access to information and data interactivity.  Technology is delivering on the promise to help improve care.  It is always on, and fits in our pockets. 

*Mark D. Smith. Disruptive Innovation: Can Health Care Learn From Other Industries? A Conversation With Clayton M. Christensen.  Health Affairs, 26, no.3 (2007):w288-w295. (published online March 13, 2007; 10.1377/hlthaff.26.3.w288)

The report says that by 2014 – there will be 400 million consumer sensor oriented devices, comprising a $4 billion market! Disruptive Women in Health Care hopes to contribute to developements in this area through its Health in Place Initiative.

To view the Rock Health report click here.

The Ovarian Cancer Symptom Diary App will help you learn about the risks, signs and symptoms of ovarian cancer. This first-of-its-kind application allows a woman to track symptoms that could indicate ovarian cancer, and alerts her if she should make an appointment with her doctor for further testing. To download app click here.

Dear Colleagues,

Health Information Technology and the substantial HITECH investment are a critical part of putting the U.S. health care industry and the U.S. consumer population on the 21^st century path to improved health and health care. The investment however is almost exclusively focused on enabling the provider infrastructure. We need a mirrored infrastructure that will help patients and caregivers navigate, access and understand the growing health information universe and what it means to them.

The newly announced “Putting the IT in TransITions” initiative is a critical opportunity to help consumers better access and use their own healthcare information, but only if it is put in context and made truly consumer friendly. This means not just plain language but with tools, translation and interpretation resources that make it actionable.

The two-page project summary “Patients and Caregivers the 1^st Step Not the Last Mile” describes an initiative that would explore how to enable a parallel consumer-facing infrastructure that complements and readily connects to the provider-facing infrastructure. Although ultimately there will be one shared infrastructure the timing and challenges of the emerging provider connectivity runs the risk of leaving consumers as the last mile.

We are stepping up to the IT in TransITions two-week challenge with a deadline of October 28, 2011 by seeking broad support for the project and its goals. We have many committed partners and we need your help in emphasizing to HHS and the industry leadership the critical importance of the consumer component to their efforts.

If you can lend your name and/or your organization’s name to this letter of support please email kossoncare@starpower.net by Thursday October 27th.

Your information, exactly as you provide it, will appear after the following statement: We the undersigned agree that successful care transitions need increased consumer IT support and focus consistent with the goals of the Patient and Caregiver Gateway project.

To kick the tires on the survey a bit, I spent time on the phone with the “3 M’s” of Manhattan Research — Meredith Ressi, President; Monique Levy, VP of Research; and, Maureen Malloy, Senior Healthcare Analyst who can recite the survey data backwards and forwards. Together, they guided me through the topline on digital health information use among U.S. adults in 2011.

The 56 million US adults who access data via electronic health records (EHRs) was a surprise to me, and to this trio, as well — so much so that they revisited the study methodology and samples to ensure that this was not a statistical anomaly. It’s not. But as with all numbers, it’s insightful to know what lies beneath the raw stat.

The big number to consider here is 24% of U.S. adults who are accessing their personal health information (PHI) from their physicians’ EHRs. In this case, the 56 million tend to be younger, better educated (more with college education), higher internet adoption, and more likely to own smartphones and tablet computers. They are also more likely to observe a physician doing digital activities during the consult – such as seeing the doctor entering information into the EHR.

What’s common among those consumers interacting with their EHR-borne health information is that they are more frequent online health information seekers than people who are non-users of their EHR data: three times more likely.

Monique Levy pointed out that EHR information users are “more acutely aware of the pain points they have in the health system: they are more likely to identify certain problems and barriers in managing care. They are a more self-aware group about what’s working, what’s not working, and what they need” out of the health system.

What’s beyond the 56 million (24%) U.S. adults who Manhattan Research calls “users” of EHR information? Another 41 million who are interested in doing so but haven’t yet.

This leaves millions more people in America who don’t appear interested in accessing their health information via a doctor’s EHR. Cybercitizen Health identified the least-engaged group within this cohort: 15% of people who have seen a doctor in the past twelve months whose doctors provided access to medical information on an EHR, but neither accessed their EHR data nor are interested in doing so.

Thus, the consumer side is only one-half of this equation: physicians, of course, play yang to the patient’s yin. In Taking the Pulse, Manhattan Research’s annual physician poll, the company found that doctors’ adoption of tablets (especially the iPad) continues to quickly grow. Their use will turbocharge physician adoption of mobile EHR capabilities, and physicians’ ability to share data, up-close-and-personal, and in seamless ways without disrupting workflow in the exam room which can happen when sitting behind a computer monitor.

