This EHR Mess We’re In

This EHR Mess We’re In

Dr. Matthew Hahn blogs about the current state of today’s EHR’s and rightly points out many of the same reasons that I have identified in my previous posts:

  1. The negative impact of Meaningful Use (MU) since 2009
  2. Poor usability of EHR’s

There are several other important concerns that have been left unanswered by our current Health IT offerings.

  1. Patient privacy and control of their health records
  2. Interoperability

Government Pipedream?

The solution Dr. Hahn proposed is one that hinges on the hope that government will abandon MU (unlikely given this political climate), and create a whole new EHR development program based on a national competition and then for the government to subsidize the cost of that winner EHR for physicians to use.

Subsequently, this national competition will engage physicians so that they have control over their destinies in designing the EHR of their dreams.  But is it realistic to hope that government will support such an endeavor?  Although I’m a believer that government should and ought to play a role in setting fair rules and be accountable to the public (for the many and not the few) and not to be overrun by lobbyists and those with the most money and influence who can rig the system, I doubt this solution will see the light of day with our currently polarized politics and the continued, large influence of big money interests in government today.

Movements as Inspiration

Here is my proposal that leverages existing platforms and technologies (but that most physicians may not be aware of) without hoping for the government to intervene today (or yesterday).  Only until a community of patients, physicians, and developers that have a common goal of creating an EHR that works for both physicians and patients, that we ultimately compel the government to support (financially) the further development and adoption of this type of system.  Those who have studied previous movements (such as the LGBT social movement, thee Civil Rights movement, and the women’s suffrage movement) took a group of like-minded individuals from different walks of life who struggle together, make their voices heard, participate, and ultimately control the cultural narrative to the point that government had no choice but to abide to the sea change that has already taken place.  This is where physicians and patients have to start.  And we have the tools to start the change as we see fit.


Open Source to Start the Movement

So rather than a national competition, let’s take an existing software development framework that’s called open source.  Open source is analogous to peer review in the medical world.  The software code is public for all to see, to poke at, to test drive, to criticize, and to improve upon.  It’s not proprietary (like almost all other EHR’s are) and one can take a base code and improve it and customize it as they please and donate back to the base code all the good features and code in the custom project that everyone else can share.  No need for reinventing the wheel.  Open source code and the ideas behind it already exists!

Another benefit of open source is that physicians can learn to be okay with learning something new, even coding.  Software code does not have to be a “black box” and hoping that some “magician” can save our souls.  It’s a directive, like a physician’s order – nothing more and nothing less.  Open source just pulls the curtain behind so one can learn how to code and learn how it all works.  Open source makes all of us (patients and physicians) more informed about the tools that we use.  Personally, I owe a lot to the open source movement, which is where I learned to code despite being a busy family physician.   I didn’t have to go to a class.  I just go on GitHub where most open source code projects are stored and published and away I went.  It can be done!

Lastly, open source is not expensive.  There is no license fee.  There is no entrance fee.  Physicians and patients do not have to belong to a secret membership or society to play…anyone can join.  This is how this community of physicians, patients, and developers is born.  This community is where we begin to discuss the common interests that we all have to improve our health care technology sphere beyond the current framework of rent-seeking middlemen, trust entities, and monopolistic EHR companies. The open source ethos is inclusive, not exclusive.

But, gosh, you might say, “it’s daunting to create an open source EHR from scratch”.  But I’ve got you covered…there are already several different fully developed EHRs for different scenarios and countries but the one of interest here is NOSH ChartingSystem project coupled with HIE of One.

What makes HIE of One coupled with NOSH ChartingSystem unique?  It addresses the issue of patient privacy and gives control back to the patient over the sharing of his or her protected health information to others.  How does this work?  To start with, let’s point out the current state of EHR’s today.

The Current State of EHR’s

EHR’s are typically owned and operated by an entity (large or small) where they store more than 1 patient chart at a time.  This could be a small solo practice, a hospital, a HIE (Health Information Exchange) and even the EHR vendor.  What’s the problem with this framework?  Aside from physician’s eternal gripes of poor design, two key issues: Patchwork privacy and security concerns.

Patchwork privacy is a situation where a patient belongs to an entity and has health information stored in one EHR and that information may or may not be shared to a patient-designated provider or person.  This is where interoperablity will likely be unachievable in our current EHR framework.  It’s also possible that there are instances where the patient may not know that their health information is being shared to someone else (and this is not OK!)  The patient literally has no control over their health information!  Furthermore, a signed HIPAA agreement or release of records does not guarantee that the patient has control of his or her health information and where it’s directed to.  It’s perfectly reasonable for patients to be suspicious for having their records stored in a central database just for this design reason.

Security concerns with current EHR’s are based on the idea that a system containing more than 1 patient will create a “honey pot” of data.  Imagine that you are a malicious hacker who wants to get data (social security numbers, demographics, medical diagnoses, etc.).  The chance that the hacker can break into a system without having to do it multiple times and on multiple systems is much less when they are trying to hack a central server with multiple patient records.  They only have to crack the code once to get maybe a million records.  It’s like robbing a bank versus robbing a home.  Which is more efficient for the hacker?  What you are seeing in the news these days of data being held at ransom due to malware is not new and will continue to be an ongoing threat.   We must move away from honey pot or centralized data systems if we are going to seriously address the issue of health information security.

The Fix

A national competition for an EHR system for doctors will never seriously address these key design issues because the traditional or current EHR system itself is a flawed framework to begin with.  The best solution is actually a complete inverse of the current EHR framework.  Imagine each patient having their own electronic data container that contains data for only one person (hence HIE of One) that belongs to him or her and not by anyone else unless they designate an individual to control it.  Let’s also imagine that these data containers can talk to each other (this is called a distributed network – such as peer-to-peer) and to other entities (hospitals, government, corporations, FitBit, health device company, you name it) but only at the behest of the patient.  Imagine that approved physicians can access, add, and update their patient data container (which is a single patient EHR, NOSH ChartingSystem) at any time irregardless if the patient is physically there (so it’s not a physical device carried around by the patient, like a USB key, because, you know, sometimes people don’t carry things with them all the time, especially if they are seriously hurt, unconscious, etc).  Imagine this data container being similar to a health journal that a patient would carry around with them and make the physician jot and update their medication list, allergies, problem lists, immunizations, medical history and it’s a running list that is up-to-date, not of dispute, and that the patient can verify.  Of course, I know only a handful of patients who diligently keeps their own medical records, but can you imagine solving the patient data reconciliation process if every person had their own legal health journal?

