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The Optimal Hospital Part II

Ochsner Medical Center in New Orleans has a very unique innovation model with a team that operates with the flexibility and autonomy of a start up, unlike the approach of most major healthcare organizations. In Part I of this series, I explained how they re-imagined patient care for a specific group of cardiology patients and shared the highlights of my tour of Ochsner’s Optimal Hospital.

This part is a deep dive into my interview with Jonathan Wilt, who was previously an engineer at Epic, and then ran his own consultancy firm, before joining Ochsner to lead the innovation team which currently consists of 18 people split between clinicians and engineers.

Omar Shaker: Thanks for having me Jonathan. Can you please explain when your innovation department was created and the purpose behind it?

Jonathan Wilt: If you want to be competitive in healthcare over the next five years, you need to think of what’s  to come. Value-based care will be the trend for entire industry, and so we must innovate to reduce cost and improve quality. The innovation department was built two years ago with the purpose of exploring new technologies and how we can use them to reinvent the clinical model.

OS: Experimentation of that sort doesn’t usually yield any return on investments in the short term though, how does your department resolve that with leadership?

JW: What we want is to reimagine how the patients are treated across the organization. The timeline on our projects’ returns are 3-5 years. Preventative care can’t show you outcomes or savings in a short time. We’re trying to prevent strokes and heart attacks. It’s not like you can say: If this patient’s blood pressure is under control then they won’t get a heart attack or vice versa.

Leadership understands that, and the department was created by Dr. Richard Milani with that vision. I don’t need results next month; I need results in a 2/3 year cycle. We can start 15 projects and they’d get narrowed down to one successful project.

To balance that, we sometimes need to work on smaller projects that are simply about optimizing existing business functions to make some revenue or cut some costs. We’d rather always be working on the cool stuff, but this is what is sometimes required to balance the budget and be able to pursue bigger things.

OS: What are some of those projects that you are working on?

JW: We have three major buckets of projects:

    • Digital Medicine Projects:

Our Digital Medicine Hypertension Program has 200 patients who had uncontrolled blood pressure and 70% of them have reached a controlled state within six months. We ask them to send a single measure per week and we get an average of six readings per patient per week!

We also have a wireless weight monitoring program for all cardiac patients, coupled with a medication adherence program done through our pharmacists who are part of our department.

The doctors absolutely love this program because it makes the follow up process much more effective and the patients are more engaged, because of the increased number of contact points that happens throughout their care plan.

    • Inpatient Care:

This is our Optimal Hospital Project which is an innovation wing in the cardiology department with 15 beds. This is where we test all our ideas and experiment with wireless monitoring, lab testing schedules, different lighting, sound monitoring and many more variables. We study how these changes help our patients’ recovery.

    • Patient Experience:

Text message appointment reminders are a good example for that bucket, where 140,000 people signed up in eight weeks. There was a huge demand that we weren’t fulfilling. The goal is to make patients more comfortable and giving them what they want.

OS: What are the biggest enablers you’ve had for your successes so far?

JW: Having agile leadership that supports and trusts us is vital for our success. We don’t need to go through approvals like other big organizations. This trustworthy atmosphere creates space for creativity.

Another thing that was instrumental for us was Apple’s Healthkit. It was a game changer, because it allowed us to push information from all these sensors straight into our medical records without having to worry about all the integration which would’ve taken immense amounts of work from us.

I’m a strong believer that things belong in their places and I’m very strict on maintenance. We can’t innovate in the future if we are constantly maintaining bad code or bad integrations. We have an electronic medical record, so we don’t build add-ons, everything lives inside of Epic. We do not want to invent a new universe or new web app, and that gives us a lot of data advantages.

Health 2.0 Europe: The European Gathering of Digital Health Champions in Barcelona

Barcelona, ​​March 31, 2016. All the stakeholders from the European digital health tech ecosystem will meet in Barcelona for the 7th edition of Health 2.0 Europe (10-12th May). Since 2010, Health 2.0 Europe has been the platform for developing and presenting new solutions in the field of digital health. The conference will showcase innovative technologies from around the world helping healthcare professionals and patients in their daily activities and lives in the hospital or remotely. The organization has chosen Barcelona to host this new edition, considering it to be a major capital for innovation with a high concentration of start-ups and their close collaboration with the Mobile World Capital Barcelona.

  • During three days, pioneers in using new technologies, investors and start-ups will meet in an international event consolidated as the leading showcase of cutting-edge innovations transforming health and health care.
  • This edition will bring together big names from the international digital health scene like Dr. Rafael Grossmann, the surgeon who performed the first live surgery with Google Glass.

