Lifetime Health Diary
Unraveling the US Healthcare Puzzle
It has been a couple of weeks since the last time I updated the blog – lots of going on here, traveling around the US, and uncovering new problems/opportunities in the US healthcare system, meeting new people and attending a few other conferences besides Health 2.0 in San Francisco.
A few days ago I attended some sessions at the AdvaMed Convention in Washington DC. Really enjoyed a session at the NZ Embassy with AdvaMed participants as well as attending the International Delegates Forum where 30 odd companies got a chance to introduce themselves and facilitate networking and possibilities of new partnerships. Even though most attendees were from the medical device industry, AdvaMed was an excellent place to learn about new emerging technologies, problems those devices are trying to solve and find possible synergies for LHD with some of them. Was impressed by how NZTE (New Zealand Trade and Enterprise) are doing an excellent job of helping NZ innovative companies attain entry into the US market, get them up to speed with current legislation and obstacles, and expand their networks.
After that was the NCPA Convention (National Community Pharmacists Association) in Philadelphia. It was an excellent expo and invaluable day spent walking around, talking with people, learning more about Medicare Part D and MTM (Medication Therapy Management), discovering that it is such a new and therefore quite flexible market with so many opportunities and ways to go particularly in MTM services and retail chains. Everyone I was talking to are seeing retail chains being a new “one stop shop” for all kinds of healthcare services including receiving healthcare and medication review/optimization services. Lots of going on in this area, though it still seems to be quite vague in terms of best practices (probably a good thing in terms of opportunities). The main problem though is still reimbursement, i.e. who pays the pharmacist or any other qualified care provider for MTM services? And how much ? (especially taking into account all the complex cases where chronic or elderly patients are on multiple medications, and the review/reconciliation/risk management, optimization for complex cases can take over 2 hours while providers are reimbursed maximum for 1 hour, etc). I was able to meet with a few market leaders in the industry, and got very good insights.
Last stop before I head back to NZ is San Diego. Seems like my company is moving in the right direction and I have some interesting developments to announce soon in terms of our US operations and business. On November 3 I arrive in Wellington, NZ to attend the annual HINZ conference - the major NZ exhibition for Health IT. I am very much looking forward to that. As some of you may know NZ is a very innovative country yet with a small market NZ companies need pipelines to enter the vast US market. These past 4 weeks in the USA have gone a long way to creating our own pipeline for LHD into the US market.
Yours in health,
Hamish
Health 2.0 Conference Highlights
It was a very patient-oriented conference. Intense, collaborative and lots of social networking. The “Patient 2.0” session concentrated on themes such as how to engage a broader population in healthy life. Behavioral change. Connecting with real people using their language. ROI on the patient, outcomes, data…
The entire conference was full of innovation. Many young companies with clever and promising ideas. Doubtful as to whether the ecosystem can support all of them, but some will end up being transformational. For example, many companies were focused on consumer compliance for medications, which is an area that has been worked on for 30 years, with mixed results.
Using aggregated data; the US Government is very keen to open data to the public, Health and Human Services CTO Todd Park is a driving force behind making that happen. Making sense of narrative data is a challenge for now, but everyone looks forward to that.Transforming data to information to knowledge to action. Ron Zeiger of Google Health spoke about
“Finding an easy and fun way to collect data, open systems. Collaborative Health Records”.
There was an excellent Venture Capital Panel (Don Case, Esther Dyson, Lisa Suennen, Mitch Kapor, Bryan Roberts) at the end of the 2nd day: About half seemed not overly keen in investing in health IT (Esther was a notable exception) because it is still a rather vague industry and the ROI is often not immediate. However, Esther Dyson made some telling points; the Health IT world has changed because ubiquitous mobile technology and ubiquitous sensors are disruptive forces that allow creators to go straight to patients and clinicians with their products and services, bypassing hospitals and bureaucratic health systems.
It was invaluable to hear some of the great advice from the investors, such as 1) tell the story about your company, why it matters, what will it do for the system. 2) Short but deep advice from Esther:
“Be imperfect”, read VC suggestions before approaching them; “Be considerate of what the other person wants to hear, not what you want to tell”.
Overall, it was a great event to attend, get a feeling for the industry, meet with innovative, visionary people, chat formally and informally, brainstorm and develop new ideas. Looking forward to keeping in touch with everyone!
Yours in health,
Hamish
Health 2.0 in San Francisco. Quick update
A very quick update from Health 2.0 in San Francisco before I post a full recap of the conference tomorrow.
It was an eye-opening event with smart, dedicated, passionate participants who are all about changing healthcare, its delivery and finding ways to provide right information in a timely manner for each and everyone.
What really stroke me during the event is a positive energy, entrepreneurial spirit and desire to find sustainable solutions to current problems. Hamish and myself very much enjoyed every session and panel starting on Wednesday with Patient 2.0 session (and its fantastic speakers – patient advocates – such as Regina Holliday, Gilles Frydman, Amy Tenderich, ePatient Dave de Bronkart and others) and finishing up late Friday with Investor Panel where Esther Dyson, Don Casey and others talked about current and future state of Health 2.0. and the path of investments in that area.