And that is what HIE of One coupled with NOSH ChartingSystem hopes to be.  HIE of One and NOSH ChartingSystem can be deployed on a small, secure web server (like a cloud virtual machine, or a physical appliance such as a router) that is on 24/7.  Using the latest encryption technologies, one can access this data on a web browser, smart phone, or tablet.  Using self-sovereign technology (which in our project case, performs as an independent electronic notary service for the person signing a prescription, encounter,  or document), any entity can go back and verify that indeed such an activity took place and was notated legally by the patient-allowed physician or user.

Is This A Dream?

No, we are actually closer to reality with what I proposed than the dream of a government sponsored national EHR competition.  The code already exists.  There is a working demonstration of this technology from start to finish.  But the catch here is that the word must get out and that a community supports this endeavor because without it, the project will only  be a small demonstration of what it could be.  Without buy in from almost everyone, we could all lose.

Who wins?

Physicians because they now have control over the design of their EHR for good because it is now in alignment with the patient and physician’s best interest, not administrators, insurance companies, or even government entities.

Patients, because they now have control over their health information and who gets to see or use it and who doesn’t.  Patients win because they can communicate with their physicians in a secure way without compromising their privacy and security.

Hospitals (yes, hospitals) and insurance companies (yes, insurance companies) because they no longer have to be liable for security breaches each time a nefarious hacker or Big Brother goes after their data.

Government (not to be confused with Big Brother) because there is now true alignment between patient and physicians which can potentially reduce health care costs for the entire population due to reduction of unnecessary or duplicate testing, better communication between a team of physicians working on one record for one patient…you get the picture.

Who loses?

Hackers with malicious intent, because it’s magnitudes harder to crack a server one by one just to get one patient record.

Rent-seeking middlemen, because their technology proposals to go between the patient and provider will no longer be relevant.

Big Brother, because patients now have control over who uses or sees their health record and not stored in some centralized database system without patient knowledge or control.

In a nutshell

So the current state of EHR’s clearly put physicians and patients on the sidelines – sowing seeds of discontent.  The fix involves the use of open source code, community support, with a novel distributed network model using one patient, one record, self-sovereign identity, and single-sign-on technologies.  The fix puts physicians and patients firmly back in the driver’s seat, kicking hackers, middlemen, and Big Brother to the curb and without needing to hope that government will open their eyes today and see the wisdom of aligning the interests of patients and physicians who care for them.

Digital Health Marketplace: Facilitating Rapid Technology Adoption and Spurring Growth in New York City.

Digital Health Marketplace: Facilitating Rapid Technology Adoption and Spurring Growth in New York City.

$200,000 in Awards to Health Tech Companies and Pilot Partners for the 4th Class of Digital Health Marketplace

Six winners were awarded of a total of $200,000 in grant funding through Digital Health Marketplace.

Digital Health Marketplace, a New York City Economic Development Corporation (NYCEDC) program, powered by Health 2.0, connects health technology buyers with market-ready sellers through biannual matchmaking and by providing grants to offset the cost of piloting their technologies in healthcare institutions. The program has provided over $2,500,000 in grant funding over the course of 3 classes. This year, the fourth class of Digital Health Marketplace winning pilots are anticipated to impact over 6,000 patients in New York City throughout the next year. The technologies span from care coordination platforms to patient engagement systems to devices.

The Digital Health Marketplace is part of Mayor de Blasio’s New York Works plan, which is made up of twenty-five initiatives to spur 100,000 jobs with good wages over the coming decade.

Digital Health Marketplace builds on a previous NYCEDC program launched in 2013 called Pilot Health Tech NYC. Over the life of the two programs, they have facilitated seven hundred matches between buyers and sellers and granted over $2.5 million in awards to health tech startups and their pilot partners. Building on this success, the City will invest $750,000 to support three years of expanded operations for the Marketplace. With these resources, the Marketplace can expand the number of matchmaking events to up to four per year, which will increase companies’ access to customers.

Below is a snapshot of the 2017 winners:

Canopy Innovations/Maimonides Medical Center
Canopy Connect is a mobile and web-based interpreter delivery and analytics platform. It improves the coordination, tracking, and funding of interpreter services at healthcare organizations, to elevate the quality of care for the Limited-English Proficient (LEP) patients. In the pilot, the Canopy Connect platform will be rolled out to Maimonides Medical Center providers in departments with a need for “on-the-fly” translation services.

CareGeneral/Northwell Health
CareGeneral offers a care coordination platform and web/mobile app that provides personalized care plans for patient adherence and education in up to five languages. In this pilot, CareGeneral and Northwell-Lenox Hill will target the Hispanic population (with a focus on diabetes management) to track patient engagement, patient adherence, utilization of hospital services and improved clinical outcomes/self-care behavior.

Klara is a cloud-based secure messaging tool for healthcare professionals used to assist with workflow, care coordination, and patient-centered care. The pilot with Betances focuses on patient communication via text messaging to triage care and increase patient satisfaction. The goal is to reduce the time per patient request and avoid unnecessary call-backs and voicemails.

PurpleSun/Northwell Health
PurpleSun offers a patented device that illuminates targeted spaces with UV light to disinfect hospital/healthcare equipment in ninety seconds. In piloting with Northwell, they aim to evaluate the implementation of the PurpleSun System between surgery cases, evaluate the quality of disinfection and assess the process/impact on operational turnover time between surgery cases.

Vital Score/AdvantageCare Physicians (ACPNY)
Vital Score supports innovative health systems and health plans in a patient-driven approach to Population Health and Quality. In three-minute digital conversations during wait time in provider visits, their point of care platform increases up to twenty times the rates of participation in services such as pediatric vaccines, diabetes prevention, smoking cessation and palliative care. The pilot with AdvantageCare Physicians (ACPNY) will build out a new model of patient-driven HEDIS to improve patient care and increase rates of immunization and medication adherence.

Wellth/Mount Sinai Health System
Wellth is a mobile based platform that helps patients change their behaviors to achieve better adherence, engagement, and overall health. In the pilot, the Wellth solution will be implemented with Acute Myocardial Infarction (AMI) and heart failure patients to increase medication adherence, decrease readmissions and reduce costs per patient at Mount Sinai.

Alyx Sternlicht is a Senior Program Manager at Catalyst @ Health 2.0.

How Much Is That CAT Scan in the Window?

How Much Is That CAT Scan in the Window?

Who knew healthcare could be so complex? The GOP proposal for health care reform rests on health savings accounts and high deductible health plans.   The basic premise is that price opacity, and deep pocketed third party payers drive up the cost of health care.   Giving patients dollars in health savings accounts they control should make them price sensitive, and thus help reduce the cost of healthcare.  A recent analysis by Drs. Chandra and others provides an interesting perspective on the matter.