All the key players of the health IT ecosystem will be represented in the conference program. This year, the conference’s structure holds three main axes: accelerating the adoption of innovative solutions by patients and healthcare professionals, increasing the investment flow in digital health start-ups, and the reimbursement of these new technologies by public and private insurance systems. Along those lines, here are some of the scheduled discussion panels:

  • Health 2.0 Trends Around the World
  • Solutions for Hospitals and Health Professionals
  • Building a New Framework for Health 2.0 Adoption in the Clinical Setting
  • Building Blocks to a Dynamic Health 2.0 Ecosystem in Europe
  • Health 2.0 Applications and Implementations in Emerging Markets
  • Health 2.0 Power to the Patients!
  • Who Will Pay for Health 2.0? An Investors’ Discussion
  • Health 2.0 Transforming the Daily Mission of Nurses
  • Reimbursement – Players, Trends, Criteria, and Processes

Health 2.0 Europe 2016 brings together digital health pioneers
Key speakers will include Dr. Rafael Grossmann, trauma surgeon and pioneer in digital health (he performed the first-ever live surgery with Google Glass); Esther Dyson, one of the most influential investors in digital health in the world – her latest investments include PatientsLikeMe, 23andMe, HealthTap, and Omada Health; Dr. Julio Mayol, director of the Innovation Institute San Carlos Health Research (IdSSC) in Madrid and advisor to biomedical technology and digital health start-ups.

More than 120 speakers, 30 investors and 50 live demos of new digital health solutions
In the last edition of Health 2.0 Europe (May 2015) “the digital solutions presented on stage were in a more advanced stage of maturity than in previous years – ready for investments and large scale implementations. The overall conference was very positive; we had over 450 attendees, a number we hope to increase again this year!” reports Pascal Lardier, International Director at Health 2.0.

Echoing the success of previous editions, 50 live demo of digital health solutions designed to help all those involved in health management (patients, healthcare professionals, pharma groups, public and private insurers…) will be showcased from a user perspective. As an example, the session “Solutions for Hospitals and Health Professionals” will be introduced by Dr. Rafael Grossmann and will showcase five of the latest most advanced tools and apps created to increase the quality of patient care and reduce healthcare costs.

Business opportunities and new solutions for physicians and patients
Health 2.0 Europe provides visibility to digital health start-ups but also funding opportunities and investor networking. The 5th edition of EC2VC- Investors’ Forum and Pitch Competition will focus specifically on increasing the investment flow in Europe. “At Health 2.0 Europe we bring together the most active international investors in digital health so they can engage early with the most promising digital health start-ups in Europe.” says Pascal Lardier, Health 2.0’s International Director.

For more information:
Margarida Mas
Communication and press 7th Health 2.0 Europe
Tel +34 626 523 034
mas-sarda@galenia.net

Health 2.0 Europe, encuentro europeo de líderes en salud digital en Barcelona

  • Durante tres días, pioneros en utilizar nuevas tecnologías, inversores y start-ups se reunirán en un evento internacional consolidado como referente en la innovación en salud digital.
  • Esta edición va a reunir a grandes nombres de la salud digital a nivel internacional como el Dr. Rafael Grossmann, cirujano que realizó la primera cirugía documentada con Google Glass.

Barcelona, 29 de marzo de 2016. Todos los actores del ecosistema tecnológico en salud digital se darán cita en Barcelona en la 7º edición del Health 2.0 Europe (10-12 de Mayo). Health 2.0 Europe es, desde 2010, la plataforma para desarrollar y presentar nuevas soluciones tecnológicas en el ámbito de la salud digital. Provenientes de todas partes del mundo, se darán a conocer ideas innovadoras que se han convertido en herramientas para ayudar al profesional médico y a los pacientes en su día a día en el hospital o telemáticamente. La organización ha escogido una vez más Barcelona por ser la capital de la innovación con una gran concentración de start-ups y por su estrecha colaboración con la Mobile World Capital Barcelona.

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Epigenetics and the Black Box of Male Infertility

Human beings have always regarded bearing children as one of the most meaningful and fulfilling acts of life, particularly in the last few thousand years. The genuine joy, fear and excitement parents feel for their children make even a cynic like me stand in awe of the role that raising kids plays in both the parents’ life and in society.

Being 28, single, and living in an overpopulated world, my priorities in life are more about my career and living new experiences rather than being focused on building a family and ‘spreading my seed’. Apparently I am not alone in this, and research shows that more and more people prefer to wait to an older age to have their first child; mainly due to secular and socioeconomic pressures.

Another trend is becoming prevalent, which is that this older population of parents are finding it harder to conceive. Though previously thought of as a cause of advanced maternal age, causes of infertility have recently been linked to advanced paternal age as well. In fact, according to the CDC, 7.5% of all sexually experienced men younger than age 45 reported seeing a fertility doctor during their lifetime (3.3–4.7 million men). Of men who sought help, 18% were diagnosed with a male-related infertility problem.

Perhaps the most frightening fact about the problem is that over 25% of these males have unexplainable infertility. They go to infertility clinics, pay large sums of money out of pocket, and make decisions about treatment while not knowing the cause. The good news is that the solution to this giant information gap might be right around the corner.

Episona, a California-based startup, is using the fascinating science behind epigenetics to study male infertility and help people build families. “To understand epigenetics, think of building a house.” explained Alan Horsager, President and CEO of Episona. “If the house, with its many components, is your genome, then the blueprint of the house’s design is what epigenetics is. It is a way for the cells to know which building blocks [genes] to use.

