Emerging Technologies Driving New Patient Care
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The Internet of Things (IoT) and Apple Watch dominated headlines in 2015. Patients are tracking more of their own health information with wearables, and expectations are changing for how to interact with caregivers. Take an inside look at how technology is affecting patient care settings, particularly the exam room. Learn how physicians are utilizing wearables to advance medical care and engage with today's connected patients. Originally presented at the 2015 Health Care Internet Conference (HCIC).
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Emerging Technologies Driving New Patient Care
- 1. Emerging Technologies Driving New Patient Care Jared Johnson Ultera Digital Steve Koch Sitewire Health Russ Maloney Sitewire Health
- 2. Understand the user’s Jobs to be Done Flickr: David Blaine Who are these people? Jared Johnson Principal Ultera Digital Steve Koch Senior Healthcare Strategist Sitewire Health Russ Maloney Senior Strategic Planner Sitewire Health
- 3. • Overview of emerging healthcare wearables and Internet of Things (IoT) devices • Barriers and how to overcome them • The human behavior influence • Takeaways for marketing/technology experts Today’s agenda
- 4. You’re familiar with today’s wearables. What comes next?
- 5. Patient care is changing, whether we want it or not.
- 6. The exam room is everywhere now. Empowered Patients Democratized Medicine Retail Clinics Home Blood Tests Quantified Self Fitness Trackers Remote Monitoring Mobile Health (mHealth) Telehealth
- 7. The current state of wearables and Internet of Things (IoT) in patient care
- 8. 2015 33 million 2019 148 million The healthcare IoT market segment is poised to hit $117 billion by 2020.
- 9. Wearables in the exam room
- 10. Exam Room Tools – Apple Watch Kareo Watch App AirStrip Sense4baby
- 11. Cedars-Sinai uses HealthKit to integrate EMR for 87,000 patients At rollout, 300 patients connected Apple Watches or other wearables
- 12. Google Clinical Research Wearable “Not a FitBit or Apple Watch competitor”
- 13. IoT (smart sensors) in the exam room
- 16. Smart Sensors Anti-Depressant Ingestible Sensor and Skin Patch Proteus/Otsuka
- 17. Smart Shoes Smart Brain Monitor Boogio Bionic Foot Sensor BrainScope Ahead 200
- 18. The wave is coming. What barriers are coming with it?
- 20. Flickr: shinya Around 20% of consumers own a wearable. 20 – 30% have a wellness app on their mobile device.Forrester 2015, HRI 2014
- 21. Flickr: shinya 75% of wearable owners are early adopters. Half are younger than 35. Nielsen, 2015
- 23. Flickr: shinya What would you pay for a wearable? HRI, 2014 $300? $100? Free?
- 24. Flickr: shinya One-third of people hospitalized in the last year adopted a wearable after their hospital stay. Rock Health, 2015
- 26. MedPanell, 2015 Med Panel, June 2015 15% of physicians reported discussing wearable health technology with their patients.
- 27. Keys to clinical adoption of wearables: 1. Population Health 2. Interoperability 3. Data quality
- 31. Flickr: shinya Less than half of wearable owners wear their devices every day. HRI 2014
- 32. Flickr: shinya One-third of users stopped using their devices after six months. Endeavor Partners 2014
- 35. Technology adoption curve Early Majority Late Majority LaggardsInnovators Early Adopters The chasm
- 36. Peak of inflated expectations Trough of disillusionment Slope of enlightenment Plateau of productivity time hype
- 39. Technologies in 2011 Cloud platforms E-reader Internet TV time hype
- 42. Check the box if you wish to register with the NHS Organ Donation program
- 43. Check the box if you wish to register with the NHS Organ Donation program 42% register ✓
- 44. Check the box if you do not wish to register with the NHS Organ Donation program
- 45. Check the box if you do not wish to register with the NHS Organ Donation program 82% register ✓
- 46. Default choices
- 47. Behavioral techniques Variable rewards Goal- and task- setting Leaderboards Default choices Team-based participation Social comparison Social contagiousness Anticipated regret Action prompts
- 49. Action prompts
- 52. What is your role?
- 54. Segment by psychographics, behaviors and motivations.
- 55. 55
- 56. Understand the different journeys your segments take.
- 58. !
- 59. ?