The researchers took a large self insured firm that required all of its employees to switch from an insurance plan that provided free healthcare to a nonlinear, high deductible plan.  The switch worked.  Health care spending was significantly reduced, but the concern was the mechanism by which spending was reduced.  One would like to believe spending reductions related to price shopping, so patients were getting the same services just for cheaper.  Unfortunately, it appeared that consumers reduced all spending regardless of whether it was worthwhile or not.  Deciding what is worthwhile in healthcare is a complicated business that I will leave for another day but I agree with the general contention of the paper – giving a patient control over health care dollars does not make for a smart price shopper.

I learned this the hard way when I chose a high deductible health care plan.  I needed an outpatient CT scan as well as some basic labs.  The local hospital was incredibly accommodating with its service as well as its bill 2 weeks later.  Almost $2,000!  No one told me the cost of any of this upfront, and I stupidly didn’t think to ask.  I have learned much since – basic labs can be availed of for $30 in the right place, and imaging in hospital owned facilities is significantly more expensive.  So when a patient (I’ll call him John) recently came to me with some concerning symptoms, and I ordered a CAT scan of the abdomen and pelvis, I was expecting the inevitable question:  “Do I really need this doc?  I have one of those high deductible health plans..”

To give you context – John is a 6 figure earning white collar individual who has an insurance plan on the individual market through the ACA.   I explained my rationale, he found it reasonable, and I reassured him that I would attempt to find the cheapest place in the city to get a CT scan and get back to him.  Thus began my little odyssey.   Philadelphia is a town of hospitals – there are four academic medical centers in the city within a 10 mild radius of each other.  So I first called up one of the academic medical center’s imaging center.

Me. I have a patient with a high deductible health care plan and was hoping you could tell me how much it would cost him to have a CAT scan of the abdomen and pelvis with and without contrast?

A.  The cash price is $1100.  That’s a 60% discount!

Me.  A discount from what? Medicare?

A.  Hesitating.  Yes, Medicare..

Me. Are there outpatient facilities you own that the rate is cheaper?

A.  Yes I think so.  It has to do with proximity from the main campus.  Location A and B have lower rates

Me.  Is the price you quoted me the lowest rate?  Could you tell me how much you charge for a CT Abd/Pelveis?

A. Yes.  And no we can’t divulge that.

I next called two radiologists I know to ask if they knew any non-hospital owned imaging centers.  There was one remaining center with a location just outside the city proper.  A friendly receptionist picked up on the first ring.

Me. Hello, I have a patient with a high deductible plan… who needs  a CAT scan of the abdomen and pelvis..

A.  Our cash price is $440, but remember, this won’t apply to his deductible.

Me. Wonderful.  He does have insurance, so do you have any idea what he would pay if he went through his insurance

A.  I have no idea – we have different contracted rates for different insurances.

Me. Could you tell me what your fee schedule is? How much do you charge for a CT, just so I have an idea what he can expect to pay.  I plan to send more patients to you, but would like to give them a sense of what they would pay going through insurance

A.  I can’t tell you what our fee schedule is – but I can tell you that your patient won’t pay more than $2,000.

It should be clear to anyone paying attention that opacity forms the bedrock of American healthcare today.  My attempts at transparency were only partially successful.  What remained opaque was the imaging providers fee schedule, or their contracted rate with the insurance company.   But I did find out enough.

The Medicare reimbursement can be looked up.  Contrary to what I heard from the first imaging center – $1100 was not 60% of the Medicare rate.  Medicare reimburses approximately $400 for this particular CAT scan.  Commercial/private insurance reimburses approximately $1100.  Medicaid reimburses ~$200.  The cash up front rate at the academic medical center I called was $1100, and at a private non-hospital owned imaging center was $400.


Medicare Medicaid Commercial Insurance Uninsured (Nonprofit hospital) Uninsured (For-profit private imaging center)
CT Abd/Pelvis With and without contrast $401 $214 $1,100 $440 $1,100

He elected to pay cash. He didn’t think he had other medical expenses that would put him over his deductible, and the contracted rate was probably 3 times what it was to pay cash.  So just to repeat this to drive home the apparent idiocy here – the ‘negotiated’ cash rate for John is two to three times less than if he were to use his insurance plan.
So I called John with the news. I explained that the cheapest option was a private diagnostic imaging center just a mile outside of the city. I explained that if he used his high deductible health care plan insurance, I was not exactly sure what he would pay. He could call his insurance company to find out the contracted rate.  My best guess was that the fee schedule for at least the private imaging facility was ~$2000, and that the contracted rate would be around half of that.  Choosing to pay cash upfront would be cheapest, but that would not apply to his deductible.  

I understand the rationale for the seemingly inflated rates at non-profit academic medical centers.  On any given day they take care of complex patients with no insurance in their ERs or in the hospital, have to staff 24/7 teams of cardiologists to open occluded coronary arteries at 2 am, and have to staff hospitals to fulfill a dizzying number of meaningless regulations.  Whether all of this should translate into a multiple of 3 for a CAT scan is also a topic for another day, but there are certain points that shouldn’t be in doubt when we think about about what to do with the 45 million patients who did not have insurance prior to the ACA.

Clearly, patients need a marketplace that allows them to price shop intelligently.  It is hard to see how patients can do this without the help of a professional adviser.  For the purposes of this post we can call this professional adviser a doctor, though I am certain some whipper snapper doing a pHd in something I can’t begin to understand will  come up with a title that includes the phrase ‘care manager’.  Of course, having a doctor on your side doesn’t much matter if prices are opaque.  In the current system, having insurance automatically shrouds the cost of health care widgets in an impenetrable fog. Clearly more transparency would be helpful, but even price transparency and a doctor on your side isn’t enough!

Strangely, the problem is having insurance.  Yes, you read that right.  In this case, having insurance means being subject to some unknown negotiated rate that will then come out of your HSA.  Perhaps transparency would force prices to be lower, though this is far from certain.

If this is about John and his ~45 million brethren that could potentially be on an individual market, it is more than a little unclear to this particular economic illiterate how insurance is helping here for the health care version of an oil change.  You can perhaps understand why ‘MD twitter’ – as derogatorily referred to by health policy wonks – would be happy with any health care plan that gave patients the freedom to spend dollars from an HSA to pay cash for a CAT scan.  You’ll also understand why the dim physicians trying to do the best thing for their patients may not quite understand the current handwringing about subsidies based on actuarial values.

