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The Future of Connected Health, Chapter 2

September 20, 2010

Many of you commented on the future – in response to my earlier blog, Chapter 1 – and provided terrific insights.  Your posts included future scenarios that I missed and reviewed critical components of a healthcare system improved by the ubiquitous information and communication technologies that have transformed essentially every other industry before us.

At the Center for Connected Health, we strive to create the context and verification for new care models that are more efficient and of high quality, while maximizing access.  As we look at the next several years, we must keep this fundamental mission in focus.

Taking into account market readiness for connected health as a solution to healthcare’s challenges, it seems reasonable to expect employers to adopt first, health plans later and providers last.  Certainly our current activities and market interest in our Center’s activities are consistent with this.

We’ve spent the last decade focused on creating the case for connected health for providers using our own system as a test bed.  That work continues to go well and the folks involved inspire me on a daily basis.  It will really take off when health care reform ‘ripens’ and payment reform takes hold.  I can’t wait.  In the meantime, we’ll broaden our horizons by creating a series of offerings designed to speed connected health adoption in other sectors.  The launch of Healthrageous is our first example of this activity.

Chapter 2, then, takes a look at how we can help broaden the reach of connected health, among more diverse populations in the future.

The connected health model has achieved success in helping consumers and patients who are motivated enough to care about their health reach a new level of health behavior achievement.  However, we’ve tended to offer solutions that are too one-size-fits-all and too provider dependent.  The next generation of connected health must:

–       allow for population segmentation and subsequent customization so as to engage all individuals wherever they are on their journey to improved health

–       include a more rich set of objective inputs; we need to go beyond obvious vital signs such as blood pressure, blood glucose and weight to new frontiers such as emotional state, motivational state and other currently non-quatified health determinants

–       predict individual coaching requirements and deliver those coaching tools/messages in the most efficient way possible

–       integrate seamlessly with EMRs, PHRs and social networks

–       integrate with the avalanche of genetic information that will be coming our way

The Center for Connected Health will be doing our part to ensure that these refinements to the connected health model will take place.  To do so, we’ll be partnering broadly across the industy in the following ways:

–       work with providers such as Partners to integrate connected health into the next phase of care delivery, including the patient-centered medical home and the accountable care organization

–       collaborate with entrepreneurs who have novel technologies and business ideas by helping them test their prototypes, products and care models, adding our 15 years of experience to the mix

–       conduct ongoing research in the areas noted above as well as deliver services both in the Partners system and beyond

–       continue to act as a market development agent by educating and convening

–       refocus slightly  to look beyond the important work we’re doing in our provider-centric context to capture new market interest in connected health

After all, if we want to change healthcare delivery, we don’t have a minute to waste and we need to look beyond our current perch, which is highly provider focused.  We’ll be eager to jump in when providers are ready to adopt – and that time is near. In the meantime, we’ll be looking to create opportunities with  other sectors, to play our role as change agents.

Where do you see opportunity, challenges and needs? What tools need to be applied, or created, to get the job done?

12 Comments leave one →
  1. AYESHA MASOOD permalink
    September 22, 2010 2:27 am

    Most patients search internet by using key words like “doctors, online” and their specific problems. Searching this way, Connected Health doesnt appear at once, rather some indian e-health doctors at Health Care Magic are very successful at getting internet patient traffic and is a very responsive site.
    I think there is a need to Advertise Connected Health and thinking of ways by which patient might try access Connected Health this will greatly increase access to Connected Health, in short care providers need to think like those needing care.

  2. September 22, 2010 12:24 pm

    Our company has a similar perspective on lifestyle health management. We have constructed a consumer health informatics model that provides a continuum of learning and learning assessment from the Home-> Employment-> Provider-> Inpatient-> Outpatient-> Home. Employees/Patients can access the learning web-tool anywhere including smartphones and providers, health organizations, employers can easily deploy the solution at a low cost on kiosks, work stations, and group learning settings. Therefore, the user is regularly evaluated, informed, re-evaluated, and reinforced with convenience.

    The New Millennia Health clinical informatics team has researched gaps in patient and employee self-management of disease, wellness, and injury. The missing link…is the ability to provide high access and easy to use measured learning tools for the user and automated clinical decision support tools for the health manager. Our HealthyTutor.com product and sister products provide this connectivity across the life continuum, provide feedback for behavior modification, prepared data summaries of patient and employee knowledge performance for the provider and employer and, the option to access federally sanctioned best practice models for a pathway to outcomes improvement.

    Another key aspect of success with connected HIT is the ability to easily integrate into existing technology. We have created the HealthyTutor solution to quickly integrate into existing EHR, PHR, and wellness products to improve overall outcomes management, reduce costs of solution delivery and help providers achieve Meaningful Use and Patient Centered Medical Home standards.

  3. September 22, 2010 5:29 pm

    I’ve been enjoying reading your thoughts about the future of Connected Health. How important is the issue of cost and outcome transparency and how might it be approached in order to speed adoption? How will providers and payers deal with this issue? Perhaps this is another wild card.