Epi is a latin prefix for the word around or next to. These are a set of rules that determine which genes get expressed or used and which remain dormant. To a large extent, our epigenetics determines who we are, what we look like, and what kind of diseases we may be prone to. They are particularly interesting because they are not only inherited, but also change with age, environment, and behavior.

Episona evaluates an individual’s epigenetic profile to determine if there may be a fertility problem that isn’t picked up by currently available diagnostic tests. Doctors then get a report with a Fertility Score, including a list of genes that are epigenetically abnormal. Doctors can use this information to better counsel their patients and direct them to the best possible treatment.

“We see ourselves essentially as a data company. What we are interested in is studying the relationship between epigenetics and the environment, and asking ourselves how we can predict disease and outcomes”, Alan told me, after explaining that they survey their patients about their general well being and behaviors. It’ll certainly be interesting to see what correlations they can find.

Episona has raised over 1.3 M US Dollars and will provide their services to infertility clinics in the US and Canada later this year.  Their studies and trials have shown that their predictive models proved to be highly accurate in classifying male fertility status (fertile or infertile), with 82% sensitivity, and 99% positive predictive value.

“The alternative right now is that these people who don’t understand the underlying developmental causes of their infertility choose between In-Vitro Fertilization, which costs about $15k and has 30% success rates, or Intra Uterine Insemination which costs $2k with about 15% success”, Alan explained, stressing the giant potential of these technologies.

Epigenetics is also being applied on a wider range of medical issues and lifestyles, and is opening up a world of options such as this study about the correlation between obesity and spermatozoa epigenetics. Companies like Episona allow us to peek into the blueprint of our bodies and essentially redesign what is necessary.

Technology for Healthy Communities Launches Today!

Technology for Healthy Communities (5)

Health 2.0, with support from the Robert Wood Johnson Foundation, is proud to announce today’s kickoff of Technology for Healthy Communities, a digital health pilot program that facilitates technology adoption at the community level by tackling the most pressing local health issues. The inaugural program connects health technology innovators with 4 under-served communities across the U.S. with the goals of improving health outcomes and building sustainable partnerships.

Despite the booming digital health ecosystem with over $4B in investments in 2015, there are significant hurdles to adoption for local communities, including lack of community stakeholder engagement and lack of financial incentive/commercial business models for startups in the community health setting.1 While innovation challenges in digital health have introduced elements of matchmaking and short cycles of engagement, there has not been a rigorous model for testing and implementation that leads to sustainable adoption.

At the same time, we live in a healthcare climate where the U.S. health expenditure is over $3 trillion and our health outcomes lag behind those of other developed countries.2 We disproportionately spend less money on social services and more on healthcare and yet a large majority of what makes us sick can be attributed to the social determinants of health— factors such as socioeconomic status, availability of resources, education, employment and access to healthcare, that affect a wide range of health risks and outcomes.3, 4 Technology for Healthy Communities has the opportunity to catalyze the adoption and use of health technologies in communities in order to impact these social determinants, improve health outcomes and create business opportunities for technology companies.

Several communities across the U.S. applied to participate in Technology for Healthy Communities. Four under-served communities were selected to move forward with the program:

Through an open application process, the Technology for Healthy Communities team will source health innovators across the U.S. that provide cutting edge solutions to the communities’ health needs. The specific technology needs identified by the participating communities can be found on the program website. Selected innovators will then be matched with communities to conduct pilots and implement sustainability plans with the ultimate goals of improving health outcomes in the community’s target population and developing a sustainable, commercial model. Successful participants will receive funding (there is up to $200,000 available in a funding pool to support pilots) and promotional opportunities to increase their visibility.The Technology for Healthy Communities team will provide pilot implementation guidance and work with the community and innovator pair to identify local commercial partners to sustain the technology adoption beyond the duration of the program.

The application process is now open to innovators who are looking to make a significant impact in under-served communities by implementing their technology solutions. If you are a health technology company, this is a unique opportunity to gain access to a vetted network of community organizations, guidance and funding from the Technology for Healthy Communities team, with the potential for commercial contracts and business development opportunities.

The deadline for innovator applications is May 17, 2016. To learn more about Technology for Healthy Communities and submit an application, visit communityhealthtech.org.

Introducing NYC Digital Health Forum

Brooklyn-Bridge-Forum4

A Conference for the Digital Health Entrepreneur

We have brought together some of the most innovative thinkers across the healthcare, technology, and venture spaces to share their perspectives and opinions on how to access and capitalize within digital health. This is an opportunity to rub shoulders with and learn alongside other entrepreneurs directly from the mouths of the New York City’s largest healthcare stakeholders and startup veterans. On May 18th from 9am to 2pm, NYCEDC, Health 2.0, and Blueprint Health present NYC Digital Health Forum at the New York Genome Center.

Entrepreneurs, innovators, hospital professionals, and industry leaders will explore the digital health landscape and discuss how startups and healthcare organizations successfully partner to bring new technologies to the forefront. Learn about the needs of healthcare partners, the characteristics of a unicorn within our space, how to design a commercially viable pilot, and much more. The full agenda is available now. We invite all entrepreneurs and healthcare stakeholders to join in the discussion. There will also be complementary competitive matchmaking sessions between regional healthcare partners and digital health innovators occurring that afternoon and the day before. Come to both events to study up and close a deal.