- 60. Understand the user’s Jobs to be Done Flickr: David Blaine Lead nurturing Lead scoring Communication optimization Personalized landing pages Lead acquisition CRM integration Social marketing Convert Marketing Automation
- 61. Understand the user’s Jobs to be Done Flickr: David Blaine Motivation nurturing Motivation scoring Communication optimization Personalized landing pages Patient acquisition EHR integration Social marketing Convert Motivation Automation
- 62. • Integrate empowered patients into your communications plan and care model • Anticipate consumers’ questions and behavior • Use your marketing and technology skillset to provide better care for patients Key points to take away
- 63. healthitmarketer.com sitewirehealth.com/cruxpoints Download this presentation at HCICwearables.com Jared Johnson Jared@ulteradigital.com @jaredpiano Steve Koch skoch@sitewire.com @sitewirehealth Russ Maloney rmaloney@sitewire.com @russ_maloney
Editor's Notes
- FitBit, Acer Liquid Leap, Jawbone, Nike
- The exam room is everywhere now – this is the lens to look through. We live in a world of democratized medicine, empowered patients, and mobile health (mHealth). Empowered patients are tracking some data and want access to the rest of it. We have telemedicine, retail medicine (Minute Clinics), remote monitoring, and home blood test ordering. 10-30% of what happens in a primary care facility will take place on an iPhone in the next 2 years (spoken 1 year ago).
- Wearables will see plenty of growth. According to BI Intelligence estimates, the global wearables market will grow at a compound annual rate of 35% over the next five years, reaching 148 million units shipped annually in 2019, up from 33 million units shipped this year. The smartwatch will be the leading product category and take an increasingly large share of wearable shipments. Estimated shipments will rise by a compound annual rate of 41% over the next five years. Smartwatches will account for 59% of total wearable device shipments this year, and that share will expand to just over 70% of shipments by 2019. The Apple Watch has kick-started growth in the overall smartwatch market. The Apple Watch is estimated to account for 40% of smartwatch shipments in 2015 and reach a peak 48% share in 2017. Fitness bands and miscellaneous wearable device types, like smart eyewear, will continue to cater to niche audiences. Fitness bands, because of their appeal to niche audiences interested in health and exercise, will see their share of the wearable device market contract to a 20% share in 2019, down from 36% this year. There will be some blur between fitness bands and smartwatches. Now that both Apple and Google are in the smartwatch market, they will dominate, much as they have in the smartphone and tablet markets. Because these platforms make up over 90% of the entire mobile platform market, many mobile users interested in wearable devices will gravitate toward Apple Watches and Android Wear-based devices. Barriers still persist, and these will inhibit consumer wearables adoption and usage. Smartwatches in particular must become standalone computing devices with more robust functionality for the devices to become mainstream. Other barriers include small screen size, clunky style, limited battery life, and lack of a "killer app" that can drive adoption.
- Physicians are utilizing wearables to advance medical care and engage with today’s connected patients
- Kareo app – physician can communicate to staff if he’s running late, or when a patient is there.
- HealthKit, a data repository for health-tracking software, may cut down on the amount of code that health-care CIOs need to write as patients use more wearables to monitor themselves. HealthKit is a software framework that can collect data from any health device or app, and share it with electronic health record software used by hospitals. HealthKit may free-up developers to work on other IT projects, such as analytics. And by encouraging patients to be more proactive about their health care, and by allowing them to control which data they share with caregivers, the arrangement may improve compliance with federal directives on the use of electronic health record software. It is the largest HealthKit integration to date. Cedars-Sinai on April 25 enabled access to HealthKit for 87,000 patients. The group includes patients who were active within the hospital’s Epic Systems Corp. electronic health record portal. Within the portal, roughly 300 patients, with a median age of 45, have opted to connect eligible Apple devices, as well as Fitbit Inc. wearables and Withings Inc. blood pressure monitors. Source: http://blogs.wsj.com/cio/2015/05/04/apple-healthkit-helps-cedars-sinai-tackle-patient-engagement-challenge/
- Google (specifically the life sciences team at Google X) is building a wearable health sensor for cardiac and activity tracking, but it isn’t a Fitbit or Apple Watch competitor: Google’s device is a clinical-grade sensor designed for investigational use. “In brief, we’ll be starting to use it in clinical studies to see if/how a continuous stream of medical-grade measurements of biological signals (e.g. pulse, skin temp, activity levels) could be useful to physicians and researchers as they try to understand and intervene earlier in disease,” a Google spokesperson told MobiHealthNews in an email. “This could give them insights that are currently only available sporadically — e.g. via a diagnostic test, or when a patient is being observed in a clinical setting.” The wristworn sensor will measure pulse, activity level, and skin temperature continuously. It will also be able to take an ECG and pick up on environmental information like light and noise levels, which might indicate to investigators that a person isn’t wearing the device or isn’t leaving their house much. Exactly how the device will send the data that it collects to users and/or their caretakers is a piece of the puzzle Google is still tinkering with.