The actuarial value refers to the total average costs for covered benefits a plan will cover.  The ACA specified that beginning in 2014, insurance sold to individuals must be at one of four actuarial values: 60% (a bronze plan), 70% (a silver plan), 80% (a gold plan), 90% (a platinum plan).  The ACA failed at cost containment because it gave patients and their physicians no good mechanism to exert any downward pressure on costs.  If you got an ACA plan – and showed up at whatever random place (with hospital consolidation, you are much more likely to end up at a hospital owned facility) your doctor told you to get your CAT scan, you were likely to pay through the nose.  If you had a subsidy you paid less, but the difference was picked up by the taxpayer.  Hospitals, especially, loved this!  It should come as no surprise, then, that actuarial values rose, and the costs in the form of higher premiums were passed on to the ever narrower band of unsubsidized patients who were buying plans on the individual market.

The effect of the new health care bill with its additional amendments is a mystery to me, and apparently the only folks with certainty about what is to come are economists and wonks.  I am neither.  Broadly speaking I have been supportive of patients having more flexibility and control of  their health dollars.  I say this not out of ideological zeal – I just want folks like John to be able to pay for his damn CAT scan out of the HSA account he funds!  It is unfortunate that any move towards lowering subsidies, or increasing flexibility is met by a religious fervor from the left that would make Pentecostal Christians proud.  It may be well intentioned, but it isn’t helping.  Health care is complex and we need to to do a lot more than find a solution for John.  Clearly the think-tanks have their work cut out for them – but would it really be a bad thing if policy econowonks started thinking like practicing doctors who see patients?

Anish Koka is a cardiologist, and wanna-be econowonk.  He can be followed on twitter @anish_koka

PS.  I also have to point out that after talking to two radiologists in the city, they could only think of one private, non hospital owned imaging center in the Philadelphia vicinity.  It makes sense – why stay private, when you could make make much more money by selling to a hospital, and get paid a salary for doing less that was better than what you could do on your own?


How Insane Could This Get?

How Insane Could This Get?

At long last, the Senate is poised to begin voting today on a measure to repeal and/or alter portions of the Affordable Care Act.

Much remains in flux regarding process and the substance of what will be voted on.   According to multiple media sources today, Senate leaders latest strategy is to hold a vote on a narrower piece of legislation than those circulated in recent weeks.

The substance of such a measure—if indeed, it exists and is submitted for a vote—is unclear as of this posting.  But it reportedly could contain just a repeal of the ACA’s individual and employer mandates and a few of the law’s taxes, such as the one on medical device companies.

This narrow, or “skinny,” bill would not have any provisions pertaining to Medicaid.

The idea, apparently, is to pass this initial piece of the puzzle—to get things going—and then to take up the larger and more controversial issues that have so deeply divided the Republican caucus.

According to the Huffington Post, House and Senate leaders would then try to negotiate a version of the more comprehensive legislation in both chambers that Republicans could rally around.

That would seem still to be a tall order, especially if they are still trying to get it all done before the August recess, which begins August 11.  Of course, that’s subject to change as well.

And there’s not yet any certainty that initial votes would allow this “skinny” bill process to proceed.  Some Republican lawmakers might balk out of concern that no replacement for the mandates and larger bill, for example, would ever be forthcoming.  That would then compel a vote to repeal the initial repeal bill since that bill would likely lead to a rush to the exits by insurers now serving the exchange markets.

CBO has estimated that repealing the individual mandate while leaving the rest of the ACA’s regulations in place would result in 14 to 15 million more uninsured and premium hikes of 20 percent within a few years.

There’s broad consensus that John McCain’s return to the Senate today adds significant impetus to Republican efforts—in terms of sentiment and possibly some outright political opportunism leveraging his dire diagnosis to spur action.

As Axios’ David Nather opined this morning: “How insane could all this get? Completely, wildly, utterly, spectacularly insane.”

Further spinning our heads in the last few days, Democratic leadership has begun to talk openly about submitting and pushing a “Medicare for All” bill this year and in 2018 if the Senate effort fails.

THCB’s editor asked me to write this quick synopsis of where things apparently stand today (July 25), and to get the ball rolling on comments and updates over the coming days.   All thoughts welcome as this historic process begins.


Health + Design, Refactored

Health + Design, Refactored

Health care providers love to vaunt the unique and subtle needs of patients. How many ads have you heard from cancer centers or health clinics touting their flexibility and showing grateful, tear-flecked patients?

But key aspects of our health care systems turn out to be rigid and heartless in practice. Despite the compassion of individual staff, our organizations tell patients in dozens of ways that they are widgets on an assembly line:

  • We force patients to come early for every appointment and fill out the same paperwork each time with information they have given before.
  • Patients traverse long, crowded corridors from one station to another, asking at each station for information they don’t get and never knowing how long each stop will take or how many more stations remain on their Kafkaesque journey.
  • Patients rush to undergo batteries of mysterious tests, sometimes repeatedly, only to wait long periods to hear the results.
  • We refer them to specialists who, it turns out, can’t see them, or who issue contradictory opinions without coordination.
  • After frustrating and unsuccessful attempts to learn the costs of procedures in advance, they receive cascades of arcane bills and watch their funds bleed out to charges that bear little relation to their experience in the clinic or hospital.

More fundamentally, our field has stuck to a cycle of diagnosis and treatment that leads to people suffering through death in a welter of tubes and IVs, while 28% of all Medicare costs are incurred in the last six months of life. Pharmacologist Jay Gupta claims that nearly 50% of all seniors in the US take a medication that is not clinically necessary. This is expensive, debases their health, and leads to greater risks of adverse reactions.

These are the sorts of conditions that the unique conference on health IT and design, HxRefactored, confronts each year. The focus is on getting organizations to change their operations, with health IT in a supporting role. Over time, the conference has de-emphasized technology–although sessions on such topics as blockchains, wearables, and interoperability are still popular–and has boosted its approach to health care systems and larger communities. HxRefactored is held jointly by Health 2.0, now operating under the umbrella of HIMSS, and the design firm Mad*Pow.

The overarching question: whither technology?

Attending the sessions of this conference, I pondered the effects on patient/doctor relationships of automation and artificial intelligence, expected to be a 6.6 billion dollar market in health care by 2021 (page 2 of PDF). Will they devolve control to patients and help them practice self-care, or will they reinforce the tendency by health care institutions to manipulate patients as widgets? There is a real risk that the large, well-funded institutions investing in automation will fit it into their familiar philosophies of control. The technologies may simply reduce the costs of doing things the current way, without involving the patient further or pushing health care past current horizons.