Buy your ticket before its gone! Updates will be made available at nycdigialhealthforum.com.
Mark your calendar on May 18th for NYC Digital Health Forum at the New York Genome Center.

The Benefits of Matchmaking

Digital Health Matchmaking

Beyond our new look, the Digital Health Marketplace (previously Pilot Health Tech NYC) is a more robust and wide reaching program than ever before. We have undergone an evolution since beginning in 2013 and developed distinct matchmaking and funding arms. We have watched two successful classes execute pilot projects with healthcare partners throughout the City of New York, and for the first time this spring, we are offering additional independent matchmaking sessions open to regional healthcare partners both within the city and beyond.

The value of matchmaking lies in its vetting and pairing service. By filling out our Find a Match application, the Digital Health Marketplace team of industry veterans from NYCEDC, Health 2.0, and Blueprint Health will perform a needs analysis of each potential healthcare partner and consider the relative capability of digital health innovators to address those needs. With input and approval on behalf of potential healthcare partners, select viable pairs will be connected via curated meetings held on May 17th and 18th at the New York Genome Center.

Our matchmaking sessions have been a resounding success in reinforcing startup sales pipelines and bolstering healthcare transformation. Facilitating relationships between larger healthcare institutions and smaller digital health startups, we created a free and frictionless and industry specific matchmaking service designed around health innovation. These sessions have not only effectively set the stage for successful pilot relationships, but also laid the groundwork for commercial growth throughout our five boroughs. They introduced companies that came to participate within our local pilot funding program, but we would love to see service go regional. With Spring Matchmaking on the horizon, we want to spread the love.

Apply by April 10th, and mark your calendar for May 17th and 18th sessions!

AMA Medical Education Innovation Challenge Winners Announced!

A team from Vanderbilt University School of Medicine won the AMA Medical Education Innovation Challenge. Amol Utrankar and Jared A. Shenson proposed the creation of Muse, an online national curricular resource exchange. This team won $5,000 and is presenting its innovation at the spring meeting of the AMA Accelerating Change in Medical Education Consortium on March 7 in Hershey, Pa.

A team from Sidney Kimmel Medical College at Thomas Jefferson University was awarded second place and $3,000. One team from Midwestern University’s Chicago College of Osteopathic Medicine and another team from the University of Louisville School of Medicine tied for third place. Each third place team received $1,000.

The healthcare landscape has drastically changed over the past decade, but despite the creation of new medical schools and curricular changes in existing ones, physician education has not always kept up with the evolving demands of the health care system. In response to this situation, the AMA’s Accelerating Change in Medical Education initiative in partnership with Health 2.0 launched the AMA Medical Education Innovation Challenge in the fall of 2015. Medical students and those studying other disciplines were asked to “Turn meded on its head” and build the medical school of the future.

The challenge was a huge success and received 146 qualified submissions. Information about most submissions has been gathered into an abstract book that is available from the Accelerating Change in Medical Education initiative website. Teams of students proposed ideas that were creative and had the potential to improve the practice of medicine and outcomes for patients.

More information about the winning teams:

Vanderbilt University School of Medicine
1st place
The Vanderbilt University School of Medicine team proposed Muse: a national exchange for medical education resources: one part information repository, one part social network and one part learning management system. LCME-accredited medical schools could publish their full curricular materials as free, open-access content for use by educators, curriculum developers and leaders. Muse’s content would include, but would not be limited to, syllabi, lessons plans, learning objectives, instructional materials (including multi-media resources), reference notes or texts, and assessment items. Muse would serve as inspiration for its users and community, driving dynamic change, free exchange of ideas and user engagement.
Video Link

Sidney Kimmel Medical College at Thomas Jefferson University 
2nd place
The team from Sidney Kimmel Medical College at Thomas Jefferson University proposed a Medical Maker program, which would provide a creative and safe space for medical students to gain technical skills and rapidly prototype solutions with 3-D printers. Based on educational sessions in core technical skill areas (computer science, small electronics, textiles, medical materials, and rapid prototyping technologies), this program would educate the future physician workforce in the use of techniques that personalize and customize care to meet each patient’s needs.
Video Link

Midwestern University’s Chicago College of Osteopathic Medicine
3rd place
The team from Midwestern University’s Chicago College of Osteopathic Medicine proposed that medical schools institute intentional community-based service-learning experiences, beginning in the first year of medical school. The four-year course outline is a combination of direct instruction, reflective discussions, and service learning that would help students form realistic, empathetic perspective on social inequality and health disparities. The curriculum would be designed in collaboration with community partners to expose medical students to underserved populations, provide opportunities for them to build relationships with these communities, and help students reflect upon how their experiences and biases may affect their potential future medical practice and communication with coworkers and patients.
Video Link

University of Louisville School of Medicine
3rd place
The University of Louisville School of Medicine proposed a curricular model emphasizing student and patient wellness as a means of facilitating communication, empathy and self-awareness. The model includes a combination of required and optional activities, such as cognitive behavioral therapy, accountability teams, reflection groups and communication training. The group also outlined a wellness accessible learning environment, faculty reward system, technology and research applications adding to the support of learners, teachers and patients. This model would promote self-care as a means of improving patient care with the end goal of realigning the culture of medicine with its core values.
Video Link

The AMA and Health 2.0 thank all of the individuals and teams who participated in the AMA Medical Education Innovation Challenge. We hope this challenge inspired medical students and those studying other disciplines to explore new ways to prepare medical students for the changing healthcare environment and to improve the U.S. medical education system as a whole.

