Monday, March 3, 2014

Malcolm Gladwell Keynotes Healthcare Data Interoperability Summit

The global narrative for “digital health” is relatively easy because the opportunities are so enormous. The only real limit is our imagination. Some of the more recent developments have been breathtaking – and include everything from genomics and personalized medicine to 3-D printing to putting healthcare literally in the palm of our hands (or the embedded sensors we will all wear or consume). At the core of it all is a single strategic component – data.
But the challenges are equally enormous – and nowhere is that more evident than data interoperability. This key alignment is at the heart of enormous (often competing) financial interests, true patient engagement and the health (both financial and clinical) of nations – including our own. The lack of this alignment is more than just inconvenient because it often results in gross inefficiencies, fraud, misaligned incentives and errors – all of which result in outcomes that are more expensive and less than desirable (including death).
There were a fair number of healthcare events last month including the largest healthcare IT event of the year – HIMSS. Now in its 53rd year, HIMSS attendance is nearing 40,000 with about 1,000 vendors and hundreds of educational tracks – all of which descended on Orlando, Florida for the better part of last week. As the CEO of Aetna Aetna, Mark Bertolini’s keynote stood out (here) and Hillary Clinton was standing room only.
But HIMSS wasn’t the only significant event last month. There was a second, smaller event that took place in the nation’s O.R. of healthcare policy – Washington, D.C.
Sponsored by West Health Institute (previous coverage by Forbes colleague Zina Moukheiber here), the daylong event – Health Care Innovation Day – was notable for three reasons. First, it had a singular focus on healthcare data interoperability; second because it was co-sponsored by the Office of the National Coordinator (ONC); and third because it included a compelling keynote by master storyteller and serial-bestselling author Malcolm Gladwell.
Gladwell’s latest book – David and Goliath – is the biblical metaphor for many modern endeavors and industries – including, of course, healthcare. In fact, the event itself was a kind of David in the shadows of the HIMSS Goliath.
Gladwell’s healthcare credentials are often overlooked but he did reference them in his opening remarks. From 1987 to 1996 he covered the healthcare industry for the Washington Post and so he openly wondered what his coverage would have been in his former capacity.
He often generates controversy, but whatever else, he is a master storyteller and there were three compelling vignettes for this keynote. They weren’t cut from healthcare cloth, but an opening line helped to frame their relevance.
But I’m only going to spend a little time talking about healthcare proper – both because I think  it’s often more useful to approach some of these issues from an angle by looking at the world outside of the one you’re engaged in – and secondly because I have a rule that I never talk about something my audience knows more about than I do. Malcolm Gladwell – Author
It’s that skewed angle – punctuated with relevant stories – as told by a master storyteller – that really puts Gladwell at the forefront as a speaker. Relative to data interoperability, Gladwell recounted the stories to help “reframe” the data interoperability dialog that continues to gridlock much of the healthcare industry – and the promise of digital health.
The first was The Beqaa Valley Turkey Shoot in reference to the rapid defeat of Syria by Israeli air supremacy in 1982. The swift and decisive victory was orchestrated by bringing different technologies together in a new and far more integrated way.
Using drones, AWAC’s and laser-guided missiles, the Israeli’s were among the first to carefully orchestrate their coordinated use in real time. The Israeli’s didn’t invent any of the component technologies, but they “integrated” their use in a new way that revolutionized military strategy with an exponentially lethal capacity.
The second story was The Shipping Container and recounted the story of Malcolm McLean – who revolutionized the shipping industry. He didn’t invent the shipping container, but he re-framed the problem in a way that transformed both domestic and international shipping.
By standardizing all of the components (containers, trucks, trailers, railways, docks, cranes and ships) in a new way (Lego at an industrialized scale), he effectively reduced the cost of loading and unloading from $5.50 a ton to $0.15 a ton. From his recognition that the problem required a broader systemic solution (not a component solution in isolation), domestic and international trade mushroomed exponentially.
The third story was The MP3 Player and how digitizing music revolutionized every aspect of the music industry. The effect of digitizing music was to make it interchangeable and interoperable. Almost overnight, music was transformed from being an album and episodic experience into one of personal and continuous use. Individual devices like record, cassette and CD “players” artificially constrained the way music was consumed.
Music stores, a dominate part of the retail landscape (and music experience) disappeared entirely within about 5 years. By un-tethering music from a rigid distribution model around proprietary formats, music enjoyment and sales exploded. From 2000 to 2010, growth in live performances and album sales both tripled.
In all three cases, it’s the combined interoperability that has the truly disruptive and exponential effect. The underlying component technology isn’t always a new invention  or exponentially disruptive.
“Sometimes when we look at innovation we make the mistake of thinking that innovation is specific to an individual invention or device. But all of those [individual] views miss the greatest transformation that’s brought about by technology – and that’s when you bring these various pieces and have them work together in combination – it’s the synergies between these tools that bring about the greatest changes in the world that we live in. You are on to something very crucial here – and I wish you all the best.” Malcolm Gladwell – Author
The urgent need for interoperability in healthcare is well understood. It could well be that interoperability isn’t the biggest problem in healthcare today  it’s just the first.
The HCI-DC conference was really designed to emphasize and accelerate the much needed national dialogue on driving medical interoperability to enable a smarter healthcare system across all the different interests. Ultimately, we’re all patients and we all deserve better care than the chaotic, proprietary and unconnected system we experience today. Together, we are working with key stakeholders to transform healthcare delivery in this country to make high-quality healthcare more accessible at a lower cost.” Nick Valeriani – CEO, Gary and Mary West Health Institute
The archived content for the day long event Sponsored by West Health and ONC (including Gladwell’s keynote) is now available in it’s entirety online (free but registration required) here.

