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  • Thinking Out Loud About A New Approach To Digital Health Innovation – PART 1


    Note To Reader – As some of you know I recently left Health 2.0 after a great three year run. Over the last few weeks I’ve spent time reflecting on my experiences and thinking about the future of digital health. This piece, which has been broken into three posts, is a distillation of my thought process and culminates in an idea for advancing digital health innovation. Today I’m publishing Part 1, and will be publishing the other parts over the next few days. I appreciate your thoughts and suggestions on how to move forward, so please feel free to comment. Thanks for your time. JL

    Digital Health Is Taking Off – Believe The Hype

    It’s a very exciting time in the world of digital health (or “e-health” or “health tech” or whatever term you’d like to use).  Back in 2007 when my buddy Ed Shin (now CEO/founder of Quality Reviews) and I launched our online clinical trials matching company, Healogica, nobody seemed to care about technology-focused health companies.  In “those days” everybody was obsessing about “Web 2.0” companies and the big ideas of the day: social networking, social media, user-generated content, etc.  Digital health definitely wasn’t sexy.


    Fast forward a few years, however, and it’s amazing how much the digital health industry has evolved.  Until recently, I was the Director/GM of the Health 2.0 Developer Challenge program, where I worked with large health stakeholders and digital health innovators to solve interesting problems using technology.  Over the course of three years, I watched interest in digital health EXPLODE with thousands of individuals and many-hundreds of companies creating new products and services to address a wide range of health care problems.

    Major pieces of legislation like the ACAARRA-HITECH, and America Competes are creating many new opportunities in digital health that simply didn’t exist before.  The excitement around the space is palpable and highly reminiscent of the mood in the early internet days (depends on your perspective, of course, but I’m talking circa mid-nineties).

    You Want Evidence?  I Got Your Evidence Right Here!

    To understand how much has changed let’s take a look at investment in digital health companies.  MobiHealthNews analyzed 10 years of publicly disclosed funding data (see graph below) for “patient-facing digital health companies”.  Their analysis showed that funding for digital health companies increased every year from 2002 to 2012 (except for a slight drop 2009), totalling $939 mm in 2012 (up from only $6mm in 2002).

    While the Mobihealth data shows a funding dip in 2013, a report by RockHealth showed a 39% annual increase in venture funding for digital health companies in 2013(totalling $1.97 B), and recently-released data from Q1 2014 show an 87% (!) year-over-year increase from Q1 2013.  Health 2.0in a report using a more precise methodologyto determine funding levels (they include venture funding, angel funding, and other sources), showed that funding for the digital health sector increased from $1.61 B in 2012 to $2.31 B in 2013, a year-over-year increase of 43%.  Bottom line – a lot of money is being invested in digital health now and that amount is growing steadily.


    What’s even more encouraging is that investment in digital health is now being rewarded with meaningful exits.  In the last month we had TWO digital health IPOs: Castlight Health (CSLT), the SF-based health transparency company, and Everyday Health (EVDY), the NYC-based digital media and content company.  By going public, these companies have shown that it’s possible to build a significant digital health company AND achieve a significant exit, something that many investors have been dubious about for a long time. An increasing number of acquisitions of companies like MapMyFitnessAvado, and Bodymedia has also strengthened investor confidence.

    There are a number of other really well-positioned companies out there like ZocDocPracticeFusion, and Vitals that could also IPO or be acquired soon, and it will be exciting to see where they end up.  I believe that success begets success and predict that the strong financial performance of digital health companies will continue to drive investment and growth in the space.

    Meanwhile, Back In the “Real World” Of Health Care

    Despite all the money invested, all the new companies formed, all the talented people who have come into this industry, and all the hype, the truth is that very little of the innovation that we are collectively building is making its way into the “real world” of hospitals, clinics, pharmacies, nursing homes and other places where health care is delivered.  Why does this matter?  Well, if you want to innovate and slow the relentless upward climb in health care costs you have to go, as Willy Sutton (might) say, “where the money is”.  Where the money is (see table below) is in hospital care and professional services (almost 60% of total national health expenditures) – i.e. direct health delivery.


    Ask yourself, however, what has changed at your local hospital or doctor’s office since the foundation of WebMD, the first big digital health company, back in 1996?  What percentage of doctor visits are booked online?  What percentage of prescriptions are filled online?  What percentage of provider-patient interactions happen virtually?  Ask yourself a similar set of questions about any other industry – banking, retail, entertainment – and you realize that health system that you and I experience every day is still phenomenally ANALOG.