- Smart Diapers from Pixie Scientific can warn parents of health issues before they become serious. The Smart Diaper uses several reactive agents and an app to monitor irregularities in an infant's urine over time and alerts parents if they need to visit a doctor. Aside from a square panel on the front, the Smart Diaper looks and fits just like a regular disposable diaper. On the inside, that panel contains several non-toxic test strips situated underneath the absorbent core, so they never actually touch the child's skin. Once the diaper is wet, the strips react to leukocytes, nitrates, and a variety of other substances that could each indicate different health problems. Parents can then use an accompanying app to scan the QR code on the outside of the diaper, which is surrounded by the colored results of each test. The app will note down each strip's reading for that day, monitor any changes over time, and apply several algorithms to identify any notable trends. If it detects a potential issue, it will send an alert to the parents to make a trip to their pediatrician, who can run their own tests and consult the app's log if needed.
- Google has partnered with Novartis eye care division Alcon to license its still-largely-theoretical “smart lens.” 2 use cases for the smart lenses: (1) Noninvasive glucose monitoring (via tears) for people with diabetes was one. (2) The other was for people with corrective vision needs.
- Proteus and its partner Otsuka have submitted for FDA approval an instrumented version of the anti-depressant Abilify. Although Proteus’s Digital Health Feedback system had already been cleared, this is the first pairing of the system with a drug. The ingestible sensor will work with the skin patch to monitor dosing patterns as well as physiological responses to the drug; the sensor will be able to send that information to a patient’s doctor.
- From your head to your toes, smart sensors can track everything. Florida Hospital, a 2,200-bed acute-care medical facility and a member of Adventist Health System, will begin testing a shoe-based wearable sensor from Seattle-based Reflx labs to assist in pediatric rehabilitation. The platform, called Boogio Bionic Foot Sensors, consists of foot pressure, balance and 3D movement sensors hidden in a user’s shoe. They connect to a mobile app, allowing doctors or physical therapists to track a patient’s progress. BrainScope currently offers two traumatic brain injury assessment devices. The first, Ahead 100, was cleared in November 2014. The other, Ahead 200, which the company says is a smaller, more rugged version of its Ahead 100 offering, was cleared in May. Ahead 200 consists of a headpiece with a number of EEG leads which connects to an Android smartphone that runs the diagnostic software. The Ahead 200 device doesn’t replace a CT Scan, but it does provide a middle ground between a CT and the questionnaire that’s much more portable and practical.
- Physicians are utilizing wearables to advance medical care and engage with today’s connected patients
- We’re still at the early adopter stage of wearables and wellness. About 1 in 5 Americans own a wearable today. And according to a Nielsen survey from earlier this year, 75% of owners are early adopters of technology, about half are younger than 35 and about a third earn more that $100k per year. So, a key takeaway from that is that for now, wearables have not gotten into the hands of the people who could really benefit – older folks with chronic conditions. And, without a doubt, for wearables to have a meaningful affect on healthcare, adoption will have to rise quickly – across all demographics. And in order to do that, it’s going to need what many call “the killer app.” Something that really excites people, that starts to motivate them to purchase.
- We’re still at the early adopter stage of wearables and wellness. About 1 in 5 Americans own a wearable today. And according to a Nielsen survey from earlier this year, 75% of owners are early adopters of technology, about half are younger than 35 and about a third earn more that $100k per year. So, a key takeaway from that is that for now, wearables have not gotten into the hands of the people who could really benefit – older folks with chronic conditions. And, without a doubt, for wearables to have a meaningful affect on healthcare, adoption will have to rise quickly – across all demographics. And in order to do that, it’s going to need what many call “the killer app.” Something that really excites people, that starts to motivate them to purchase.