For Cybercitizen Health, Manhattan Research surveyed 8,745 U.S. adults age 18 and over via online and phone in the third quarter of 2011.

Health Populi’s Hot Points: In The Two-Way Street of Patient Engagement in Health IT, I wrote in California HealthCare Foundation‘s iHealthBeat on September 27, 2001, “In the two-way street that is patient engagement, it is health care providers  who will play a key role in getting the mass-middle of people more involved in  their health data. That may be a lot to ask of health care providers given their  already-cramped workflow, but doctors and hospitals will be motivated by at  least two market drivers: payment and consumer pressure.”

Manhattan Research found that people who have begun to embrace their PHI via EHR tend to have physicians who bring them into the process in the exam room: physician engagement with meaningful use is drawing patients into conversations about their personal health information and, therefore, their health.

Further fanning the flame of physician involvement is Meredith Ressi’s observation that, “once you get an iPhone or Droid in physicians’ hands, it changes their behavior.” She noted that access to the web is the first changed behavior: doctors are doing medical information searches via smartphones wherever they are — and with iPhones, the use of simple-to-access apps further bolsters their mobile health behavior.

Originally posted on Health Populi on October 14th.

There is excitement in the air about how mobile phones are the breakthrough technology for changing health behavior.  Last Saturday, I was convinced this must be true. In two short hours, I:

• Skimmed the NYTimes op-ed, You Love your iPhone. Literally, that (questionably) claimed that functional MRIs show that our brains react to our iPhones the same way they do to the proximity of someone we love.
• Received an email on my iPhone from NYC Health Business Leaders inviting me to come to a meeting: Is Mobile Health the Next Killer App?
• Came across this podcast on how mobile technology is going to vastly change care for seniors with chronic conditions.
• Read a beautiful review of the behavior change literature that asks the question Is Mobile the Prescription for Sustained Behavior Change?
• Received a text about the highly anticipated release of the iPhone 5.
• And came across the entire kitchen crew of a fancy restaurant staring into/talking on their mobile phones.

Now I’m sure that the seductive power of our mobile phones hasn’t escaped your notice. Certainly, if you are concerned about people engaging more fully in their health and health care, you have seen the thousands of apps that intend to exploit the combination of widely available mobile phones with advances in Web-enabled technology as the new best way to spark and sustain health behavior change.

I love the optimism that has driven the development of these apps to date.  The theoretical reasoning of the behavioral scientists that finds mobile apps to be a potential game-changer – this is why this technology is different and what it offers above all other technologies and approaches — is subtle and compelling. And I love imagining the personalized guidance and support that will be possible to deliver to us once these theories are transformed into more sophisticated apps for our mobile devices.

I also love it because this health and lifestyle behavior change stuff is really hard for us – whether we are individuals or caregivers or clinicians…and it is really important: it’s necessary for many of us to act differently if we are going to become or remain active and healthy.

We love our phones. They distract us when we are lonely or bored and inform us when we are lost or curious.  They allow us freedom of place and space.  And the rewards they offer are immediate, efficient and entertaining.  But we mostly love them because we like what they do for us.

My friend Lou has early Alzheimer’s and her caregivers have set up a locator app on her iPhone to track her when she goes out.  When her resentment about being spied on builds up, she hides her phone in her house and heads for the door, almost always forgetting where she put it or that she hid it at all. Even in her confused state, she’s willing to let go of that treasured phone —which is her main link to the people she loves — when she associates it with negative emotions and experiences.

I am trying to gain weight.  I want to eat and know I should eat every hour and I have a full array of tempting snacks by my side at all times.  And I have carefully set up an app to deliver a different alarm every hour to prompt me to eat. Yet I reliably delay my response to each alarm and then forget to eat the nuts and even the cookies.  You cannot imagine how easy it is to turn that little sucker off and promise myself that I’ll eat as soon as the conference call is over, when I finish this paragraph, or when I get off the subway.

Two small examples but telling ones.

While mobile phones can do so much – and will soon be able to do much more —to monitor our movements, tailor information to our interests, send us strategic messages, and remind us with alarms, our will is still our own.  When the device becomes the driver of change, rather than us, it becomes an electronic substitute for a nagging clinician or spouse, a voice that reins in and confines, bringing out our worst adolescent tendencies: mischief; defiance; disobedience.  I’m not sure that an app exists that can wrangle that impulse into submission in most of us most of the time.

We prefer fun, enjoyable activities and avoid irritating ones.  If an app becomes the source of unwelcome advice or beeps, or we feel intruded upon or our response to some app brings unwanted attention to us, we will have no problem circumventing it.