    [This was highlighted for me by a bill for services from a large academic hospital’s ED I visited recently. It was a Saturday night cautionary visit prompted by my PCP who was justifiably concerned about rabies exposure and possible contact with a live bat…in my house.

    I received an itemized bill for $2,457.55! (Fortunately, insurance covered all but the $50 co-pay.) Review of each line item confirms that health care billing mechanisms are dysfunctional. In my case, it included “therapies” that did not occur.]

    Larry Heimlich
    617-416-4751
    http://www.linkedin.com/in/larryheimlich

    • September 22, 2010 5:38 pm

      My initial response is that transparency is important as long as we stay in a fee-for-service system. Once we get into bundles and capitation, I think its less of a concern

  4. Jim Dunlap permalink
    September 23, 2010 7:51 pm

    I agree with Ayesha Masood that there needs to be some advertising so that the general public better understands Connected Health. Maybe the pharma’s should be emulated and the public trained to ask their doctor “If Connected Health” is right for them? Of course the average physician outside of Massachusets won’t know what they are talking about in all likelihood. I am concerned as to how Connected Health will work in the present day medical environment. We are losing, or have lost, the concept of a primary care physician who treats the patient holistically and if a specialist is required,makes the referral and then integrates the findings with the patient’s medical record. The specialists don’t wait for referrals and accept any and all patients that come to them. Frequently I suspect the PCP never even knows their patient went to specialist. The specialist examines and treats the organ they specialize in and and are not concerned about the whole patient although everything is interconnected and one issue may be related to one or more other issues. I understand the need for specialization because the bank of medical knowledge is so unbelievably vast that no doctor can handle the stream of information, which is akin to taking a drink out of firehose!
    For connected health to work holistically it is more likely to succeed if one doctor, the PCP, is managing it but we don’t have nearly enough PCP’s. In short we don’t have enough doctors period. The baby boomer generation is turning into “seniors” at a very rapid pace(some 78 million of them) and if Obama care lives to provide coverage for all of the additional people that it is supposed to, there won’t be enough doctors to go around.
    Then we are likely to see clinics manned by nurse practitioners, PA’s and technicians supervised by one or more MD’s . How will Connected Health work in that scenario????

    • September 23, 2010 8:09 pm

      I completely agree that more education (marketing) around the concept is required. thanks for your thoughts

    • Ayesha Masood permalink
      September 25, 2010 5:29 am

      Yes that can be managed by Networking.
      The PCP should be able to contact any EMR connected online community of Specialists for their patients requiring care by a specialist, and for this to be efficient there should be well known online channels of specialist that PCP know or there can be few referral systems that a PCP should contact and have their patients checked by specialists who can be contacted by the PCP too, for this there is again a need for advertising and making online community or communities more accessible for search by a patient or a PCP.

  5. Micheal monson permalink
    September 24, 2010 2:14 pm

    These are great suggestions for how we move forward to improve healthcare. One area I didn’t see mentioned was the need for much better informatics. Too many decisions are left to individual clinicians which, in turn, leads to wide variation in care. We need to use more powerful system algorithms to routinize care where possible around evidence based practice. This will have the double benefit of improving quality of care while reducing expense associated with scarce clinical resources (whose time will be better managed)

    • September 24, 2010 3:35 pm

      I couldn’t agree more that the area of informatics/pattern recognition/rules engines, etc. is key to the success of this vision.

  6. September 28, 2010 3:39 pm

    I am certainly amazed at the level of innovation within the healthcare field. It is important that we use the technology in a most positive and effective manner, without losing sight of the fact that people are people. Currently, there is a wide array of products and services designed to make life easier for the elderly as well as their caregivers, I cannot imagine what will be available in the future!

  7. James O'Connor permalink
    September 29, 2010 12:05 am

    I think the more health data which gets moved to the cloud the better which seems, at least in part, to be Healthrageous’ goal. Examples such as these (http://gadgetwise.blogs.nytimes.com/2010/04/09/auto-tweet-your-weight-to-the-world/) in which users can Tweet their weight to the world embody the endless potential to inspire improved health through prevalent, easily accessible, and transparent data. All bodily functions are essentially measurable and there’s no reason why my body’s vital metrics couldn’t be tracked and monitored in some fashion. This could theoretically be accomplished through regular checkins (short term) or even implanted monitors (long term). Layered with the proper privacy securities, I would love to see analytics engines built on top of a crowd sourced health monitoring databases. To have that level of societal health data in near real-time would be invaluable.

    • September 29, 2010 10:37 am

      indeed, I have direct experience with the Withings scale and did tweet my weight to the world for a couple of months last year as an experiment. Your comment points out the ease now of gathering objective information about individuals. We’ve found that if an individual is motivated, gathering that data alone can be instrumental in changing behavior (witness quantifiedself.org). The ease of sharing is becoming more obvious too, as Withings illustrates. Our experience is that the strategy for who you share with, how the data is shared and the understanding of the parties that are recipients of the data are all important. When i tweeted my weight (http://tinyurl.com/yjfw4um), I did not find that there was much response. Others, who have recruited members of their social network to act as health coaches and advocates have found the sharing to be very helpful.

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