New technology
Health should not be a burdensome task on our daily “to-do list”
A year ago I knew nothing about our healthcare (besides few facts such as having to co-pay $5 every time I visit my dentist and having to wait for my appointment for at least 1 hour before I see a nurse for 5 minutes and my physician for another 3 minutes). But look at me now: I read healthcare and HIT news daily (not that I understand 100% everything. Well… in my defense, our Healthcare system is too complicated and disconnected that it makes it difficult to digest all the current news), with the same frequency I visit patient advocate blogs, I twit recent news, I tell my friends about PHRs and EHRs (not that they understand what I am talking about. As other 93% of our population they are too busy with a daily routine, and thinking of taking another responsibility such as engaging in their own health makes them feel overwhelmed), I attend monthly Health 2.0 Meetups in NYC where tech savvy and passionate about healthcare people discuss current issues, present demos of new patient-centric tools and connect to each other; I also attended Health 2.0 Conference in SF in October (where I had a pleasure to meet even more people passionate about healthcare transformation, and where I got to see demos of even more patient-centric tools).
However, this is my experience. I probably would not be engaged in healthcare and my own health unless I gotten evolved in the company where I am at now. Look at my friends – they still do not understand what I am doing and why do they need having their health records available to them all the time wherever they are. (Yes, they like to use a few iPhone apps which help them track fitness and diet progress though). They just do not get it! And looking at the current statistics most of our population does not get it either (e.g. only 7% currently use PHRs).
What it tells me is this is a time to finally start rolling out campaigns directed on the patients (I purposely do not use “consumers”) to bring awareness, education, engagement and, finally empowerment. Health is local - so let’s start educate and talk to people at where they are at now, talk to them in their “language”, show the demos of available patient-centric tools to them, let people know that no doctors will help them to be healthier unless they make a decision themselves to do so. Health should not be a burdensome task on our daily “to-do list”. It should rather be an enjoyable part of our daily lives (taking in account all these cool HIT gadgets available our there, and, yes, people actually like cool gadgets – we just need to be aware of them) reducing the stress, time and money spent on the doctors, preventing preventable diseases and helping us create healthy, engaged and conscious population.
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
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
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
Ray Avery’s Medicine Mondiale – affordable healthcare for all
Ray Avery in his garage lab
Aga and I went to see Ray Avery talk about his autobiography, Rebel with a Cause.
Ray has a mission for his life.
Use science to change the world
You can’t change the cards that you are dealt but you can change the way you play them. He sees success over a “diaspora” of difficulty. And so he set up Medicine Mondiale as an organisation to help him change the world.
We are trying to change world healthcare by getting global organisations who aren’t doing it well to improve their delivery and reduce the costs of doing so. For him, observation is the key to innovation and he learnt to observe closely because he is dyslexic and words are ‘shapes’ to his eye.
He continues
I started to look at the world to see what made things work. Few of our inventions come from linear academic research. We were investigating and watching in Kathmandu Hospitals. Incubators are ventilated and humidified with local water. This meant we were ‘cooking’ babies in a microbial broth coming from the water supply. So we patented an air filter which enabled local, unpurified water to be used.
Before this we worked on developing a cheaper inter-ocular lens for people with cataracts. This is an easy operation and truly life-changing. But each lens costs around US$300. The Fred Hollows Foundation recruited Avery to help build a factory making a new lens design in Eritrea both providing local skills, employment and around $2m profit per annum.
We collapsed the world price for inter ocular lenses from $300 to around $10.
I didn’t want to repeat the sins of other development agencies where a large percentage of programme funding never makes it to the people who need it. They get round this because ‘everything’ is categorised as programme funding including managers in the country of origin as well as visits around the globe so only around 15% of donations actually get to the project.
By an accident of birth around 90% of children have inadequate healthcare.
We think of ourselves as good global citizens. I see the world as a social anthropolgist and I think we can direct a proportion of our intelligensia to create a better world.
Think of a way you can make a difference.
What a great challenge – LifetimeHealthDiary will be thinking up ways to contribute to the disadvantaged.