For more information on the AMA Medical Education Innovation Challenge, visit innovatewithama.com

About American Medical Association

The American Medical Association is the premier national organization dedicated to empowering the nation’s physicians to continually provide safer, higher quality, and more efficient care for patients and communities. For more than 165 years the AMA has been unwavering in its commitment to using its unique position and knowledge to shape a healthier future for America.

About Health 2.0

Health 2.0 promotes, showcases, and catalyzes new technologies in health care through a worldwide series of conferences, code-a-thons, prize challenges, and leading market intelligence.

 

One on One with HxR Conference Featured Speaker: Peter Levin

Matthew Holt sits down with Peter Levin, CEO of Amida Technology Solutions, to discuss APIs and interfaces, data integration, Blue Button, and so much more. He will be one of many featured speakers at this year’s HxRefactored Conference in Boston, MA from April 5-6, 2016. Click here to register

Matthew Holt: This is Matthew Holt, delighted to be on with Peter Levin.  An old colleague from the years of the early part of the Obama administration — actually, I think until the second term, I believe.  Peter, you were the CTO at the VA.  You’ve been at Health 2.0 a number of times talking about, suicide hotlines and data integration, and of course Blue Button, which is as much your baby as anybody else’s.

So, welcome and we are really delighted to have you in your new role as CEO of Amida Technology Solutions at HxR coming up on April the 5th and 6th this month.

Peter Levin: Well, Matthew, thank you so much for including me in this conversation, and obviously for including me in HxR, and it’s always great to talk to you, and I’m looking forward to this conversation, too.

Matthew Holt: Great stuff.  So let’s go back to — I want to say 2010 when you were making projections of like 25,000 people who might download their records in the VA when you have this new fangled Blue Button thing up.  It’s obviously gone a lot further than that.  And then on the other hand, it hasn’t perhaps gone as far as we’d like– interoperability is still a long way away, both in  the private sector and even in the public sector.

So, give me a sense of what the arc has been and how you think we’re doing in terms of freeing the data, which incidentally is the name of the panel you’re going to be on.

Peter Levin: Yeah. So let me start with the Blue Button conversation, and thank you for the shout out there.  I will say today, what I have said to you in Berlin in November of 2013, which is it’s going better than we had possibly imagined, right?  DJ Patil just put up a White House blog, and I don’t have the number in my head, but I want to say five million people have used it and a 150 million people have access to it.  So as you correctly remembered, what I told Secretary Shinseki at the time that we were launching the program around the time of President Obama’s announcement that I thought we would be on solid ground if we said we would get 25,000 people.  As you might recall, the gag is that we’ve got 25,000 people the first month.

So, for me to be talking to you today about the millions of people that have used it and that rely on it, for me, is there is no better validation and there is no better confirmation that we were on to something then, and I think that we still are.  So, specifically, the Blue Button, I am still very much a proponent of that kind of exchange.  Obviously, I am not– and I think most people are not–religious about whether you’re talking specifically about a Blue Button format or a Blue Button program.  Obviously, for me, I still work on that very hard, but there are many, many choices here.  CCDA Exchange through Direct, the Argonaut Project with FHIR-based exchange, and I really think that we still should be focused on a portfolio of options, some of them patient-centered like Blue Button. I still believe that that’s probably our best shot and certainly what I put a lot of time and energy into from an institution to institution perspective, and those institutions can be insurance companies, healthcare providers, even patient advocacy groups, different disease groups or different kinds of caretaker concerns.  You just want the choice, right?  You just want there to be a number of safe, reliable secure choices.

Frankly, from my perspective, I don’t think we’re doing very well.  I am disappointed as an outspoken member of the community, outspoken and proud member of the community, that if you really look at the number of records that have been exchanged and how they’ve been exchanged and with whom they had been exchanged, there is still an enormous reluctance I would say subjectively still on the part of the incumbent EHR vendors, but not just them, some of the data holders as well, to actually do this. Matthew, I don’t know if you saw, I published a piece recently with Joy Hwang in FCW where we were talking a little bit about how people are still sort of standing behind the shill of privacy as if that’s the reason you shouldn’t be exchanging data.  I don’t see it that way and I think that that edifice is about to fall.

Matthew Holt: So, let me give you two little examples.  So yoy know I have been maundering around the healthcare IT blogosphere. One is Tim Histalk who used CareSync to try to get his data out of an academic medical center somewhere in the Midwest or the South where he lives. Basically he was unable to get them, and actually put in a complaint to OCR, the Office of Civil Rights, I think  they closed this complaint without actually doing too much about it. So he is kind of feeling that there was a lot of effort, but it was pretty much the old world.