- Because for many non-early adopters, they’re just not seeing the point. In fact, according to a recent survey, that’s the number one reason people weren’t interested in purchasing a smart watch. And in the HRI survey, when consumers were asked how much a wearable would have to cost before they would purchase, very few said they would pay over $300, about 2 in 5 were open to the $100 price point, but you had to get down to free to get close to 70% of the respondents to be interested in using a wearable. The good news is? The point is coming. Within a short period of time, some of those functions that will push wearables from early adaptors to the early majority are on their way, or almost here. Things like heart rate tracking, calorie tracking, more compatibility, 4G connectivity and simply better looking devices are just around the corner. That’s one reason that we’re going to see growth in the wearable market like Jared showed us earlier. In fact, last week, eMarketer released its first wearable forecast, stating that the wearable market will grow 60% this year and predicting that by 2019, 40% of US internet users will own a wearable. And three weeks ago, Rock Health noted in a study that wearables could be moving beyond healthy early adopters – 1/3 of people hospitalized last year adopted wearables after their hospital stay.
- We’re still at the early adopter stage of wearables and wellness. About 1 in 5 Americans own a wearable today. And according to a Nielsen survey from earlier this year, 75% of owners are early adopters of technology, about half are younger than 35 and about a third earn more that $100k per year. So, a key takeaway from that is that for now, wearables have not gotten into the hands of the people who could really benefit – older folks with chronic conditions. And, without a doubt, for wearables to have a meaningful affect on healthcare, adoption will have to rise quickly – across all demographics. And in order to do that, it’s going to need what many call “the killer app.” Something that really excites people, that starts to motivate them to purchase.
- We’re still at the early adopter stage of wearables and wellness. About 1 in 5 Americans own a wearable today. And according to a Nielsen survey from earlier this year, 75% of owners are early adopters of technology, about half are younger than 35 and about a third earn more that $100k per year. So, a key takeaway from that is that for now, wearables have not gotten into the hands of the people who could really benefit – older folks with chronic conditions. And, without a doubt, for wearables to have a meaningful affect on healthcare, adoption will have to rise quickly – across all demographics. And in order to do that, it’s going to need what many call “the killer app.” Something that really excites people, that starts to motivate them to purchase.
- For wearables to really work, they will need to get implemented into clinical workflws. That’s easier said than done. It’s no surprise to any of us that the clinical visit is in the midst of a transformation, primarily being led by EHR adoption. So, it’s no surprise that just 15% of physicans of reported discussing wearable health technology or the use of mobile health monitoring with their patients. There’s already huge challenges associated with data generated by the EHR making the doctor’s visit less personal– adding data from a wearable or mobile device is just one more piece to manage. But, as with consumers, there is light at the end of the tunnel when it comes to clinical adoption of wearables. Because while few physicians are discussing wearables with their patients today, 79% believe that using mobile devices can help physicians better coordinate care. So there is a future for wearables in the clinical space. And, like with consumers, we’re not too far away. There are a few key trends that will help us get there: Population health This is no surprise to anyone, to reach the goals of population health, monitoring needs to play a large role. Interoperability I just mentioned the amount of data today’s physicians need to navigate. In order for wearables to be a more consistent part of the patient exam, the data needs to be seamlessly integrated into the EMR. Data quality We’re at the early stages of wearables, and while some of the data is accurate, much of it is not accurate enough to make medical decisions. But it will get there. If you’ve read the book “The Digital Doctor by Bob Wachter (and if you haven’t I highly recommend it) I loved his point that before we had the iPad, we had the Newton. Some of today’s wearables are nEwtons, but the iPads are coming.
- For wearables to really work, they will need to get implemented into clinical workflows. That’s easier said than done. It’s no surprise to any of us that the clinical visit is in the midst of a transformation, primarily being led by EHR adoption. So, it’s no surprise that just 15% of physicans of reported discussing wearable health technology or the use of mobile health monitoring with their patients. There’s already huge challenges associated with data generated by the EHR making the doctor’s visit less personal– adding data from a wearable or mobile device is just one more piece to manage. But, as with consumers, there is light at the end of the tunnel when it comes to clinical adoption of wearables. Because while few physicians are discussing wearables with their patients today, 79% believe that using mobile devices can help physicians better coordinate care. So there is a future for wearables in the clinical space. And, like with consumers, we’re not too far away. There are a few key trends that will help us get there: Population health This is no surprise to anyone, to reach the goals of population health, monitoring needs to play a large role. Interoperability I just mentioned the amount of data today’s physicians need to navigate. In order for wearables to be a more consistent part of the patient exam, the data needs to be seamlessly integrated into the EMR. Data quality We’re at the early stages of wearables, and while some of the data is accurate, much of it is not accurate enough to make medical decisions. But it will get there. If you’ve read the book “The Digital Doctor by Bob Wachter (and if you haven’t I highly recommend it) I loved his point that before we had the iPad, we had the Newton. Some of today’s wearables are nEwtons, but the iPads are coming.