Feeding my concern over the purpose of technology was the presence of several companies who have found a viable business model by occupying niches in a bad system: for instance, optimizing one aspect of finding a doctor in the maze of providers, or optimizing one aspect of a broken and wasteful billing system. I appreciate the critical importance of finding a place for yourself in the system, but the cleverness of these entrepreneurs worries me in two ways: first, that they profit from health care anarchy instead of fixing it, and second, that their business models may evaporate if saner health care systems come into play.

I hope that Mad*Pow’s recently launched Center for Health Experience Design follows through on conference goals and consistently champions the rights, responsibilities, and needs of patients, doctors, and communities. The opening keynote by Mad*Pow founder Amy Cueva touched on all the right themes, with such statements as “collaboration is the new innovation” and “worldwide, people are struggling to be heard in health care systems.” I will raise questions of control by patients, doctors, and communities throughout this article.

Conference themes

The expanding scope for design was laid out by Cueva. Classic design used to restrict itself to a single object (such as a Wiener Werkstätte teapot or the classic Eames chair), but the newer human-centered design invites in the users of a system to inform the design.

(Of course, many designers historically have raised their eyes beyond the object–just visit a home architected by control freak Frank Lloyd Wright–but for a long time they were outliers. As an unfortunate representative of the norm, consider the notorious Tilted Arc by Richard Serra, a striking artistic statement designed in 1981 with a total disregard for its effects on people and the environment in which it was set.)

Going further, purpose-centered design considers the object’s environment and how people interact with it, potentially rerouting an organization to meet its goals. If classic design focused on making a single web page beautiful and easy to read, human-centered and purpose-centered design would define the service offered by the site and how visitors can navigate through its pages to achieve their goals. Health care design can employ psychologists, teachers, technologists, and others.

Empowering patients

Although hospitals (and the Centers for Medicare & Medicaid Services) conduct patient surveys, I can’t find data on whether they use these surveys to good benefit. If hospitals do listen, can surveys improve anything more significant than the selection of TV channels?

A more intense, and perhaps more productive, effort is the Human Theater Project started by two medical residents, Omar Ishaq and Saad Mir, who described it in an HxRefactored keynote. These doctors lead patients to describe their stresses and experiences, capturing results on video. They claim that patients who participated have better outcomes and survival rates, while the professionals who viewed the videos showed increased empathy.

Payaal Patel, in the panel on the “Patient experience of the future,” said that researchers need to talk to patients to find out what really concerns them. For instance, a person who has trouble using her hands will be worried about how she can brush her teeth–a question that probably wouldn’t come up in a normal clinical setting. Too often, Patel said, we collect data only on deficits and disabilities, leading patients to feel depressed about their conditions and to overlook the strengths they possess that can improve their lives.

Researchers in health care, including pharmaceutical companies, are learning the benefits of listening to patients. If they design trials around topics that patients care about, more will sign up for the trials and persist to the end.

Ultimately, to fix the health care system, it must engage patients on a daily basis in caring for themselves better than they are doing now, and technology will play a key role. Particularly intriguing, to me, are opportunities for new data sources to break the stranglehold that health care institutions have maintained on patient data. These new data sources may well democratize the health care system simply because they run ahead of EHR vendors’ abilities to trap the data, and of hospitals abilities to monetize it. If a Fitbit can produce key insights into your health, maybe you can build a personal health care system around them. HIE of One is an example of an open source personal health record that allows the patient to share data flexibly with many caretakers.

New data sources came up during the session “Breaking down the silos,” ostensibly a technical session about interoperable software, but with intriguing forays into how to help health care systems evolve. Sumit Nagpal, co-founder and CEO of LumiraDx, started his argument with the observation that we need to reduce health care costs by moving treatment into lower-cost settings, notably the home. We need large care teams including the patient, the family, and various professionals, all sharing a care plan. And we need to focus on prevention and wellness. Nagpal was not afraid to say, “individuals have to be accountable.” But a holistic treatment plan based on prevention requires a lot of data that current EHRs don’t hold.

Holistic treatment also brings diagnosis and treatment closer to the patient. Modern equipment allows much testing to be done in the home, a drug store, or even an ambulance, rather than the lab or doctor’s office. Environmental sensors and social media monitoring can contribute to a 360-degree view of the patient. Predictive analytics can remind the patient to take her medications, keep her appointments, and so forth.

Another element of Nagpal’s proposal is a broadened consent policy, so that patients can share data with numerous caregivers without extra paperwork. He did not explore how this system might interact with segmented records, which would let patients restrict the kinds of information their providers can see.

Keynoter Robin Farmanfarmaian said that 70% of routine doctor visits could be done remotely. (The hedge-word “routine” here is ambiguous and probably significant.) She mentioned, as an example of bringing health care into the home, that patients with neurological problems could take tests as often as once a week, and that the tests could be gamified to make them appealing.

Research on telehealth is encouraging, but sometimes ambiguous. Although patients seem to like virtual visits, other data suggests that they might not reduce health care costs because virtual visits sometimes encourage patients to overuse their doctors.

Even insurers–favored targets for public invective–are evolving toward holistic, prevention-based care. These efforts were laid out in the session “Navigating the health system.” As Robin Gasco, from Blue Cross/Blue Shield of Massachusetts said, “We won’t fix health care with an app or a portal–we must straighten out the system.” This Blue Cross/Blue Shield pioneered bundled payments when most payers were just talking the talk.

Insurers in general are becoming alert to the financial distress caused by rising premiums and deductibles. Understanding the financial as well as clinical effects of treatment may actually be good for patients. However, innovation here may require patients to trust insurers with more personal data than they have in the past. Insurers are also large, slow-moving institutions that can take years to move an idea from a concept into the mainstream.

Empowering doctors

We now know that more and more doctors hate their work. Alarming numbers are quitting the profession–you can tell that by reading the KevinMD blog for a couple weeks–or at least opting out of the government’s safety net programs. Can technology lift the burdens of regulation and insurance from doctors instead of worsening them? Can the clinical experience be redesigned to favor doctors?

Danny van Leeuwen of Health Hats, whom I met through the Society for Participatory Medicine, told me of a company called Herald Health that gives doctors control over system alerts. The innovation that makes this different from standard EHRs is the control given to the individual physician. When the vendor, the clinic, or the hospital determine what alerts are delivered, they tend not to be appropriate for the doctor’s workflow. Whether or not the imposed alerts are important, they tend to get ignored. Better to let doctors define alerts themselves and share the ones they like with other doctors, who can then choose whether to adopt them.