Come back tomorrow for a 2-day Conference recap!
Health 2.0 Conference
Our theme today is the Health 2.0 Conference, taking place this week in San Francisco.
I will be in San Francisco Oct 6-10 for Health 2.0
San Diego 10-14 (Biotech and Pharma)
DC / Penn / NY? And Boston? 15 – 24
The conferences I hope to attend in this time include AdvaMed, Connected Health, and maybe the NCPA 112th Annual Convention and Trade Exposition
Health 2.0 – is the first on the list. Katerina and I will attend the Patient 2.0 session on Wednesday:
Time: 3pm-6pm, October 6
Place: San Francisco Hilton
Advocates include:
- Regina Holliday, Medical Mural Advocacy Project
- Amy Tenderich, DiabetesMine
- Nicole Boice, The Children’s Rare Disease Network
- Ian Eslick, MIT Media Lab
- Gary Wolf, Quantified Self
- Gilles Frydman, ACOR
- ePatient Dave de Bronkart, Laugh, Sing and Eat Like a Pig
- James O’Leary, Genetic Alliance
There will be a stream of tweets, the conference official hash tag is #health2con. Katerina will be tweeting updates as well from @katekson
- Here is the agenda
- This year’s main theme is “the emergence of the data utility layer”, which will include the changing landscape of Healthcare, social media, patient empowerment through knowledge, self-tracking and engagement.
- I am looking forward to the demos by new companies, commentaries from leaders in the industry on different issues such as data mining and analyzing, patient communities, consumer-centric healthcare etc. I should be in San Francisco until late Saturday.
By the way, good news…we finally finished applying for patent in the US, and are pleased to announce our new B2B product LHD MedView™ – which we will be looking forward to talking about with people during the conferences. Here is link to our info sheet for this new product
I am really excited and looking forward to connecting with people in the US the next 3 weeks. We’ll be posting blog updates every other day or more often directly from the conferences.
Yours in health,
Hamish
Solving the Unsolvable? Putting Pharmacy data in front of everyone at once
You would think Pharmacy data would be easy – after all, how difficult can it be to capture a person’s medicine regime and display it to the health professionals who need to see it?
Well, if the physicians, pharmacists and specialists are all on different software and systems, and the patient has no access at all, it is close to being unsolvable.
Thanks to sterling support from the pharmacists and pharmacologists in New Zealand we have been working with, we have managed to convert pharmacy data into not only a more easily comprehendible display, but allow that display to be viewed in real-time by any health professional the patient chooses to authorize. Yes, that’s right; the patient owns the record, and is able to authorize the relevant health professionals to view it. With clinicians in New Zealand, we are collecting initial consent from the patient at community pharmacies, which are motivated through the writing of regular prescriptions to have repeat customers collect medications at their store.
The more we work on this, the more we find out the problems people are having with the current system that keeps patients effectively in the dark. We are creating a small brochure to describe LHD MedView™, and the printer who we are using for the job spent a few minutes telling me about his wife who is on a real cocktail of medicines, hardly any of which he could remember as she was whisked to hospital suddenly a couple of weeks back. It also turned out that when her regime was analyzed, it was not optimal to begin with and the hospital instigated a number of changes. Changes which her next GP visit will probably not have easy or even any access to!
It is staggering to think how much inefficiency, wastage and suboptimal outcomes occur simply because patient’s medicine regimes are not well stored nor tracked, nor optimized over time.
We are very happy to be able to release the beta of our new product, LHD MedView™, which we hope will go some way to help solving these issues. I will write about LHD MedView™ next week – I should also be able to include a live link to the product by then as well.
There are quite a few acquaintances in the USA waiting to see this product, so next week I will jet off to the USA to visit them. If you are in or near San Francisco, Los Angeles, San Diego, Washington DC or Boston area (possibly NY too), then let me know. I would be happy to meet up to chat a bit more about it and find out if it can be of benefit for you.
Yours in health,
Hamish
Tools to assemble all the pieces of primary care data together – Part 2
Last Thursday (see my post from last week) I gave a talk to the General Practice Research Group at Otago University. one of the two main medical schools in New Zealand. It was a really interesting discussion, with much the interest being centered around providing General Practitioners with the ability to view medication regimes in a more easily and quickly comprehensible format.
There was also interest in using Lifetime Health Diary™ in extreme patient cases, where it can be difficult to draw up a complete patient background and keep track of it – particularly when a patient is seeing multiple practitioners and specialists. Some of the GPs present said they would like to try using it with some of their “problem patients”.
Perhaps unsurprisingly, there was also interest in Lifetime Health Diary™ assisting with smoother handoffs between different care settings and providers (including a better follow up and communication tool after discharge). One concrete example mentioned of interest was helping community pharmacies reconcile health and medication regimes of patients and providing a strong link between nursing homes, GPs and pharmacists. In other words, a genuine Health Reconciliation Tool.
This ties in strongly with another theme of interest – Distance Medicine and Rural Health. Rural pharmacies, as the only dispensary for many miles around, have the potential to serve as a pure source of community pharmacy usage – unlike in cities, where consumer choice in using any pharmacy creates data silos between patient and the various pharmacies and GPs they frequent.
