Health 2.0

The Health 2.0 conference returned to San Francisco for the fifth year, with a record-setting attendance of 1,500 this time around. The zeitgeist continues to be that of information technologists eager to fix all the problems of healthcare. With 35% of doctors carrying iPads and 85% with smartphones, there is plenty of opportunity for technology, but this year, there was also a closer attention to payment models and to incentives for use, both financial and psychological.

In his keynote, Mark Smith, President of the California Health Care Foundation, said that while technologies such as the Internet had transformed banking, travel and research, medical consultations were still being done the same way they had for the past 50 years. However, it is not enough to provide technology. He stressed that he wanted to fund projects that incorporated financial models that would encourage use. He said too much of what he’s seen in the past resembled the Underpants Gnomes of South Park, with business models consisting of 1. Invent Widget, 2. ????, 3. Profits!

Smith said that the most important element of any new initiative was that it reduce costs, not just by shifting them around, but by reducing the “perverse incentives” that encourage volume above all else. Other opportunities lie in improving convenience to patients, rapid learning for providers on how to make sense of the increasing volume of data and enrollment for the uninsured. As an example of how this could work, he cited how Kaiser-Permanente’s introduction of Electronic Health Records reduced specialist visits by 25%.

There was plenty of innovation on display on the stage and in the exhibit hall, such as:
•    A heart rate tracker from Basis that you wear like a wristwatch
•    A web site from GoodRx that does comparison shopping for prescription drugs
•    Consumer health management and social media systems from WellnessFX, Numera Social, HealthTap and OneRecovery
•    GE Intel Care Innovations home monitoring and communication system.

One of the most interesting talks was from Alexandra Drane of Eliza. She used her company’s automated phone call system to conduct a survey of patients, asking them to rank the problems in their life in terms of how much those things mattered to them and how much they received support on those issues from the medical establishment. The ratio, which she called the Ostrich Index, was around 1.0 for typical medical issues such as obesity, but far higher for other sources of stress such as consumer debt. Furthermore, people with multiple issues with high Ostrich Indexes were far more likely to suffer from serious illness. Her message to the audience was that it needed to take a much broader perspective on issues that affected health and that “health is life, not what’s measured in the doctor’s office.”

Video-Enabled Language Interpretation

SBR Health’s initial customer was a large teaching hospital that approached us with an interesting problem. Like all healthcare facilities, it had a responsibility to patients who needed help communicating with their providers. State and Federal laws, as well as accreditation standards, require that patients with Limited English Proficiency (LEP) be provided with interpreters. Many of the smaller institutions deal with these needs by contracting with telephone-based interpretation agencies, but the larger facilities have their own cadre of trained interpreters who can be dispatched to meet in person with the doctor and patient.

Our prospective customer’s problem was getting the interpreter, doctor, and patient all in the same place at the same time. Too often the interpreter would go to the exam room to find the doctor was running late. Eventually the interpreter would need to leave for his next appointment, only to have the doctor arrive and be unable to proceed without the interpreter. This was enough of a problem when only three people were involved, but when an entire surgical team had to wait before they could obtain informed consent, things could get very expensive and potentially life-threatening.

The solution our customer sought was to move the interpreters to an outlying suburb where space was plentiful and have the interpreters deliver their services via video to where the doctors and patients were located. There was only one problem: the system needed to work at all times and all places, not just when everything was going normally in a wired-up exam room, but even after an earthquake, in a triage tent set up in a university parking lot. Furthermore, the system needed to be simple enough to be used on a laptop by someone with no training, but sophisticated enough to make connections to an interpreter without requiring the services of a dispatcher.  As we worked on implementing a solution for this customer, we validated our core premise that the success of any technology depended only 10% on the technology itself and 90% on how it was integrated with the organization’s workflow and protocols. Working closely with the Guest Services and IT teams, we first developed new workflows based on the desired operational model. Then we used rapid development techniques to prototype clinician and interpreter-specific interfaces, incorporating the desired workflow methodology into each. This allowed us to test the user interaction and ease of use, iterating as needed to create the optimal solution.

As our first customer realized, the ability to effectively communicate is paramount for optimum patient treatment, and in emergency situations, the delay of treatment or inaccurate information obtained by poorly communicated pre-conditions can result in patient harm, unnecessary complications, and in extreme cases, adverse outcomes.

We were able to addresses the shortcomings of remote interpretation services through the use of low-cost video technologies, any device/any network deployment, skills based routing, intelligent queuing, n-way video calling, and a video-based distributed call center. Now we are setting out to redefine how video is used across the Arc of Patient Communications™.