    I will admit that there has been some progress made in the use of technology to deliver health care, particularly in the area of electronic health records (EHRs).  A recent study showed EHR adoption increasing year-over-year across all provider group sizes (small physician office, large physician office, and integrated health system), with the overall adoption rate in 2013 being 61% (vs. 50.3% in the prior year).  I think everyone would agree that the adoption and use of electronic health records is a good thing.

    The cynic in me, however, would like to point out that the increased adoption of EHRs has been fueled by big-time government incentive programs that won’t go on forever.  The part of me that “keeps it real” would also like to point out that the incentives have driven the adoption of antiquated legacy EHR systems that primarily allow providers tobill more aggressively, and don’t really improve the quality of health or the health experience.

    Aside from EHRs I’m sure that there has been some progress made in other places, but overall I think it’s safe to say that we’re not anywhere close to where we need to be.

    Next Up: Thinking Out Loud About A New Approach To Digital Health Innovation – PART 2 (Coming Next Week). In the next post I’ll talk about the issues holding us back and how we addressed the innovation problem at Health 2.0.

    HxRefactored Sneak Preview: Catherine Rose, Senior Manager, Healthcare Lighting Applications

    CatherineRose-300x300Our next interview is of Catherine RoseCatherine (along with Derek) made the Lightaide, a teaching tool for children with low vision and those with cognitive disabilities.  Read on for this next HxR sneak peak.

    What is your burning mission in health and why?

    CR: I am passionate to make sure that our daughter’s care is not an exception; but rather it is a norm that parents have tools to support themselves. I’ve shared how to build a team to discuss with doctors, find a community for support and communicate frequently with our care team. I look forward to a world that consolidates silos to care for patients in their single body, cares for patients where they are, communicates compassionately and creates a future for Alexis’ health and well-being. Caregiver stress spikes from unplanned hospitalizations. My dream includes using innovative technology to allow more care to be delivered at home.

    What is your patient story?

    CR: As an empowered and engaged caregiver, I am Alexis’ voice, I’m her pattern recognizer, I’m her numbers gal. I have pulled on my strengths and give it my all to have her have a chance for life. The first words about Alexis were “Your daughter is going to die within the first month of her life. And if not then, she’s surely going to die within the first year.” I had already said goodbye to Alexis’ twin, Kaitlyn, who had died in utero at 29 weeks. I am empowered by using technology to invent new devices to support Alexis’ health and wellness. I am equipped by knowledge through researching references and interacting with other parent caregivers to improve Alexis’ and Jessica’s care.

    What new health-related website, app, or technology do you think will improve health?

    CR: We have the following success stories from parents using LightAide: “Olivia has never truly had a toy that she has been attracted to enough to remember to play with. When she came home from school the other day, the first thing that she did was run to the LightAide. Cognitively, this modality had such an impact on her that she remembered. Wow, I have no words. I possibly just witnessed a miracle!” -Anna, Olivia’s mom “Aly loved the LightAide immediately! She was very drawn to the light and movement. The switches helped with her purposeful movement by utilizing cause and effect. Using the LightAide has been an eye opener for me. I have seen the LIGHT. Lights are the key to unlocking my daughter’s learning potential.” -Brittany, Aly’s mom

    Why should people come to your session?

    CR: LightAide might have been an idea from a mom, but the journey to bring LightAide to market inspired a team, which in turn has inspired a company. LightAide is highlighted as one of the products in the Innovation+You. Attendees will get to learn first hand how a little product with big potential is helping kids throughout the world.

    HxRefactored Sneak Preview: Judith Weader, Customer Experience Strategist, Blue Cross Blue Shield of Rhode Island

    JudithWeader-300x300Judith Weader is a customer experience strategist at Blue Cross Blue Shield!  At the HxR Conference she’ll be talking about the changes that made a difference for Blue Cross Blue Shield’s customers.

    What is your burning mission in health and why?

    JW: I want people to have access to affordable, quality health care so they can live their lives to the fullest. Health insurance is a big part of that equation, and I want to inspire and empower my co-workers so that we can be a positive, supportive partner for our customers.

    What is your patient story?

    JW: One of the most intense patient experiences I ever had was when I was in the hospital to deliver my first child – my daughter. No matter how much you’ve read or learned about beforehand, nothing fully prepares you for having a child. When I was being prepped for my c-section, and the anesthesiologist pushed the spinal anesthetic, my blood sugar dropped like a stone and I started to feel incredibly sick and dizzy. I explained the situation to the anesthesiologist and he immediately gave me a sugar drip – which brought me back to normalcy. It was a perfect example of a healthcare provider listening to and trusting a patient, and that made the rest of the delivery a snap for me. Even better, with that knowledge under my belt, I was able to educate the anesthesiologist helping with my second c-section 3 years later, and he pushed sugar right after the spinal, so I never even had a moment’s difficulty. It was through those two deliveries that I learned that as much as I wanted to have a great obstetrician, it’s also incredibly important to have a great anesthesiologist, too! When doctors listen to and work with their patients, the experience is better for everyone.