I look forward to being able to release the view of our new medication optimisation tool in the next few days, I will post that on next week’s blog, and discuss why clinicians we have spoken to are looking forward to using it.
Yours in health,
Hamish
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Tools to assemble all the pieces of primary care data together
This coming Thursday I give a talk to the General Practice Research Group at Otago University.
Otago University is one of the two main medical schools in New Zealand, and is highly regarded internationally for its innovative research and education of top class clinicians.
Some of the General Practitioners in the Department have expressed interest in Lifetime Health Diary™, especially as we are now beginning to be used on the ground by registered nurses in community health settings. Anything that can alleviate pressure points in healthcare delivery, particularly around early interventions and patient engagement, is something of interest to General Practice and I look forward to the opportunity to demonstrate what our product can do.
Topics I will be covering will include…
- How to improve communication between patient, community care provider & General Practitioner.
- Smoother handoffs between different care settings and providers (including better follow up and communication tool after discharge.
- Provide better and quicker understanding of poly-medication regimes.
- Medication Optimisation and measuring patient progress by regimes.
- Health Reconciliation Tool between rest homes, GPs and pharmacists.
- Distance medicine / Rural health.
- Green prescriptions (i.e. exercise and lifestyle recommendations), patient health management & patient safety.
- Preparing for the upcoming 40-year bulge of aging Baby Boomers
I look forward to writing up some notes about GP reaction, comments, and generally what happened at the talk next week.
Yours in health,
Hamish
OpenNotes research into opening EMRs to patient viewing
- Image via Wikipedia
I was on a particularly stimulating Twitter Chat session today with the #HPM (Hospice and Palliative Medicine) group. During the session Christian Sinclair introduced the chat topic
Recent program called OpenNotes got some press. Patients can see their medical record. How should hospices approach this?
Katerina mentioned the project in one of her earliest posts back in July. Thus, just to remind OpenNotes is a “demonstration and evaluation project exploring what happens when the medical record becomes far more transparent than in the past.”
Now, from LHD’s point of view open-ness and transparency is a critical part of patient-centered medicine. The ability for a patient and her carers to choose whether or not to read the doctor’s medical notes is what matters. Technically the linking of computer systems with external email and in a secure environment may make rolling out a program like this expensive.
Fact: some people want to be more engaged with their health than others.
The Researchers elaborate further on their underlying hopes for the study
OpenNotes is a simple, but potentially disruptive intervention that aims to transform the patient-clinician relationship as it furthers both transparency and the democratization of health care. The “bottom line” evaluation of OpenNotes is straightforward: Will patients and doctors want to continue when the study period ends?
Some of the issues which this raises are
- should the doctor write in a different manner because the notes may be read by a layman
- will this raise the time doctors spend on documentation
- will this create greater engagement by the patient and her carers in the treatment
- can this new channel of communication ease the administrative burden on doctors
What will be interesting is whether there is any variation in the research findings from the three different hospitals selected for the study. I am glad that it’s planned to be a long term study running for over a year and the researchers are actively encouraging the public to contribute their views. The research methodology summary.
We found some bloggers writing about OpenNotes:
- Why OpenNotes and access to the medical chart is important (kevinmd.com)
- Should Patients Read the Doctor’s Notes? (New York Times)
- Conversation Continues Around OpenNotes – Let the Researchers Know What You Think (rwjfblogs.typepad.com)
- Open Notes Project – Right Thing or Wrong Question (ehealth.johnwsharp.com)
- Should Patients Read Doctors’ Notes? Wrong Question (Roni Zeiger, Google Health)
Better hospital hand-offs for patients with multi-med regimes
Last week I wrote about Hospital hand-offs and medical errors, and how they are a systemic problem in hospitals and that it is an area that needs to be improved.
It is a complex problem, a number of organizations are embarking on projects in attempts to solve the issue. There are various innovative strategies such as Project BOOST and Project RED (Re-Engineered Discharge), which respectively provide a comprehensive toolkit for handoffs and patient-centered interactions to learn about after-care plans following discharge.
Paul Levy, CEO of Beth Israel Deaconess Medical Center in Boston writes about a Senior Resident, Kelly Graham, who helped initiate three simple interventions that dramatically improved patient handoff outcomes.
Recently I met with the CEO from Mercy Hospital in Dunedin, who said that
a better tool for medication hand-offs would help during admissions as well as patient discharges. All too often now the “Hospital Reconciliation Tool” consists simply of patients bringing a bag with all the meds they are on
- we checked with Beth Israel Medical Center in New York, where it is also the same procedure. Conversations we have had with various clinicians indicates that to hope that all medications are all neatly noted down correctly and then made available for clinicians in the hospital to view whenever required is just that, a hope.
We hope we can provide a solution to at least the medicine reconciliation part of the equation soon with our new Med Optimization tool. It should work for hospital handoffs as well as community-based healthcare at pharmacies. If anyone working at a hospital would like to try out a better handoff tool for medication regimes, by all means drop us a line.
Yours in health,
Hamish
