Patient powered care
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Pat Salber's (CEO of HealthTechHatch and Host of The Doctor Weighs In) presentation to the 10/21/15 at annual meeting of the Diabetes Technology Society. It focuses on technologies that support patient-powered care.
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Patient powered care
- 1. PATIENT- POWERED CARE HOW TECHNOLOGY IS SHIFTING THE “PATIENT” PARADIGM
- 5. 4 TECHNOLOGIES FUELING PATIENT-POWERED CARE • Ready access to high quality medical information • Tools for self-diagnosis, self care (DIY or DIT) • Peer-to-peer and communities • New care delivery models
- 6. ACCESS TO HIGH QUALITY MEDICAL INFORMATION • Wikipedia • Branded info (e.g., Mayo Clinic, WebMD) • PubMed • Medical journals • Googling • Peer to peer (more on this later….)
- 7. TOOLS FOR SELF- DIAGNOSIS, SELF-CARE
- 9. NEW MODELS OF CARE DELIVERY
Editor's Notes
- In 2010 I wrote an article on do-it-yourself healthcare where I suggested that newly available technologies were going lead to patients being engaged in self-diagnosis and self-care in a way that we haven’t seen before. So, although our patients probably are not going to be operating on themselves anytime soon, they are going to be doing more things for themselves – things that they may have previously been dependent on us to get done.
- In addition to technology, the rise of the ePatient movement has also contributed to the era of patient-powered care. This is a photo from an interview I recently did with Dave DeBronkart, a kidney cancer survivor who has become one of the most well known patients in the e-Patient world….in fact he is best known by his twitter handle: ePatient Dave. He has the notable distinction of just having completed a Visiting Professorship in patient experience at the Mayo Clinic. When I asked him what the e stood for he said: empowered, engaged, equipped, enabled, electronic, expert, evidence oriented, etc. etc. Of course I know that not all patients are like Dave, but I think you are probably already seeing people like Dave in your practices – they are all over the place and they are out their recruiting more and more people to the movement.
- In this udpated eHealth Enhanced version of the Chronic Care Model from the Journal of Medical Internet Research, you see that improved outcomes rely, in part, on informed, activated patients What we are going to talk about in this brief presentation are technologies that are informing and activating patients, and in some cases going even farther by empowering them to do more for themselves and liberating them from total dependence on the healthcare system…all good things.
- With that as background, lets take a look at 4 technologies that are fueling patient-powered care: Ready access to high quality medical information Tools for self-diagnosis & self-care – both for do-it-yourself, but more commonly for do-it-together care. Peer-to-peer and community support New care delivery models
- At the beginning of my career in medicine, I was the owner of medical knowledge for my patients. It was either in my head, in the big books on my bookshelf or in the medical journals piling up on my desk waiting for me to have time to read them. Not anymore, the internet has democratized access to even the most sophisticated medical knowledge and patients are accessing it - whether via Wikipedia or branded medical information sites, like Mayo or WebMD. But patients are going farther than that. They are using PubMed to find the latest literature on their medical conditions and reading, even subscribing to medical journals on topics they care about. They are also googling and that can get them into trouble as you know. There is a lot of misinformation, junk science littering cyberspace and it isn’t always easy to distinguish the good from the bad. Patients are also getting information to take care of their issues from peers – sometimes in person, but increasingly frequently via the internet. We will be exploring this more in a bit.
- When I was doing research for the article I was writing on do-it-yourself health care, I discovered you could turn your spare room into a doctor’s office by buying whatever you want or need on Amazon – ranging from home defibrillators to portable interpretive EKG machines and ultrasound devices. And, I found that patients were loving it – a woman with a high risk pregnancy raved about the Doppler ultrasound she bought to listen to fetal heart sounds and a mother gave thanks for an otoscope that allowed her diagnose her daughte’rs ear infection faster than she could get a doctor’s appointment. Here’s a selection of digital tools that patients are or will be using with or without you. Starting in the upper left, that house is a graphic to represent Opternative, a web application that lets you do an eye refraction at home. Although it isn’t as sophisticated as the expensive gadgets in the ophthalmologist’s office with all those dials to fine tune the measurement, it apparently is good enough to generate a prescription that eye doctors will fill for your next pair of glasses or contacts. You can do the refractive eye exam for free on the site, following simple instructions read to you via an app on your smartphone. If, after you are done, you want a prescription, you pay $40 and it generates a prescription signed by a board certified ophthalmologist licensed in your state. Right below it, is the AliveCOR single lead EKG that works in conjunction with your smart phone. Developed by cardiologist Dave Alpert, it is works via a smart phone app to help patients understand their heart rhythms. All they have to do is hold onto the sensors or hold the device up to their chest and it records a 30 second single lead ekg. AliveCor’s FDA cleared “Normal Detector” can determine instantly if the rhythm is normal. In addition, AliveCor's FDA-cleared Atrial Fibrillation (AF) Detector can immediately detects atrial fibrillation in an ECG. For a low fee per recording, patients can get an ECG analysis report from a board-certified cardiologist or U.S.-based cardiac technician. This service is also available in the U.K. and Ireland, provided by U.K.-based cardiac physiologists. And, of course they can always share their ECG with their own physician for no additional charge. In the top middle, you see the EKO stethoscope – I love this in part because it was developed by three UC Berkeley grads – an electrical engineer, a mechanical engineer and a business guy. They created an add-on that converts analog stethoscopes in to digital devices that clarify and amplify heart sounds as well as generate phonocardiograms. The recordings and the phonocardiograms can be sent to cardiologists for interpretation. And they can be entered into the medical record in order to monitor for changes over time. This device is also FDA-cleared – in fact these guys are the youngest team ever to win FDA approval. Just below that, and while we are on the topic of youngest ever developers, I have included the Aezon Tricorder. This was developed by undergraduates at Johns Hopkins to compete in the Qualcomm Tricorder X-Prize. This contest will award $10 million dollars to the team creates a device that allows consumers to accurately diagnose 16 health conditions – 13 required core conditions and a choice of three elective conditions – in addition to capturing five real-time health vital signs - independent of a health care worker or facility. They also have provide a compelling consumer experience. Aezon is competing against some well-funded companies including Silicon Valley’s darling, Scanadu. They just made it into the list of 7 companies still in the running for the prize. Cell Scope is a device that attaches to the iPhone and allows consumer to visualize the ear drum when they are concerned a family member may have an ear infection. Although designed as a “do-it-together” (DIT) device, families will undoubtedly learn how to diagnose normal and avoid unnecessary trips to the ER or their pediatrician’s office. The last company on this slide is CliniCloud. I met these guys about a year ago – two recent MDs from Australia who wanted to design a device to help people in the developing world diagnose lung problems. They spent some in Silicon Valley and ended up pivoting to create CliniCloud – what they call a connected medical kit for the home. The kit consists of a digital stethoscope and a non-contact thermometer. They are not only great devices, but they are also beautiful and will undoubtedly have great consumer appeal.