Empowering communities

Ever since running water was introduced into cities–and perhaps even earlier–the biggest gains in public health have come through, well, public health. Simple interventions could make a huge difference, such as housing the homeless or providing deliveries of fruits and vegetables to neighborhoods known to be food deserts.

Some modern efforts in public health were highlighted by Olga Elizarova and Samantha Dempsey in a keynote and panel. They pointed out that you can miss racial and economic disparities if you look at the city or state level. Data must be more fine-grained, highlighting differences between neighborhoods.

Education provides a crucial example of community-based intervention. There have always been expensive private schools that offer intensive one-on-one coaching and individualized learning plans. But some organizations, such as the Harlem Children’s Zone and the Northside Achievement Zone of Minneapolis (described by director Andre Dukes) apply these principles to at-risk children in deeply underprivileged areas. Such organizations bring in professionals to counsel parents and children alike. They partner with organizations that can provide evidence of successful interventions. The motto of the Northside Achievement Zone is “Every child can and will attend college.”

Like Gasco, whom I quoted earlier, Elizarova and Dempsey said their solutions don’t use apps. Our health problems are complex and embedded in communities, so the solutions must take communities into account. Furthermore, changes in housing, education, etc. take a long time and don’t offer fast, Silicon-Valley style returns on investment. Finally, designers who want to help communities need to recognize their own biases, coming as they usually do from privileged backgrounds relative to whom they’re collaborating with.

Like home-based treatment plans, public health plans require a lot of data. Traditional healthcare data is not enough.
HxRefactored squeezed a lot into two days. Some major catches, such as Aneesh Chopra and Bakul Patel (Associate Director of Digital Health for the FDA), offered keynotes. Attendees can take many lessons away from the conference–this article has focused on those that touch on empowerment throughout the system.

Winners Announced: RWJF Choosing Care Challenge!

Winners Announced: RWJF Choosing Care Challenge!

Ever step out of your doctor’s office feeling overwhelmed and instantly forget all of your doctor’s instructions? Instinctively, you look down to your phone to check your texts and emails–wait, no. Instead, you look down to your phone and see that your doctor has asked you to get an X-ray and you need to pick up your Advair prescription. You can see your options for local imaging centers and pharmacies, and what they will cost you, based on your specific insurance plan and location, right on your phone before even getting home. Well, that’s new.

The days of being rushed out of your doctor’s office and forgetting your care plan are over, thanks to the Choosing Care Challenge sponsored by the Robert Wood Johnson Foundation. The challenge, launched at Health 2.0’s Wintertech on January 11th, 2017, encouraged the development and advancement of technologies that help patients and providers identify and locate prescriptions, imaging labs, and specialists, all to fit an individual’s specific needs. Participants were equipped with resources such as APIs and data from PokitDok and Vericred. With over sixty initial Phase I applications, solutions ranged from chatbots, to web platforms and AI apps. The applications were reviewed by a panel of expert judges and narrowed down to five finalists, each awarded $5,000 to further develop their solutions.

For Phase II of the challenge, each of these five finalists were required to prove that their app or tool is more effective than the others. They displayed the app or tool and how it would be used in a short video, and provided the working solution itself for the judges to interact with in real time. The judges evaluated each submission based upon the following four criteria:

  • How helpful is the solution to patients?
  • How strong is the solution’s potential for scalability?
  • How effective is the UI/UX design for user friendliness?
  • How impactful is the solution for patient-specific needs?

The challenge prompted participants to “make it simple,” and that they certainly did. Phase II winners made health care decision-making especially simple.

Taking home first place, with a grand prize of $50,000, is (drumroll please) Stroll Health (@StrollHealth). Also a previous winner of Traction 2016, Stroll has built a seamless web platform that enables health providers to send patients directly to local imaging centers and specialists, and helps to manage prescriptions. Stroll’s easy-to-use platform provides automatic referrals, prior authorization and real-time scheduling. For the challenge, Stroll expanded their platform to include hundreds of thousands of specialists and more than five thousand prescriptions across the nation. Let Matt and Jordan walk you through the platform themselves in this video.

Coming in second place, with a prize of $15,000, is Moment (@momentdesign). Moment created “Orderly,” a web based platform which allows patients to receive up-to-date lists of preferred specialists, imaging labs and pharmacies. Patients can also use Orderly to view data such as cost, coverage and location, and even schedule next steps through provided contact information and online booking tools. “Orderly” builds on the relationship between patient and physician to understand, discover, and choose referral options together. See how it works here.

And finally, the third place prize of $10,000 goes to Project Helix (@kcdigitaldrive). The solution includes a chatbot within a mobile application to help patients navigate their prescription costs with convenience in mind. The solution is a low-tech interface with complex data-driven decisions on the backend. The chatbot connects with the patient each step of the way via text notifications and API data, tailoring results to the patient’s needs. Learn about how this chatbot makes it simple here.

So, next time you leave the doctor’s office scratching your head, just look down at your phone and relax because all of the information you need will be right there waiting for you with help from these challenge winners

To learn more about Catalyst @ Health 2.0 and other programs or opportunities, subscribe to our Newsletter, and follow @catalyst_h20 on Twitter.

Chelsea Polaniecki is a Program Manager at Catalyst @ Health 2.0.

Giving Cancer Hell

Giving Cancer Hell

There are 80,000 new cases of primary brain tumors diagnosed every year in the United States.  About 26,000 of these cases are of the malignant variety – and John McCain unfortunately joined their ranks last week.  In cancer, fate is defined by cell type, and the adage is of particular relevance here.

Cancer is akin to a mutiny arising within the body, formed of regular every day cells that have forgotten the purpose they were born with. In the case of brain tumors, the mutinous cell frequently happens to not be the brain cell, but rather the lowly astrocyte that normally forms a matrix of support for brain cells.  Tumors made up of astrocytes are called astrocytomas.  Classification schemes for brain tumors in the era of molecular subtypes has grown enormously complex, but a helpful framework is provided by the appearance of these tumors under a microscope.  Grade 1 tumors are indolent, with little invasive capacity, while Grade 4 tumors are highly invasive, marked under the microscope as dense, sheets of cells that can even be seen to grow their own blood supply.  Senator McCain has a grade 4 astrocytoma, otherwise known a a glioblastoma (GBM) – the worst kind.   Social media from all sides of the political spectrum lit up with well wishes – with most casting the disease as something to be defeated.

Others within the medical community took a different take.