    What new health-related website, app, or technology do you think will improve health?

    JW: I think integration on the mobile device will be of critical importance in the future. People don’t like fumbling with multiple passwords and systems, so integrated systems that combine weight-management tools with pedometers/speedometers and wellness incentive programs will encourage and educate patients without adding additional complexity. The more we make it easy for people to do things that are healthy – like tracking what they eat, how much they move, etc. – the more likely they are to do it.

    Why should people come to your session?

    JW: I’m here to show that you can improve the customer-centricity of an organization, even with limited resources. If a company operating in a traditionally paternalistic industry like health insurance can think more like a retailer, anyone can make customer-focused changes that improve their customers’ health and the company’s bottom line!

    HxRefactored Sneak Preview: Adam Connor, Experience Design Director, Mad*Pow

    AdamConnor-300x300Today, we present another HxR sneak peak! Adam Connor works at Mad*Pow to ensure that customers reach great design solutions, with a better design education and better collaboration.

    What is your burning mission in health and why?

    AC: I guess I have two. First, I want to help teams, whether they be patients, doctors, analysts, developers, whomever work better together to improve patients lives. I believe that collaboration is critical, but it takes a lot more understanding and action than just putting people together on a team and expecting them to make something. Second, I want to help bring basic, compassionate, empathic human-to-human interaction back to healthcare and avoid the industry becoming so enamored with technology that patients become database records, or usernames that log into apps and websites. Technology is great, used as an assistive tool it can add both power and speed to interactions, but nothing, nothing is superior to meaningful human interaction, especially when it comes to a person’s health.

    What is your patient story?

    AC: I was diagnosed with a rare, chronic condition when I was five. Given how relatively little is known about the condition, I’ve gone through a wide variety of treatments and dealt with the relative successes and failures of each. Over the long view of that time, I’ve had great experiences and healthcare, and some that we’re so mind-blowingly absurd it leaves you to question wether anyone knows what they’re doing. In my experience these absurdities tend to happen between things, between events, for example transitions of information from one doctor to another. These situations leave patients feeling helpless and hopeless. Getting teams to think through these kinds of challenges is part of what drives my interest in designing for healthcare.

    Why should people come to your session?

    AC: Chances are you’ve worked as part of a team. And it’s more than likely you’re going to have to again in the future. The success of your projects and of your organization rely on teams being able to work together. Taking a step back and understanding the challenges that teams face so that you can proactively address them means better ideas, better progress and happier team members. And I’m pretty sure that those are all good things.

    News & Updates

    The ONC is inviting voting for ideas submitted in its Digital Privacy Notice Challenge, which include games, responsive templates, a Web widget, and an NPP generator.

    eCaring raised $3.5 million in a Series A round for its platform to support aging in place. The platform, which monitors day-to-day behavior and activities, helps identify any changes indicating a decline in patient condition or anything that requires a rapid response. Ascent Biomedical Ventures led the round.

    BlackBerry invested in Patrick Soon-Shiong’s NantHealth. The companies are jointly developing a smartphone optimized for viewing diagnostic images, scheduled for a late 2014 release.

    HeiaHeia, a Finnish startup offering a social and corporate wellness platform that helps employees live a healthier lifestyle raised €1.5 million in funding led by Finland’s Wallstreet Financial Services.

    CMS introduced a Code-a-Palooza Challenge to encourage developers to create apps that use the new Medicare payment data to help consumers improve their healthcare decision-making.

    Stockholm, Sweden-based calorie counting app company Lifesum (formerly known as ShapeUp Club) raised $6.7 million in its first round of funding led by Germany’s Bauer Media Group and SparkLabs Global Ventures. The company has 4.5 million members and 6.5 million downloads in Europe for its Android and iOS apps. At the end of last year it reported having about half a million monthly active users.

    Anoto, a digital writing solutions provider, achieved Health Insurance Portability and Accountability Act (HIPAA) compliance for its Anoto Live™ forms as a hosted or locally installed solution to the US health care market.

    Sandlot Solutions, a health interoperability and analytics provider, signed a five-year contract with Dialysis Clinic Inc. to provide clinical interoperability. DCI will implement two Sandlot modules, Sandlot Connect, for comprehensive data gathering and exchange, and Sandlot Dimensions, which combines a data warehouse with business intelligence tools.