I will give you another example– you’ve probably seen my little kid.  I had a lot of problems when he was born, initially getting record between different parts of the same  system and moving stuff around within one hospital on Epic.  A little bit later, which I haven’t written up yet, but I should, he got sick — not very, very ill, but he was sick enough that we got a referral to a pediatrics specialist back at the same big hospital.  But in that case, they had outsourced their pediatrics specialty clinic to Stanford, also on the Epic System.  As I stood behind the pediatrician, I could see her use Care Everywhere from Epic and see the set of records in the Stanford records.  But then when I try to get my parent’s access to the set of record for that one visit, Stanford insisted that I drove down to Stanford and sit in the medical records office and sign something in person, so I never bothered to do it.

Now I have heard many other tales like that.  I also am hearing anecdotally that there is a sort of a movement that people are — those big data holders and the EMR vendors are changing.  So before we think about Epic — before we think about Argonaut and FHIR, where do you think the market is in terms of realizing that what’s been going on forever can’t go on forever?

Peter Levin: Honestly, I don’t think that it has evolved very much in the last couple of years, and we can talk about why, if you want to.  I have some frustrations with how things have been led and how things have been implemented.  There is clearly no urgency anymore on anybody’s side of the table, whether it’s the public sector or the private sector or the commercial sector or not for profit and commercial sectors to be specific.

This is the weird thing about this whole topic, right? You don’t know that you need it until you really need it, and then those episodes tend to be very short, right?  So if you’re in the emergency room and you need access to somebody’s med list, you either have it or you don’t; and if you don’t have it and you’re a clinical care provider, you’re just going to make a best guest, you hope that the patient is coherent enough or that they have some mechanism that gets it for you.  Or if you have some kind of acute condition where access to your medical history could lead to a different or better decision, and you don’t have it in that moment — well, I am at least not aware that anybody has actually been sued for the viscosity of that data exchange?  There is no way to at this point retroactively go back and say, “Well, jeepers.  We know for sure that that patient would not have suffered an adverse reaction or perhaps even that patient wouldn’t have died if only we had that data.”  Of course, the people who have that data are not very forthcoming, not very forward-leaning and sharing those kinds of outcomes with us.

So, part of I think what we’re facing here is that people who are health professionals, but not necessarily clinical care providers — I count myself as one of those — are advocating for a safety cause, a safety mission in an overall global outcome’s perspective where many people who are not involved in the healthcare profession or who don’t see patients every single day, they just don’t think about it that much, unless they have an elderly parent or in your case, your kid who’s now better. But imagine a situation where he didn’t get better as fast and you were still trying to get that data. Let’s say you didn’t know you or you didn’t know me.  Who do you call and what do you say when you have that conversation?

So for me, this is a transcendent moral cause.  I have said that many times, and I think that the nascent data does exist, and we see this now certainly on the payers’ side where at Amida, we do now help some of the payers think about this problem in a more careful way than they have in the past than frankly than they needed to in the past.  We can actually now start in a very gentle, very non-confrontational, very scientific and methodical way think about, well, how do we demonstrate that that access is a good thing, how do we demonstrate that continuity of care, care orchestration, care integration is a good thing.

The data is coming, right?  But for whatever reason, in part momentum, in part history, in part selfish commercial interest and all these things get in the way, and then people just lose interest, right?  Your son does get better and my wife does get better and we don’t do what we thought we were going to do, which is turn this into a larger cause.  But happily, there are people like you who don’t let it go and that’s what gives me optimism.

Matthew Holt: Yeah, my son is a little too well at the moment, actually.

So I want to ask you a bit about the technical evolution of what’s going on, and I was kind of joking before we started that there used to be interface engines and there were armies of consultants building interfaces between different parts of the systems within big hospital systems, and then we have companies who have built on that.  Now, you’re saying a group of newcomers who are using somewhat newer technology, and I put Redox and MI7 and some others in that market, who seem to have a somewhat different approach to that data integration.  Is there something different technically going on that I was missing before?  I know that we have FHIR and some emerging standards, but it’s just something that this happened that it’s sort of exposing in terms of a technical change over the last few years or is it just more people.

Peter Levin: The short answer for me, Matthew, is yes.  As you know, prior to my time in public service and then certainly during it, I have been a longstanding proponent of open source.  For your listeners who may or may not know or be familiar with it, fundamentally we’re talking about the difference between me selling you a proprietary solution for which you pay a license fee, sort of like rent on my intellectual property, or an open solution which is that you don’t get to see the data of course that’s somebody else is private information.  But you do get to see the systems, right?  So there is a new kind of business model, not just unique or peculiar to health, you see this actually in a lot of places right now.  Even for example in cybersecurity, which is a place that we work in a lot, where you do not pay a license fee.

So you’re paying companies and we’re not alone, of course.  Happily, we’re not alone!  You pay us a professional services fee to configure, to customize, to install, and in our case, we’re very happy to report that we get money to operate those systems on behalf of customers.