Mehreen is right.  GBM is a deadly disease,  the 5-year survival rate for patients with GBMs is <3%.  The majority of GBM patients live less than a year.  Yet, the medical community of neurosurgeons and oncologists that treat these tumors go to battle with these tumors.  Why?

I asked a very busy neurosurgeon this same question.   I asked him what he told patients. He told me that he never mentions the word cure.  There is no cure.  The goal is to manage the disease and buy more time.

Median survival for GBM is measured in weeks, not years.  Do nothing, and expect 14 weeks; combining surgery, radiation therapy, and chemotherapy may give you 45 weeks.


What we describe is median survival, of course, and as Stephen J Gould eloquently put in his diatribe against statistics in cancer – the median is hardly the message.   The oncologist you want is the one who doesn’t tell you about median survival when breaking the news to you of your cancer – she implicitly understands each GBM has a different path.  Here are three such paths.

Case 1.

Margie is 35 year old redhead who hails from Wildwood, New Jersey, where she helps her parents run a boardwalk diner.  I first met her 7 years ago after she had presented with a seizure.  In this case the seizure was precipitated by a GBM.  A resection of the tumor followed – the postoperative course was complicated by more seizures, and an arrhythmia that brought me into her orbit.  I’m a cardiologist so I didn’t see her again until she returned 7 years later with a surgical wound infection – but with no evidence of cancer recurrence.

Case 2.

Mr. Walker was a 74 year old man with a very sick heart when he presented with difficulty speaking.  A retired executive who was used to being loquacious, he had survived a heart attack with the help of a stent a decade prior, but had been left with disease in little vessels that gave him occasional angina. Otherwise it allowed him to shuttle between his house and his daughter’s house to enjoy his grandchildren.  A granddaughter had a wedding in a few months he was hoping to attend.  The question to me related to his cardiac risk of surgery.   Was there anything that could be done?  He was on anti-platelet blood thinners that would have to be stopped to cut into the brain. Would that be ok?  I discussed the case with everyone – his eldest son was an orthopedic surgeon, and his daughter was a medical malpractice attorney.  I said nothing that they didn’t already know.  He was high risk.  I quoted a 10% risk of a heart attack or death with the procedure.  Mr. Walker wanted to proceed with the proviso that no heroic measures should be undertaken in the case of a complication- in the event of a cardiac arrest, he did not want to be resuscitated.

Five days later,  I received a call from the neurointensive care unit.  Mr. Walker had been out of surgery for an hour, and his heart rate was low.  I was driving to another hospital, but I asked to be sent an electrocardiogram.  What I saw made me turn the car around.  He was having a heart attack.  The stent he had placed some years ago had occluded.  He was having mild chest pain and looked uncomfortable.  Taking him for an urgent cardiac intervention was out of the question. This would require not one but four potent blood thinners – almost certain disaster in a man hours removed from major brain surgery.   Of even more immediate concern was his heart rate.  It was dipping dangerously low – he had developed heart block – a condition where the upper chambers of the heart don’t communicate with the lower chambers.  This disconnect is at times reversible, but other times not.  As his block worsened, there were seconds that would pass with no heart beat at all.  With his daughter at his bedside, I tried to explain what was happening, as I tried to figure out what to do.  After a particularly long pause in his heart rate when he passed out, he made it easy – he told me – “I’m not ready to die today”.   We placed him on a breathing machine.  It took me twenty minutes to thread a wire hooked up to an external pacing box into his heart.  As the wire passed through the upper chambers of his heart, it precipitated a rapid arrhythmia. Diseased conduction tissue conducts even slower when asked to work harder, and the fast impulses from the upper chambers caused a heart rate too slow to effectively perfuse his brain.  He coded.  The wire in his heart wasn’t going where it needed to, and I asked the team to start chest compressions.  A long minute later, wire situated, rhythm restored, I walked out to talk to his daughter who had been observing the events outside.  She wasn’t happy.  She demanded to know what I was doing.  I explained the best I could – he was completely dependent on his pacemaker, intubated and sedated.  I didn’t think he had suffered any significant brain damage from the recent events, but I wasn’t sure how his heart would do as his heart attack completed.  We decided to see how he did overnight and make a decision in the morning.

The next morning I walked into a cheerful Mr. Walker eating scrambled eggs, wire still in place, still pacing him.  What else was there to do?  I explained to Mr. Walker that without his pacemaker he would die – the next day the electrophysiology team placed a permanent pacemaker, and weeks later, a still cheerful Mr. Walker walked into my office with his daughter.

He made his granddaughter’s wedding, but six months later his brain tumor recurred. He died quietly at home a week later.

Case 3

Frank was a large burly 64 year old, accompanied by his wife, wearing a faded Harley Davidson jean jacket adorned with a a bald eagle and an American flag.  He was another man with a cardiac stent heading into surgery for a GBM.  As happens frequently, he asked me as I started to finish up with him if I knew the surgeon and anything about the surgery.  As I shook his hand, I assured him he was in good hands with the surgical team.  He held my hand a little longer and told me that he wanted the best treatment, but he didn’t “want to be hooked up to no machines if there was no hope”.  His resection was uneventful, but a week later he returned to the hospital.  His wife kept a constant vigil as his clinical state worsened.  He had not responded to any commands in days, and a ventilator was breathing for him.  The surgeons and the intensivists told me that his wife would not let him go and wanted everything possible done.  But there was nothing to do.  I couldn’t understand it.  His wife had witnessed our conversation.  I don’t ordinarily discuss goals of care in patients with non cardiac diagnoses.  But I felt compelled to advocate for Frank. I gently reminded his wife of our conversation in the office.  She remembered.   An awkward silence followed, and I slipped up.  I asked her how she could do this.  I regretted the words the moment they left my mouth.  Her eyes took up the flat look of someone being attacked.  I clumsily made my exit, and heard later of her displeasure with my conversation.  I never saw Frank again.  He died a week later, 4 weeks after I shook his hand in my office.

The population health brigade would have us ignore the messages each patient has to give us.  But there is so much here that each patient taught me.  Margie reminded me that median survival isn’t destiny.  Mr. Walker made me appreciate the fog of decision- making in the terminally ill patient.  It is hard to let go of life.  Mr. Walker wanted to live on that day.  Much of the dollars spent on health care in America are decried as wasteful and I imagine that on paper the dollars spent in the last months of Mr. Walker’s life exemplify waste to some.  Yet, you’ll understand how some may see not defeat, but victory in the image of a proud grandfather at his granddaughter’s wedding.  Frank’s story is a tough reminder of what I see all too frequently in a world where patient and family autonomy is sacrosanct – moribund patients kept alive by families that can’t let go. There is a fundamental tension between paternalism and autonomy – go to far in either direction and you end up lost.