    The SMART Platforms project at Boston Children’s Hospital formed an advisory committee to guide the project on strategy, technical approach and business development. Members include The Advisory Board Company, AARP, BMJ, Canadian Institutes of Health Research, Centers for Medicare and Medicaid Services, England National Health Service, Hospital Corporation of America, Eli Lilly, MyHealthBook, Polyglot Systems, and Surescripts.

    MeMD, a telemedicine company, will now provide telehealth services in all 50 states in the US. Patients will be able to request a medical consultation with a MeMD Provider and obtain an e-prescription. MeMD provides both single-use and monthly membership-based options for consumers as well as businesses seeking telehealth services and health benefits.

    Txt4health, a mobile health and wellness program for adults age 18 and over, reached 100,000 enrolled members since launching in December 2013. Txt4health provides timely and personalized health information on recommended guidelines for physical exams, preventive screenings, flu shots and vaccinations, etc.

    HxRefactored Sneak Preview: Ahava Leibtag, President & Owner, Aha Media Group

    AhavaL-300x300Here is an interview with Ahava Leibtag, continuing our HxR conference sneak peak series.  Ahava will be talking about how population research/information should inform design.

    What is your burning mission in health and why?

    AL: For people to get quality healthcare information, no matter where they are and which device they are using.

    What is your patient story?

    AL: Don’t have one.

    What new health-related website, app, or technology do you think will improve health?

    AL: Better content out there.

    Why should people come to your session?

    AL: To learn the dos and don’t of writing healthcare content that converts AND educates!

    HxRefactored Sneak Preview: Krisa Ryan, Service Designer, Mayo Clinic Center for Innovation

    krisaThis interview is with Krisa Ryan, who works on the Practice Redesign platform for the May Clinic Center for Innovation.  Come watch her speak at the HxR conference.

    What is your burning mission in health and why?

    KR: My burning mission in health is to enhance awareness, anticipation and communication for care teams and patients through knowledge and tools.

    What is your patient story?

    KR: Two patients I’ll never forget were the “Two Fathers.” They had the same disease and medically looked identical on paper. They would have received the same treatment until we were able to use design tools to highlight their lifestyles and formative backgrounds. To me, the Two Fathers represent the need for design in healthcare, the need to meet patients where they are, and the need to see patients as individuals.

    Why should people come to your session?

    KR: People should come to my session to find a passionate designer willing to share stories.

    HxRefactored Sneak Preview: John Yesko, Senior Director of Online Customer Experience, Walgreens

    JohnYesko-300x300The next preview of our HxR conference is with John Yesko.  John is the UX master behind Walgreens.com and associated sites.

    What is your burning mission in health and why?

    JY: My mission as it relates to Walgreens is to extend the 100+ year tradition of customer convenience to the digital space. That means giving our customers frictionless access to the products and services that can help them lead more healthy and happy lives. It also means helping figure out how the digital realm and our 8000 physical stores can not only co-exist, but make each other better. More personally, I’m interested in understanding the journey that consumers go through when trying to avail themselves of self-service experiences. Where are the pain points, and how can design make it better? I feel that we will never run out of poorly-designed services that – with a little love – can be so much better.

    What new health-related website, app, or technology do you think will improve health?

    JY: In general, devices and apps that allow patients to monitor their own health, communicate it seamlessly to their caregivers, and make the right decisions.

    Why should people come to your session?

    JY: My talks tend to be light on theory, and heavy on real-world applications. I intend to use real-world examples to make my points, and but them into terms that everyone can appreciate. I might even throw in some humor.

    Solving the Health Puzzle: Can Wearables Actually Disrupt the Health Industry

    With consumers showing more interest in tracking everything from sleep patterns to blood pressure, it’s no surprise that wearables are gaining the lion’s share of attention in the digital health space. Even employers are providing wearables to staff as part of their benefits package.

    There’s a glaring need in the health care industry to gain better insight into consumer health behaviors so insurance companies, care providers and even employers can drive healthier outcomes. Wearables – such as FitBit, Nike FuelBand and Garmin Vivofit – provide this real-time, individual data, so they are uniquely positioned to revolutionize how health programs are a managed and delivered. The problem is that insurers and providers don’t have the ability to ingest and interpret this data to create such programs.

    Before wearables can really disrupt the health status quo, there are two particular challenges the industry must first address:

    1. Connectivity. Health and insurance providers need actionable data. Without a software interface that allows stakeholders to better understand consumer health data – in aggregate, anonymous form – wearables fall short of providing the actionable insights needed to create effective health benefits, care and incentives. For example, how does your health and related spending change if you log a certain number of steps in your FitBit?
    2. Accessibility. Wearables need to appeal to a diverse population and not just the health conscious or tech-savvy. Design, durability and ease-of-use need to be achieved for widespread adoption. It is important to factor in not only the twenty-something who runs on her lunch break and logs 10,000+ steps per day, but the senior citizen with hypertension and diabetes.