So, if I were to answer your question, the discriminator to me is that in the past, you had a lot of solutions that were very isolated, ferociously competitive and deliberately not sharing.  They deliberately would keep their data within their systems and charge outrageous fees or do other silly, and I would argue in certain cases unethical, things to keep that data from getting into your hands or into your provider’s hands.  Now, part of what has changed, and we certainly have benefited from that change, part of what has changed is people understand, “Well, look, if we’re not really talking about money anymore, because the open source solutions are less expensive, and if we’re not really talking about vendor lock anymore, if I go with a specific EHR vendor and my official care provider has another one, we may or may not be able to exchange data.”

From that a patient’s perspective, that’s outrageous, right?  From a patient’s perspective at the very least is inconvenient in exactly the moment that you’re looking for convenience.

If you have some kind of serious acute condition, the last thing in the world you want to debate with somebody about is whether you have access to your records or not.  You just need the records to go from your PCP to your specialty care provider full stop, right?  So if we have ways of doing that now that are economical that are super secure and that are easy, easy from the provider perspective, but perhaps most importantly easy from the patient’s perspective, then what’s not to like.  We are seeing the first signs of that change.

Matthew Holt: That’s good to hear, although your cautious optimism, I guess, is the watch word. The last technical question here, which is we’ve heard a lot — obviously, the last year-and-a-half about FHIR and the Argonaut Project sort of advance along and very strong probability that’s sort of new and API-based.  We’re hearing more and more about APIs.  We’ve seen Epic in front of Congress talking about their API.  Whether or not you believe that, there seems to be a greater level of openness going on in an incursion to the “fortress” world, the enterprise world.  You’re certainly seeing more discussions like that. Obviously, you’re seeing more people thinking about open source, although again not as many as you might thought would have done, given its success in the VA and some other countries elsewhere. The question is much more do we need to do in terms of building new standards, API, for APIs and interfaces?  How much of this is technical building out problem and how much of this is a marketing and implementation and convincing people problem?

Peter Levin: Well, look, I mean with great respect to the Argonaut project, which I’m a full throated  supporter of — Amida has built a fire stack where we’ve got a commercial version of this that we install for customers.  So clearly, I put my company’s money and my time where my mouth is.  It is not a technical problem, at least not in my opinion.  I say that again, and I can’t emphasize this enough.  I think the FHIR standard is a great idea and we make money off of it.  But we also know, and I think anybody would tell you, I think the leaders of the Argonaut Project would also not disagree that it actually is being an implementation problem.  This is sort of like the ACH number for money transfers or the 10 digit phone numbers.  It’s a modicum of standardization between the various mobile phone carriers, even though for many years it’s less true today, but for many years they had different kinds of modulation scheme.

You, as a customer, you didn’t know whether it was CDMA or LTE or third generation or fourth generation, you just wanted to dial the freaking phone and get a phone call through and it worked, and it worked because there was enough collaboration there with sufficient cooperation between various carriers that they understood that it was not in their interest to trap people in their specific ecosystems in their particular gardens while they’re not. The same thing happens now today in health data interoperability.

So to the extent that FHIR is a rough analogy, I don’t want to stretch the metaphor too far, but to the extent that fire looks like the ten-digit phone number — great.  It’s not the only one, right?  I mean, there is in fact the Blue Button standard.  There is in fact a CCDA.  There are many, many other ways of doing things, and what you’re finding, the second sort of rock that the people don’t want to do this behind.  The first one is always patient privacy which is just not legitimate, right?  It’s not credible and in any way anymore.  The second is, well, we don’t know what standard to use and we have to wait for the industry to tell us what to do, and that’s non-sense as well.  I mean, these were the major, major objections that we’ve dealt with at the time, and this is now going back unbelievably seven, six years ago around the time of the Obama announcement and the Shinseki announcement about Blue Button, where people were climbing up the walls about how can you give patients their information, and “what if they lose their USB stick”, and it’s not even interoperable.

It’s just all kinds of absolutely nonsense stupid  reasons.  I could be using even more explicit language, right?  It was absolutely nonsense, the reasons that they gave us, and I always think that Eric Shinseki had the best answer to this, which is, going back to veterans at that time, these are people who we trusted to carry loaded weapons with live ammunition to defend our freedom, I think we can trust them with their health records, and I think that you don’t need to be a gun-totting soldier to be trusted with your health record.  In fact, we now know that it is your right to have them.  So people who stand in the way of giving them to you are acting illegally, never mind unethically and immorally.

Matthew Holt: I have much opinion about that.  All right.  So last and not the least, can you give us a very quick plug when you come to HxR of the kinds of things on a more technical level you’re going to be talking about.  So in the session, what might they learn about how you’re thinking about this and what you guys do at Amida?

Peter Levin:  So we’re walking the talk very much along the lines of what I was doing before Veterans Affairs when I was deeply in mesh in the cybersecurity space and while I was at VA where we got to talk about patient-centered models of course, of course Blue Button, the OSEHRA Custodian, making sure that not just from a data perspective, but also from a systems perspective that these things were open that we were having sensible, careful conversations about ways to avoid vendor lock and alternative commercial business models.