Telemedicine: Doctor Visits via Video Calls

(Corrects reference to the technology used by Lindsay Kolowich in the sixth paragraph.)
One night last fall, Beth Ferrin’s 9-year-old son came home with a swollen throat and fever. It was after dinner, so she flipped open her laptop and dialed into LiveHealth Online, a service offered by her insurer, WellPoint (WLP), that connects patients with doctors via video calls. Fifteen minutes later, Ferrin says, “we were on with a doctor.”
After a quick diagnosis of an infection (the doctor, Ferrin says, treated it as strep, though couldn’t diagnose that without a test), a prescription for an antibiotic was called in to a pharmacy near Ferrin’s home in Bellbrook, Ohio. “By 10 p.m., I was back home,” she says. “It was quick and easy.” Her other options would have been to see a doctor in the morning or risk a long wait at an urgent care facility. The video call was faster and cheaper—it cost $40 instead of the $100 a pediatrician would charge, she says.
Hundreds of employers of all sizes are contracting directly or through their insurers with telehealth providers to cut medical costs and give workers 24-hour access to doctors and nurse practitioners. WellPoint teamed up with Boston-based American Well to offer telemed services to 3.5 million of its health-plan subscribers last year and intends to extend the service to another 32.5 million over the next 12 to 18 months. UnitedHealth Group (UNH) began a pilot program in January, providing 310,000 subscribers in Nevada with virtual doctors’ visits.
Telemedicine has been spurred in part by the Affordable Care Act, which is funneling more patients into a system plagued by physician shortages. By 2020 the U.S. will have 91,500 fewer doctors than needed, says the Association of American Medical Colleges. Telehealth providers say they help make up for this shortfall by aiding doctors in delivering services more efficiently. WellPoint says users of LiveHealth Online saved an average $71 per visit and most of them saved two to three hours of time.
The widespread use of camera-equipped devices has made remote medical connections easier, and high-definition video often provides enough detail for medical professionals to make diagnoses. “Sometimes if it’s a rash, we can see the rash,” says Katherine Sandstrom, a nurse practitioner in Portland, Ore., who sees a few patients via video each week through health-services provider ZoomCare.
Lindsay Kolowich, a 23-year-old marketer in Boston, recently consulted a doctor through American Well. She wanted to check on how her foot was healing after recent surgery. Her surgeon was far away and only available midday, so she opted for a teleconsult that didn’t require time off from work. “It saved me four or five hours,” Kolowich says. “I had to show him where it hurt and how flexible my foot was, and he gave me easy directions on what to do,” she says.
Telecare works well for treating common conditions such as colds, flu, pink eye, and sprains, providers say. The larger telemedicine companies contract with doctors with an average 15 years’ experience who are certified to practice in the states from which patients call.
The American Telemedicine Association is developing an accreditation program for telehealth providers. A bill introduced in Congress last year by Representatives Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio) would create federal telecare standards.
“I don’t think we know how it works, the risks and benefits at the moment,” says James Perrin, president of the American Academy of Pediatrics. When asked about the throat infection of Ferrin’s son, Richard Rosenfeld, chairman of otolaryngology at SUNY Downstate Medical Center in Brooklyn, N.Y., said: “The only way to diagnose strep is with a test. Best practices say you can’t just throw an antibiotic at somebody.” He says there’s only so much a doctor can tell without an examination performed in-person and telemedicine visits could result in unnecessary medication.
Telehealth companies say they track their doctors’ prescribing practices to ensure they’re in line with the prescription levels of in-clinic doctors. “Reaching out to your primary physician is the best way to be treated,” says Timothy Howard, senior medical director for telemed provider Teladoc. “But if that physician is not available, we would like to be that next level.” Many doctors who provide telehealth services often advise patients to follow up with their doctors.
Most users pay about $40 a visit and receive the services through their insurers. A small number have signed on directly, paying as little as $10 a month for a subscription. About 20 states require private insurers to reimburse doctors for services provided remotely. At least 10 additional states might enact similar laws this year, says Jonathan Linkous, chief executive officer of the American Telemedicine Association.
Telehealth companies are reporting double-digit revenue growth and attracting high-profile investors. MDLive raised $23.6 million in January. Its investors include former Apple (AAPL) CEO John Sculley. “Our service is expected to increase 10 times in the number of patient visits this year,” Sculley says.
“It’s going to be just like urgent care was in the U.S.—it’s now completely acceptable,” MDLive CEO Randy Parker says. “Within the next few years, no consumer will even remember not being able to connect to their providers through telehealth.”
The bottom line: Investors are putting money into telehealth services, used to treat common ailments.
Kharif is a reporter for Bloomberg News and Bloomberg Businessweek in Portland, Ore.