Rebecca Caroe
Government Priorities in New Zealand Healthcare for the Disabled and Disadvantaged
- Every health organisation collects patient healthcare information.
- Health results to be made available to clinicians.
- By 2014 an individually owned health record by all New Zealanders.
“Health IT is hard because it is a reflection of a culture and its beliefs”.
“Where do the 5%-10% of people with different disabilities and chronic illnesses, who actually really need improved health information management systems and who are obviously among the most costly to treat, fit in this system? Will we have to wait till 2014 or beyond until something will be available? Would it be an idea to put something out there, maybe not very pretty, but something simple, test it, get feedback from the users, improve, test again, get feedback, improve etc? We can quite quickly develop something which can change not only how the data is managed but actually positively impact the lives of many people and organisations who are supporting them, leading the way to transformation of medical industry.”
Our First Community Group Meeting! (Part 1: Introduction)
Yesterday, with help of Sue Russell from DCOSS, Ignite Consultants held a meeting under the theme: Healthy Community Enabled by Information: Social Innovation at Work. Representatives of nine different organisations attended. Despite very short notice they kindly came to share their ideas and feedback on what can be done to address some of the problems arising due to inefficient information management systems between patient, doctors, caregivers and other parties engaged in patient health management.
We started the meeting with everybody introducing themselves, I gave a short introduction followed by guest speaker Hamish MacDonald who presented his innovative technology, Lifetime Health Diary™
I met Hamish nearly one year ago, when running my Social Entrepreneurship Project. He approached me to tell me about the global mission of his company including the 5 billion plus of those who are the most health disadvantaged in the global community, including even in our communities such as the disabled, cultural minorities, people living with chronic conditions, the elderly, etc. who very often face significant challenges in obtaining adequate access and delivery of health services.
But it wasn’t till 2 months ago when he actually showed me what, together with his team, he managed to build and how the vision becomes reality. Intrigued, and seeing a huge potential in how this tool could help people with different disabilities, I took the idea to different organisations to see what they thought. The response was overwhelming.
Lifetime Health Diary™ is a secure, free, patient-owned, internet-based health diary for recording, monitoring and self-managing one’s health, as well practice health prevention. It captures and systemizes all data inputs into an easily understandable “Graphic Natural History” of your heath through lining up all your data by temporal correlation – which is a fancy way of saying your background lifestyle factors and life events are lined up by date alongside your clinical data. This allows your unique clinical story to be better understood by clinicians and caregivers that you personally invite by secure email link to view your health record.
During the meeting Hamish talked about his friend and business partner, Dr. Atsushi Matsunaga, the inventor of the software and a person very frustrated with the inability of the healthcare system to prevent illness in the first place. Hamish shared the history and idea behind the innovation outlining 7 Requirements for the system: i) Better health outcomes for you; ii) Quicker prognosis for your doctor; iii) Shared Patient Care among your Caregivers; iv) Interoperable amongst their different systems; v) All under your Control, vi) Transferable; Accessible, Portable & Private; vii) Free for both you and your doctor.
Hamish finished his short talk, and suddenly, “Access to information”, “Better health care delivery”, “Control and empowerment”, “Patient in the centre of the health system”…a lively discussion had suddenly started and Hamish was under a stream of questions. Details in the next blog post…!
“Smart pill”? “Smart Contact Lenses”? Age of Sci-Fi…
This week I stumble upon two new developments. Both impressed me so much that I could not help myself but to share it with you: contact lenses that monitor your health and “smart pill” that is once in your stomach reports to the computer/cell phone it was taken.
Both developments involve nanotechnology and are in an experimental mode yet, and it may be a long way before you actually start wearing those contact lenses that monitor health and display information on the body temperature, glucose level, inflammation, infection or fatigue, and swallowing your morning pill. However, the fact we have dedicated researchers working on these kind of projects who combine Health IT, science and nanotechnology, gives me a hope that we are still capable of coming up with a true innovation in that area besides just developing new software, “innovative” social networks, etc.
