Monthly Archives: September 2011

Health 2.0

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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

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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™.

Welcome to SBR Health

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In 2008, I was serving as Chief Product Officer for a company started by some Stanford University graduates to address a need they saw for a video communication product that was as inexpensive and as easy to use as consumer products like Skype but that had enterprise-level collaboration tools and military-grade security. The initial markets for this new company’s products were users throughout the intelligence community, the military, and other government organizations. With the government market now firmly established, I began looking for commercial market opportunities, and to that end, I began analyzing the database of more than 5,000 businesses that had downloaded the free trial product from the company’s website. One thing that intrigued me was the number of users in healthcare who had downloaded and were using our product. When I called many of these users to inquire how they were utilizing our product, I found they were looking for an easy and low-cost way to communicate with their patients wherever they were, an application that is an aspect of telemedicine.

The term telemedicine can be used to describe any kind of healthcare delivered at a distance using a communication media such as remote data monitoring, store-and-forward transmission of images, or interactive video. Until recently, the specialized equipment and expensive network infrastructure required by video made it impractical unless the patient was a great distance from the doctor. It’s no surprise that some of the most extensive implementations were in places where the population was dispersed over a vast distance, such as Nebraska or Northern Ontario. Still, a number of the healthcare professionals I talked to felt that the real benefits of video were yet to be realized. If the cost and complexity could be brought down, there was a much larger population of patients who may not need to travel long distances but still could be better served if they could avoid traveling. These patients were in local community hospitals, rehab facilities, nursing homes, assisted living facilities, or in their own homes.

However, after much additional interaction with a variety of forward-thinking healthcare professionals using our televideo platform, we learned that simply reducing the cost and complexity of televideo technologies did not solve the larger problem of how to utilize these technologies seamlessly in existing IT and clinical processes. In effect, we discovered something that proved to be true throughout healthcare: The success of any technology depends only 10% on the technology itself and 90% on how that technology is integrated with the organization’s workflow and protocols. It isn’t that the healthcare community is crying out for more, cheaper technology, but that it needs solutions to facilitate the delivery of care in a more efficient and effective manner.

Out of this discovery, SBR Health was born. We exist not to create televideo products; rather we strive to create healthcare solutions that are video-enabled.

One-Clickify Change

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At the Inbound Marketing Summit, part of the Future M events, last week, Dan Heathtold a story about a study conducted at Stanford University which found that an unkind rich person with a map was three times more likely to donate food than a kind person without one.

Dan Heath speaks at the Inbound Marketing Summit in Boston.

So what does this story have to do with marketing and SBR Health? During his talk, Dan made a point that particularly resonated with me: One-clickify the change you are seeking, meaning make it easier to change by removing obstacles in the path to change and minimizing the amount a person has to do to implement the new system. It means thinking about how to alter a situation to get a different result. The researchers at Stanford made it easier for the “less kind people” to donate food by telling them a specific item to donate and giving them a map to the drop-off location. Similarly, business leaders need to give others a map to allow easy adoption of their ideas or services.

Since joining SBR Health, I have talked to more than fifty doctors and specialists who are interested in using televideo in their practices, but find the technology either too difficult or expensive to implement. What is needed is a change management process that is the equivalent of giving the doctors “a canned good and a map.”

Therefore, my team and I are working with clinicians to figure out the shortcomings of their existing systems for monitoring patients and how televideo can overcome those challenges. For example, doctors mentioned that unnecessary hospitalization costs were a burden on their hospitals; however, without being able to see the patient remotely, a doctor had to ask the patient to come in or visit the emergency room for an assessment. Others mentioned the difficulty of conducting post-operative checkups for patients who lived far away from the hospital. Yet, others were faced with the challenge of connecting with a specialist when there was no specialist working in or near their hospital.

Telemedicine technology does already exist, but there are too many obstacles in the way of implanting it. During our conversations, some doctors indicated that a cart-based system was impractical for them to use or too few practitioners would be able to access it. Others didn’t have the time to go through the process of getting an expensive system approved by the hospital IT department. Still others worried that the technology wouldn’t work well over the hospital’s Internet connection or it would be too difficult to learn how to use.

Each of these conversations has further inspired us to continue working to refine the SBR Health telemedicine platform: an inexpensive and easy to use video communications product that efficiently and securely links together any combination of patients, clinicians, specialists and extended care givers. It’s our way of one-clickifying communication in the healthcare industry. In the meantime, if you have any ideas for us, please share your thoughts here.

Welcome to the SBR Health blog

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The healthcare industry is ever evolving, and here at SBR Health, Inc., we are excited to be part of it.

SBR Health is dedicated to changing the way that clinicians deliver healthcare. We create real-time, video communications solutions specialized for the healthcare industry. Three months ago, we opened our doors at the Cambridge Innovation Center in Kendall Square, next door to MIT. Now, we’re in full swing, working toward our goal of making it easier for caregivers to provide better, more targeted care to their patients. To accomplish this goal, we’re engaging with a variety of medical professionals to learn how our platform can help solve some of the issues they face today.

The intersection of technology and medicine is an exciting field, and we created this blog as a way to engage with the community. Read about developments in telemedicine, SBR’s experiences in the field, the start-up business community in Boston and more.