- So once you have consumers purchasing wearables and physicians utilizing them in the clinical space, you have a new challenge – ensuring the patients stay engaged with their wearables. Because in most cases, the patient must use the wearable consistently for it to show value. But, according to a study from HRI, less than half of wearable owners wear their device every day. According to another survey, from endeavor partners, one-third of users has still stopped using their devices after six months. But again, there is hope. According the Rock Health report I mentioned earlier, many of the wearables that end up in the drawer are gifts – those that purchase a wearable for themselves are more likely to keep using it. So, there is progress, but this really is the largest challenge associated with integrated wearables into patient care – the patients must be engaged. And that gets into motivation and human behavior, a complex space to say the least – but it will be key to the success of wearables moving forward. And it requires more than a couple of slides and me to explain, so I am going to hand it over to Russ.
- So once you have consumers purchasing wearables and physicians utilizing them in the clinical space, you have a new challenge – ensuring the patients stay engaged with their wearables. Because in most cases, the patient must use the wearable consistently for it to show value. But, according to a study from HRI, less than half of wearable owners wear their device every day. According to another survey, from endeavor partners, one-third of users has still stopped using their devices after six months. But again, there is hope. According the Rock Health report I mentioned earlier, many of the wearables that end up in the drawer are gifts – those that purchase a wearable for themselves are more likely to keep using it. So, there is progress, but this really is the largest challenge associated with integrated wearables into patient care – the patients must be engaged. And that gets into motivation and human behavior, a complex space to say the least – but it will be key to the success of wearables moving forward. And it requires more than a couple of slides and me to explain, so I am going to hand it over to Russ.
- The exam room is everywhere now – this is the lens to look through. We live in a world of democratized medicine, empowered patients, and mobile health (mHealth). Empowered patients are tracking some data and want access to the rest of it. We have telemedicine, retail medicine (Minute Clinics), remote monitoring, and home blood test ordering. 10-30% of what happens in a primary care facility will take place on an iPhone in the next 2 years (spoken 1 year ago).
- So, as Russ has shown, once the the patient has the wearable, they key part of a strategy will be keeping the patient engaged beyond the honeymoon phase – the first few weeks. And, when you look at us – marketers and digital strategists – we’re now into our realm. One way or another, we are all part of developing communication strategies and tactics, right? Success will be defined in the wearable space by executing the right communcations strategies and tactics. And the key to success in developing communication strategies is to understand your patients and their motivations on a more granular level. The way to get there is by talking to your patients through research. As you all know, there are more types of research than any of us know, but we’d like to point a couple of approaches we recommend you consider.
- The first step in truly understanding your audience is to segment them. People in your community are going to interact with wearables in different ways. The types of communication that will motivate them will differ among segments. It is important to understand the nuances between these different groups. One key – don’t segment by demographics. It’s easy to say, one group is millennials ages 18 – 34 and another is boomers ages 55 – 70. But that won’t help you – you want to segment by psychographics, behaviors and motivations. Only through that approach will you gleen the insights you need to optimize your communication strategies.
- So, how can you segment by psychographics, behaviors and motivations? You need to collect that data through surveys and make sure you are asking the right questions. And as you review all of the data, you will find patterns and clusters of people grouped by similar motivations and behaviors. These clusters are what will tell the true story about the segments you are communicating with – not their age and gender. And while segmentation will provide the foundation you need to develop an effective strategy, it’s just one step. Russ is going to talk about the next step.
- How do they differ by segment? At what point do they fall off? Where do they need that extra piece of motivation? You must accomplish this by speaking to your audiences directly. Only they can give you actionable insight.
- Motivation Automation.
- Motivation Automation.
- Instead of creating a communication strategy, involve marketing, clinical and technology in creating a wellness strategy that breaks through all walls and silos within the organization. Think like a sociologist. Think like a psychologist, an economist… Think about what words or actions will incentivize the actions we want to see.
- Motivation Automation.