New Zealand
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.”
The Benefits of Medication Management & Optimisation
My post last week on Tools to help pharmacies manage medications has received comment in various places, so I thought I would extend it out a little more.
Last week I observed that both here in New Zealand and in the USA, pharmacies are increasingly moving into the field of medicine optimisation through medicine management. Why not? After all pharmacists are acknowledged experts at handling medications.
Dave Nazaruk in a white paper he produced for StayWell Custom Communications lists some revealing statistics on P.15 that show the cost of not managing medicines properly:
- The (US) healthcare system incurs more than US$177 billion annually in mostly avoidable health care costs to treat adverse events from inappropriate medication use.
- MRPs (medication-related problems) rival the costs of cardiovascular disease…for every dollar spent on prescription medications, we spent approximately the same amount treating MRPs associated with those medications.
These are pretty sobering statistics. Medication management and optimisation is currently a very ad-hoc system, full of loopholes and inefficiencies. GPs do not necessarily know where your prescriptions will be filled, and pharmacies do not know if you are on medications from other GPs in addition to the GP clinic that their pharmacy prescribing systems is directly connected to.
Apart from the inefficiencies, it is downright dangerous for people to be on multiple medications without having a systematic method of management. From my own anecdotal evidence, earlier this year a GP here in Dunedin told me that the worst case he had heard of in New Zealand concerning a lack of medication management resulted in an elderly lady being on 73 medications prescribed from 42 GPs! I asked him what safeguards were in place to prevent that kind of situation, and he replied, “Nothing!”.
So what might better risk assessment tools look like? Ultimately, such a tool needs to be wrapped around the patient, so the record can travel with them. In the short term however, a lot of efficiencies would be gained from community pharmacists and GPs and other providers being able to better comprehend a multi-medication patient’s medication regime. Currently, the data sources are not only disparate, but understanding them is non-intuitive, difficult and time-consuming.
This is easier said than done, gathering medication sources is not just difficult technologically, but involves an exercise of covering up data gaps and assumptions behind members of the care providing team that are often not captured systematically. And then reconciliation of all the data take the challenge to a new level altogether! However, the rewards in terms of better health outcomes for individuals, as well as system savings as a result greater efficiencies make this space an imperative for innovation.
Yours in health,
Hamish
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…!
The Project: A Healthy Community Enabled by Information
The project is a result of a partnership between Ignite Consultants and Lifetime Health Diary Ltd and a number of community groups. We all see a great need to address some of the pressure and problems resulting from the inefficiencies of the current health information management system. A significant slice of the population is not receiving the healthcare they should be, for a variety of reasons. This only makes all of society poorer, as their conditions and quality of life get worse and more expensive to treat than would otherwise be the case with timely interventions.
We believe in a bottom-up approach and harnessing the power of technological innovation, academic expertise matched with real needs of real people on the ground, powered by the spirit of young, talented students who want to make a difference.
We want to work together to, in a collaborative manner, enable cost-effective solutions and drive a movement of access, empowerment and knowledge in healthcare.
I am thrilled to be a part of it and I truly believe that this is the beginning of an exciting journey of collaborative effort to not only empower those the most disadvantaged to live better lives but transform the way we manage our health and interact to create a healthy community enabled by information.
We want this blog to be a communication platform for everybody who is involved and who is supporting this initiative, to share ideas and track our progress. Let`s get it started!
A Little Background About Me
My name is Aga and together with 6 outstanding individuals I run Ignite Consultants, an organization which aims to channel resources, train leaders and build partnerships between businesses, the not-for-profit sector and academia for the growth of a sustainable society.
I am from a very entrepreneurial background, interested in how to make a sustainable difference in communities. I grew up in Poland, studied and worked in Glasgow, and have been continuing my life adventure here in Dunedin, New Zealand for the past year and a half.
While running a Social Entrepreneurship Project here in Dunedin, New Zealand, I came across Hamish MacDonald and Lifetime Health Diary Ltd. But it wasn’t until 2 months ago when he actually showed me his innovative software that with my experience of working with different disability groups and not-for-profit organisations, I saw it as a tool which could make a huge difference by enabling people to better communicate with doctors and caregivers as well as putting control back into their own hands.
The last couple of months has been an exciting journey; a huge learning curve, meetings with more than 20 organizations, discovering problems, thinking, rethinking, matching pieces of the puzzle and creating a strong vision of Healthy Community Enabled by Information
Encouraged by support from Otago University, local bodies and politicians we have decided to kick off a collaborative project which we strongly believe will create a huge impact in Dunedin’s communities and hopefully later, other communities in New Zealand and around the world.
This series of blogs will document our work, results, learnings, progress and everything else involved in bringing better health to communities! If this is a topic of interest for you, I would love to hear from you, wherever you are!