As much as we depend on the convenience of our mobile devices, they are only tools.  While my mobile phone can link me to information, advice, friends and support, I don’t confuse it with them. I can get to these valuable resources via my phone when I want them.  But I know that when I am sick, the disease is located in my body, not my phone.  Regardless of what is going on with my phone, I’m the one who has the cancer and I’m the one who takes the chemotherapy drugs, pleased as I would be to delegate that responsibility to an inanimate object.  When the alarm goes off that your mom has fallen, it is your hands or the hands of the EMR technician that help her get up, not the mobile device. When Lou gets lost, even when she has her phone with her, it is her caregivers or the police who find her and bring her home.

I am convinced that behavioral scientists and app developers will be successful in getting those mobile phones to do what they want them to: deliver clever tailored behavior change strategies directly to us through our mobile phones.  And I am equally confident that many of us will try those apps. But if they don’t do what we want them to —if they become a burden, an intrusion or a bore —we will ignore them, delete them, or, when all else fails, carefully place our beloved phone in the vegetable drawer of the refrigerator and head out the door.

Steve Jobs 1955-2011

The day before my daughter Elise’s 15th birthday, the new iPhone went on sale.  My birthday was 4 days later.  So Elise figured out we should buy each other an iPhone to mark our big days.  She planned (and saved) for months.  She spent weeks talking to friends, researching apps on line, planning for such accessories as protective covers, and educating herself on how to maximize her minutes.

When the big day came, we made our way to the Apple store and stood shoulder to shoulder with hundreds of others waiting on a very long line.  Two and a half hours later we were invited, actually escorted, in to the store by an extremely friendly, knowledgeable young man who stayed with us during the entire purchase transaction.

He answered tons of questions (mine, not Elise’s…she already knew everything), politely reviewed various functions with me (Elise was extremely patient during this process), and made great suggestions about which plan was best for us.

While we were waiting on line, I looked around at the people waiting with us–we were an extremely diverse group–and wondered (a) Why in the world were we all willing to wait hours to buy a telephone, a very expensive telephone?  (b) How did the folks at Apple get us to this point? and (c) What lessons could we take away and apply to health care?

Here’s what I came up with:

Cool. The iPhone is not your mother’s rotary dial wall phone.  The engineers and creative types figured out how to make a very uncool, but necessary, object not only aesthetically pleasing, edgy, and fun, but useful, convenient, and easy to use.  They stimulated demand.

Now if the Apple  folks could only do for colonoscopies what they did for telephones.  I am only half joking.  How do we make taking care of ourselves and our loved ones cool?  How do we make boring, sometimes not so pleasant preventive measures cool and edgy?

Hospitals are scary places–while some newer facilities have made efforts to look more appealing (open atriums with green trees, brighter colors and lighting), many are dark, smell strange, are old and creaky, have tons of frightening tubes, machines, noises, and for most people are places to be feared and avoided.

What amenities can be added to make it harder for patients to find excuses not to get that mammogram (valet parking, anyone?), not to go for that follow up, not to just give up and leave after waiting for two and a half hours in the waiting room (Elise and I waited that long–and the friendly folks at Apple handed out water, and updated us on our progress).  The only water I could find in my local hospital emergency room last week (when we were there with my son) was a nasty water fountain that had stuff in it that would make a petri dish cringe.  There were vending machines with chips, candy and soda, but it was broken.

Service. Imagine for a minute that when you enter a clinic, doctor’s office, or hospital, you are accompanied by a knowledgeable, helpful, pleasant individual who can speak to you in a non-condescending, judgmental manner, in language that you understand.  Someone who can help you navigate a complex system of decision making.

Quality. Pretty obvious attribute.  Quick–think Mayo, Cleveland Clinic, Johns Hopkins.  What is it about these institutions that people think of when asked to list “best” hospitals.  How do you (should you?) rate different doctors? Nurses?  Most people buy the iPhone because they believe they are buying a high quality product.  How can we be sure we are buying high quality health care?

It’s interesting when you look at the literature.  Quality is defined in many different ways by health care professionals and by patients.  Sure there’s overlap.  But in addition to better health outcomes, living longer and better–patients highly rank items such as convenience, hours of operation, waiting times, and location as quality indicators.  Apple stores have better hours than most clinics and physician offices.  My dog’s vet has better hours than most doctors.

Value. Why was a 15 year old willing to save her hard earned money for an expensive phone (and why was I willing to pay not insignificant monthly charges) for the iPhone?  Because we thought it was worth it.

If only we could figure out a way to get people to see that it’s worth it to exercise, eat healthy, get annual check ups, not smoke… and get that colonoscopy.

I know, I know it’s October…but hey, we are disruptive so celebrating on the exact day seems so well, ordinary.  And the past three years have been anything but ordinary.  We all had something to say about the new health reform debate and ultimate passage.  We still have much to say about the new law, as well as a multitude of other topics.