There is something insidious about those who take issue with terms like battling, fighting and hope in these patients.  There is a deeply nihilistic message that lies at the core.  You are going to lose – so why fight? Why endure brain surgery, or the radiation or chemotherapy to come? The barbarians at the city gates in healthcare are those who believe the primary role for doctors in this unlucky group of patients is to ferry patients gently into that good night.  Baloney.  Some patients will choose to fight because they want the opportunity to make that next wedding, others will choose to go home.  These are hard decisions best left to the patients and their physicians.  You’ll excuse me if I don’t begrudge those wishing the Senator well in what ever path he chooses.  Give ’em hell, Senator.

Anish Koka is a cardiologist in Philadelphia.  Follow him on twitter @anish_koka

I Finally Understand US Health Policy

I Finally Understand US Health Policy

The following exchange occurred during an interview of President Trump with journalists of the NYT:

HABERMAN: That’s been the thing for four years. When you win an entitlement, you can’t take it back.

TRUMP: But what it does, Maggie, it means it gets tougher and tougher. As they get something, it gets tougher. Because politically, you can’t give it away. So pre-existing conditions are a tough deal. Because you are basically saying from the moment the insurance, you’re 21 years old, you start working and you’re paying $12 a year for insurance, and by the time you’re 70, you get a nice plan. Here’s something where you walk up and say, “I want my insurance.” It’s a very tough deal, but it is something that we’re doing a good job of.

President Trump presides over the health-care experience of millions of Americans. Does his answer scare anyone else as much as it scares me?

Watching Obamacare Die

Watching Obamacare Die

It’s hard to know what “Trumpcare” is, but whether it’s “repeal” or “repeal and replace with something terrific,” it was and is going to fail. It was either going to fail to be enacted by Congress, or if it was enacted, it was going to set off such a bipartisan backlash it would be repealed, either by a chastened Republican Congress or a new Democratic Congress and president.

The reason Trumpcare was doomed was that health care is not like global warming or police shootings or use of military force in foreign countries: It is an issue a large majority of Americans agree on, and it is an issue voters can assess with their own eyes in their own kitchens.

Republican voters are almost identical to Democratic voters in what they want in a health care system. They want comprehensive coverage, low out-of- pocket costs and affordable premiums, freedom to choose their own doctors (they could care less about freedom to choose between Aetna and Humana), and freedom from interference by bureaucrats (be they public or private). Obamacare became a liability for Democrats because the public clearly perceived that the ACA could not meet those requirement for millions of Americans. The public now clearly perceives Republicans want to enact legislation that would be even worse than the ACA.

These facts — Americans want the same thing in a health care system regardless of party, and it’s difficult for politicians to fool the public about the success or failure of a health care bill — were obvious to thinking people even before the new Republican-controlled Congress began writing their “repeal and replace” legislation. But it was not obvious to Trump and most congressional Republicans. For some reason they thought they could remove 20-30 million people from the ranks of the insured, hand most of the savings over to the rich, and the public wouldn’t mind.

Now they know. The public has a little problem with that.

The good news is that Trump and the Republicans learned before enacting their dreadful “repeal and replace” bill that the public doesn’t like it. The bad news is that Trump is the president, he has the power to accomplish repeal by sabotage, he doesn’t seem to care what happens to the Republican Party now that they elected him king, and he might well force the country to undergo a rough equivalent of repeal without the formal consent of Congress. In that event, we will have to watch Trumpcare die AFTER it harms millions of people who have insurance now, and after it inflicts much damage on the GOP.

Trumpcare was and is doomed. The only question before us is how it will die. — the new way to think about health tech — the new way to think about health tech

I’ve also been having a bit of fun with creating a new site called, which uses the new .health domain extension. Well you knew you needed both a new definition to replace the fuzzy term “digital health” and .com is so 1999! But what am I talking about when I use the term, and why? I was asked to write a piece about technology in health for USA Today spin-off, and I’ve repurposed it here to celebrate the official .health launch.

There’s a big change coming to our health care experience — driven by technology. Health care is moving from a point-in-time event to one of continuous care. Think of your last doctor’s visit. You probably had a few minutes with a rushed clinician and were sent on your way. The next steps, such as correctly interpreting the instructions, getting prescriptions filled and figuring out next steps was left largely on you. Yet, most conditions, like diabetes, heart disease and asthma, require continual monitoring and management to avoid painful and costly complications. In fact, what happens outside the doctor’s office is more important than that meeting in it.

A new way

Relying on the old point-in-time interventions doesn’t work. To this point, most hospitals and doctors have only had information tools that record what they did in the visit or during the procedure. Instead, technologies will enable clinical teams to perform continuous care. SMAC stands for Social & Sensors, Mobile, Analytics and Cloud. These are the underlying technologies behind what we now use every day — Skype, texting, WhatsApp, iTunes, Facebook, Google, Amazon, et al. To reach patients wherever they are, thousands of relatively new companies are building similar technologies and services that will help a combination of today’s clinicians and tomorrow’s automated artificial intelligence systems manage patients — and help patients manage themselves. And hopefully they’ll be doing it with a big dose of empathy — hence our adding the “K for Kindness” to the lexicon.

Information influx

The other big change is going to come in what we use those technologies to do. For sure, patients are already way, way better informed than they were 15 or 20 years ago. They can access great content online, including information shared by other patients on sites like PatientsLikeMe, MedHelp and Smart Patients. Patients and their caregivers will use those tools to be better informed about their care and inform each other and their clinicians. But that’s not all. We are already seeing services like American Well, Teladoc and DoctorOnDemand (sometimes provided by current health insurers and hospitals) enabling video visits. A whole range of cameras, sensors and medical tools will make those services, and a host of others, better able to connect patients with clinical solutions.

What’s next

We are also going to use new technology to diagnose and treat. Computer algorithms from companies like PhysIQ are already remotely reading abnormal heart rates via disposable patches. Soon, a range of devices will be in the bathroom reading your spit, poop, blood, breath and vital signs. Companies like Philips and Nokia and startups Kinsa, uBiome and CloudDX are bringing them to market. They’ll first be used by the sickest patients, but soon they’ll be mainstream consumer goods. Finally, mental health, physical therapy and more are already being delivered by avatar-based artificial intelligence like and Reflexion Health.

The health care system faces huge changes adapting to the realities of these new technologies. But when it does, it will improve the experience for patients and clinicians. And it will bring patients and society better health outcomes.

Matthew Holt is the publisher of THCB and Chair, Health 2.0 Conferences