    Below are three ways the health industry can make wearables more useful on a larger scale:

    Leverage consumer engagement platforms: The majority of insurers and providers are simply not set up to capture and make sense of the data wearables provide. This is where consumer engagement platforms come in: they bring together data from every source that collects health information – whether that’s a wearable device, doctor charts, biometric screenings or HRA forms. From there, insurers and providers can examine and draw conclusions to create benefits, plans and incentives that will actually move the needle, while motivating consumers to use these platforms for these health and financial rewards. However, this also means that wearable companies need to make their API’s open. And even further, become truer partners and work with providers and insurers on initiatives like clinical studies to better understand efficacy.

    Expand accessibility Health devices of any kind should fit seamlessly into a user’s life. It’s all about making it easy – more durable, longer battery life, more water-resistant. It should be better designed for the every-man and the everyday. Wearables will also gain popularity as the insights become smarter. For example, rather than simply counting the steps a person takes in a day, it would be more useful for consumers to know the specific distance they should walk to reach their doctor’s prescribed amount of daily activity.

    Measure the Data to Outcomes: Finally, data consistency across all devices will allow the health industry to actually measure lifestyle data against health outcomes. To do this, we need a way to audit the data from these devices to ensure that it’s truly accurate and not falsified. As this is achieved, consumers, insurers and providers will be better able to answer questions like: If a person walks one mile per day, how does that lessen their need for certain medical services? And what does that mean in terms of cost savings for the insurer and the consumer?

    Across the United States, we’re already seeing a trend of insurance companies and health care providers adopting consumer engagement technology, with wearables playing a vital role. But to truly disrupt the health care industry, the data from these devices must be more actionable so behaviors can be correlated to real results and cost savings.

    Naimish Patel is VP Product Marketing at Audax Health. He can be reached at @naims88.

    HxRefactored Sneak Preview: Elizabeth Bacon, President & Founder, Find Wellness

    ElizabethBacon-300x300Elizabeth Bacon is the Founder of Find Wellness, and at the HxR conference, she’ll be talking about app design.

    What is your burning mission in health and why?

    EB: America’s healthcare system is broken, and its focus on providing “sick care” leaves most people without a guide when it comes to preventative care and wellness. My startup, Find Wellness, aims to support people in seeking care from natural health & wellness practitioners; we have intuitive search tools for people to find the right, qualified providers for their needs as well as easy-to-use solutions for practitioners to manage their practices. When it comes to technology, as well, the western medical system is burdened with too many disconnected systems, almost all of which are frustrating to use and some of which interfere with the delivery of care. My mission, given my background in user experience design, is to humanize technology at every touchpoint between patient and provider. By focusing on people’s goals, we can deliver innovative solutions that reduce friction and ease the way towards optimum health.

    What is your patient story?

    EB: Even my relatively limited experiences as a patient in the western healthcare system tend to leave me feeling disrespected and lost. At one point, I was told that my diet had no relationship to my intestinal problems, and that I needed to take four pills a day for the rest of my life to manage my symptoms. This approach seemed ludicrous and wrong, and I had to embark on a lengthy journey with odd twists and serendipitous turns to find my way to a healthy diet and lifestyle that has me pain-free and prescription-free. What would a less-activated patient have done in that situation? We can’t let the system beat patients down and deny our inherently individualized needs when it comes to health & wellness.

    What new health-related website, app, or technology do you think will improve health?

    EB: Naturally I’m throwing my weight behind my startup’s technology (see our website at http://www.findwellness.com) which aims to transform healthcare by growing the market for natural health & wellness practices by operating at the intersection of intuitive search, personal health tracking & big data analysis. Beyond this, I have a lot of hope for telemedicine & related efforts like those of Bright.md to simplify the pursuit of routine healthcare and lighten the load on primary care providers. Additionally, the ongoing scientific validation of ancient practices like meditation to reduce stress and improve health represent the vanguard of embracing approaches to health that don’t fit into the current western medical system model.

    Why should people come to your session?

    EB: At the session I’m leading with co-presenter Lorraine Chapman, we will share our experiences using the tools and techniques of user experience design and research to inform the creation of awesome health apps and health IT. When we understand people and their context, we can deliver solutions that fit into their lives and let them achieve their health goals. UX methods can improve both technology and health outcomes, and we hope to surprise people with how easy they are to learn and apply, no matter your role.

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