So what I expected to be talking about in Boston in a couple of months is how we’ve actually made that dream a reality, right?  So we are doing quite well.  We can always do better.  I don’t want to discourage anyone from applying for a job or approaching us from a customer perspective, but what I hope you and your colleagues and the folks that have been either cheering for us in the front row or sending us good vibes and good karma indirectly, I hope that you will be pleased to know that that model works. This mechanism of releasing the source code and the commercial approach of configuration, customization, integration actually works very nicely and we are starting to see the first trickles of data interoperability in the health space and in places where it never existed before.

So we’re just going to keep hammering that anvil.  We’re pretty sure that we’re on to something here.  We’ve doubled for three consecutive years and this year is not looking so bad.

Matthew Holt: That’s great to hear.  So was Peter Levin   Former CTO of the VA and now CEO of Amida Technology Systems. He will be at a HxR in Boston April 5th and 6th.  So yeah, thanks for your time.  Great catching up with you.  looking forward to seeing you in a couple of months.

Peter Levin: My pleasure.  Thank you very much.  Looking forward to seeing you.

Pip unveils Deeper Insights and Actionable Data into Stress with My Pip

My Pip provides deeper insights and motivation to help individuals learn to better manage everyday stress.

Galvanic, the company behind the Pip (www.thepip.com), a device that detects stress, announced the launch of My Pip – a cloud platform which enables users to better manage everyday stress. My Pip syncs with Pip’s suite of Apps, providing deeper insights and actionable data into the user’s response to stress, encouraging and motivating them as they learn to manage everyday stress.

‘Launching My Pip is a key milestone for us’ says David Ingram, CEO. ‘Following a successful Kickstarter campaign, Pip was launched in October 2014 and has been incredibly well received by therapists, psychologists and consumers around the world, who are using it with great success. With My Pip’s launch we’re further adding to our customer experience and this, together with recent global retail distribution agreements, allows us to further deliver on our promise to bring Pip’s benefits to consumers worldwide. ‘

Ensuring consumers’ data privacy with HIPAA Compliance

My Pip is a HIPAA compliant cloud platform. The Health Insurance Portability and Accountability Act (HIPAA) is the primary U.S. law governing the security and privacy of personal health information.

‘As a company we respect our customers’ privacy and prioritise protecting and securely storing their data’ said Daragh McDonnell, CTO. ‘Our compliance with HIPAA ensures this commitment to Pip users. Just as Pip is putting professional stress management techniques into consumers’ hands, My Pip is ensuring general consumers have professional-level data security.’

About Pip
The Pip is a device that allows you to see your stress levels. The Pip detects electrodermal activity (EDA), a scientifically validated indicator of stress. The Pip connects your emotions with engaging Apps. Through biofeedback – an effective stress management technique, the Pip teaches users to control their response to stress.

Launched in October 2014, the Pip is trusted and recommended by Stress Experts. Over 30 research institutions and organizations around the world are incorporating the Pip into research studies to help manage stress.

The Pip is offered in 2 colours (black and white) and comes with a suite of 3 free Apps (iOS and Android). It is available to purchase on thepip.com, amazon.co.uk, amazon.com and select retailers for $179 / £145 / € 179.

Further information
Contact: media@thepip.com
www.thepip.com

Health 2.0 Unveils “10 Year Global Retrospective”

10 Year Global Retrospective Graphic_Option 1 Final

Health 2.0 announced today “10 Year Global Retrospective”, a platform to recognize outstanding achievements in health tech over the past ten years.

For nearly a decade, Health 2.0 has served as the preeminent thought-leader in the health tech sector and showcased and connected with thousands of technologies, companies, innovators, and patient-activists through an array of events and conferences, challenges, code-a-thons, and more.  Since its first conference in 2007, Health 2.0 has grown into a global movement with over 100,000 entrepreneurs, developers, and healthcare stakeholders, and 110+ chapters on six continents.

In recognition of its 10th year, Health 2.0 will honor the superstars of the health tech community over the past decade through the global retrospective, a platform which will poll the collective insight of its vast network of health tech stakeholders who will nominate and vote for the top influencers in four categories. The winners will be showcased at Health 2.0′s 10th Annual Fall Conference in September in Santa Clara, CA.

The four categories open for nominations:

Industry Leaders (non-patients)
Patient Activists
Technology Companies
Health Care Organizations

Rules
Open nominations begin February 11th, 2016 and will close April 15th, 2016. Any person, company, or organization can be nominated and need not have appeared on the Health 2.0 stage to qualify.  Each individual may nominate and vote only once and must nominate a minimum of two per category, and no more than ten for each category. All nominations are submitted anonymously.

What Happens Next?
After open nominations close on April 15th, they will be reviewed by an expert panel (to be announced soon!). Health 2.0 will announce the top ten nominees in each category on May 9th, at which time a second round of voting will open. Voting will remain open for each category for one week:

May 9 – 15, 2016:  Industry Leaders (non-patients)
May 16 – 22, 2016:  Patient Activists
May 23 – 29, 2016:  Tech Companies
May 30 – June 5, 2016:  Health Care Organizations

Winners will be announced June 27th and the top three finalists from each category will be invited on stage at the 10th Annual Health 2.0 Conference in Santa ClaraSeptember 25-28, 2016.

Please Nominate, Vote and Share this Link!

 

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