One area that I have been thinking a lot about is the exploding area of mhealth (mobile health), remote monitoring, and telehealth.  Technology alone is not the answer of course.  But technology, coupled with innovative care delivery models (think health reform), and patients, caregivers and clinicians more comfortable with smartphones, apps, data sharing and online connectivity have all contributed to a new framework of health and wellness.  Aging in Place, staying connected, eICUs, PHRs and EHRs.  Exciting stuff.

But, like most solutions in health care, success must look beyond the health sector.  Here’s what I mean by that: staying healthy can’t just take place in a health setting or even in your home.  Maintaining your health and wellness or managing your chronic disease or disability requires a connection where ever you are — in other words, Health In Place.  Young people with epilepsy and diabetes still attend school, go on vacation and use public transportation.  Elderly individuals aging in place still travel to visit gradnchildren. And, adults maintaining exercise and nutrition regimens who travel for work need to stay connected to maintain wellness.  The Health In Place concept takes this broad view and will be bringing together thought leaders from not only the health field, but the telecom, travel, automobile and real estate sectors as well. 

The organizers of the 2011 mHealth Summit were so taken with this idea that they invited Disruptive Women to launch the Health In Place or HIP initiative with a reception on December 6th–we couldn’t be more thrilled or more flattered. So SAVE THE DATE:

Health In Place (HIP)™ — Disruptive Women in Health Care is Launching a New Initiative

Tuesday, December 6, 2011, 5:00–7:00 PM
Location: Pose Ultra Lounge & Nightclub–at the Gaylord Hotel in National Harbor (Washington DC)

Overview: The concept of Health In Place™ is built around the idea that our homes are more than just homes, our offices are more than just workplaces, our schools are more than just places of learning, and even our cars are more than just modes of transportation. Thanks to wireless communications and emerging technologies, each of these venues has become potential health and wellness centers or HIP. No matter where we are or what we’re doing, we can be protecting and enhancing our well-being. For this facet of 21st century health care to achieve its full potential — for more Americans to have the tools to link to their caregivers, to protect against and manage illness, while monitoring their well-being — a number of public policy issues are involved, cutting across multiple disciplines from health care regulations and benefit structures to tax policy to technology incentives. That’s why Amplify Public Affairs and the Disruptive Women in Health Care® blog (along with our media partenr, The Hill) have formed the Health In Place™ Initiative — to bring together policymakers and change agents from multiple industries.

 Please join us as we unveil this new initiative.

 Speakers:

• Robin Strongin, President & CEO, Amplify Public Affairs & Creator, Disruptive Women in Health Care — Moderator
• John Marttila, President, Marttila Strategies (a national polling expert)
• John C. (Jack) Lewin, MD, Chief Executive Officer, American College of Cardiology
• Pamela Cipriano, PhD, RN, NEA-BC, FAAN, Professor, University of Virginia School of Nursing, Editor-in-Chief, American Nurse Today, 2010-11 Institute of Medicine Nurse Scholar-In-Residence (and a Disruptive Woman blogger)
• Halle Tecco, Founder & Managing Director of Rock Health (and a Disruptive Woman blogger)

Stay tuned for more information.  And by all means, please come out on December 6th and celebrate with us.

At three years of age, we are not only Disruptive, we are also HIP.

You can read the full HuffPost story here: http://www.huffingtonpost.com/2011/08/20/dolphin-with-prosthetic-tail_n_927463.html#s330792&title=Dolphins_Fake_Tail

How do you feel about health-related social networking? Would you join an online health program? What concerns – privacy, quality of service, etc. – do you think this presents?

Read the full text of the Healthcare IT News post here: http://healthcareitnews.com/news/social-media-tools-may-reduce-attrition-online-health-programs

The new apps (FaceDecide & BreastDecide) come in addition to their six existing Orthopedic patient education apps — including an orthopedic app called ShoulderDecide, which was recently reviewed by iMedicalApps.com. While these latest apps are obviously less focused on chronic medical conditions than the original six, they do call attention to just how great the extent of the potential for mHealth seems to be.

In the next few weeks, Orca MD will be rolling out additional features, including an introduction and some infographics dealing with Orthopedic & Cosmetic Surgery. To keep up with these releases, check out their apps, and more, ‘Follow’ @OrcaMD on Twitter, ‘Like’ OrcaMD on Facebook  or check out their YouTube Channel.

Health-related smartphone apps are a relatively recent innovation, and there is no telling what will come. What do you think about the BreastDecide and FaceDecide apps? Would you download them? As the field of mhealth begins to evolve and mature, how do you think apps like this will fare? Do you think these present privacy concerns for users?