- Switching gears, I want to talk about peer to peer support and patient communities. Patients Like Me was founded by the brothers of a young man with ALS. They created some of the earliest online patient communities and figured out how to monetize by sharing, patient data in a responsible way. What they do is probably more effective than a typical phase 4 trial. Omada Health, although only 5 or so years old, is now consider one of the granddaddies of peer based patient support. Their first product, Prevent, is based on the accepted curriculum for diabetes prevention – working with the legendary design company, IDEO, CEO Sean Duffy, on leave (I suspect permanent) from the Harvard MD-MBA program, designed a program to mimic bricks and motor diabetes prevention programs that were already being reimbursed by Medicare. They have been very smart about their development building clinical trials of their effectiveness into the business from the beginning. Quantified Self is not really a company, rather it is a movement based on the incorporation of technology that allows individuals to self-track using a variety of digital devices. It was first discussed in 2007, but really took off when Wired Magazine editor Gary Wolf spoke about it at a 2010 TED talk. The first QS conference was held in Silicon Valley in 2011 and now there are over a hundred QS groups in 34 countries around the world. Smart Patients was co- founded by former Google doc, Roni Zeiger. The idea was kind of a mix of Kate Lorig’s in person peer-to-peer groups and Patients Like Me. They have developed a platform that allows people to form communities based on a shared clinical condition. They have dozens and dozens of clinical communities now and have a mechanism in place that makes it easy for groups of like minded individuals to work with them to form more. They are very engaged with the empowered patient movement and continually iterate with patient input. Finally, CrowdMed. I love this company. They have developed a platform that allows individuals with hard to diagnose conditions (on average these people have been sick 8 years, have seen 8 physicians and they have cost an average of $60,000) to submit their case to the platform for CM experts to comment on. So this is really a crowdsourced approach to diagnosis. Although a lot of CrowdMed’s “Medical Detectives” are retired physicians or have some connection to the health professions, some are just interested others. CrowdMed Medical Detectives suggest possible new diagnoses that the patients then take to their doctors for definitive diagnosis.
- Bright.MD and Zipnosis are similar. Both are using sophisticated algorithms to take histories from patients. Both focus right now on relatively simple conditions – UTIs, colds, flu and so forth. Bright.MD’s differentiator is that they want to automate everything in an office visit that can be automated so doctors can spend their time practicing at the top of their licenses. To wit, the history is taken and then translated into an easy to digest note for the doctor to read. If he or she wants more information, they can access the questions and patient answers on the intake form. The algorithm generates a suggested diagnosis, but the physician makes the final determination. After the diagnosis is made and treatment recommended, Bright.MD’s software generates a formal chart note and generates a bill. Because doctors don’t have to spend much time on these relatively simple routine cases, it frees them up to focus on more time on complex cases. HealthSpot (center of the slide) is one example of a new telemedicine platform. They have developed kiosks that can sit in clincs or pharmacies that patient can use to generate a video visit with a physician from a prestigious HealthSpot partner, such as the Cleveland Clinic. They are also partnering with Rite Aid in Ohio. They seem to be getting some decent traction. What I like about HealthSpot is the kiosks come fully equipped with digital diagnostic devices (scales, stethoscopes, otoscopes, dermascopes, etc.) that allow a definitive diagnosis of certain conditions at the time of the video visit. In addition, because they are co-located in pharmacies, patients can complete the visit by piking up the drugs or other stuff needed to follow the doctor’s treatment plan. I am going to finish with Health Tap and Pokitdok. They both allow consumers to connect online with doctors. Health Tap does this by allowing patients to connect with doctors willing to provide free advice via their platform. PokitDok that has created a platform that allows consumers to shop for local physicians providing services they need and want. It allows docs to set up their own transparent e-commerce market place. They can use the platform to benchmark competitors, set competitive prices, and offer patients a chance to negotiate for what they want to purchase. I suspect this platform will continue to evolve as patients and providers get used to buying and selling health services online.
- So I know that was a whirlwind tour of patient powered care, but I hope it whetted your appetite to learn more. What I like about this digital health revolution is that, if everyone fully engages and helps to shape it, it will allow us to deliver on the Quadruple Aim: better outcomes, lower costs, improved patient experience and for you all….an improve physician experience.