Redesigning HealthCare: More Thoughtful, More Caring

April 29, 2013 1 Comment

I went in to the dermatologist last week for an annual skin check and, instead of a humiliating, cold, and uncomfortable paper gown, this cotton spa robe was instead waiting for me to change into.  My experience of whether I was working with an empathetic and caring physician was shaped before she even set foot in the exam room.  Small touches like this robe can make a dramatic difference in the patient experience.  This does not mean that “luxury” can or should replace high-level medical care.  However, thoughtful touches like this robe can enhance and augment high quality medical care to make it even better, and we should not ignore these opportunities to make our patients feel more comfortable.

Spa Robe and Sonos at Doctor's Office

 

 

 

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TEDMED 2013: Reactions and Themes

April 19, 2013 Leave a comment

I am just finishing up a packed few days at TEDMED 2013 as a FrontLine Scholar.  There were over 1,800 people there, from a broad spectrum of occupational backgrounds, countries, skills, and areas of interest within healthcare.  This made for an unending cascade of “unexpected connections,” the theme of the conference.  Indeed, though there were many engaging speakers who told stories about turning personal tragedies into discoveries and new passions, to me, the real action at TEDMED was away from the conference stage at “The Hive” (set up with booths showcasing innovators as well as comfortable and open meeting spaces).  I met dozens of amazing people, with whom I had dozens of thought-provoking conversations.  I will follow with another blog post about some of the specific companies that I met and spoke with at The Hive.  There is more to write about from 3 1/2 days at TEDMED than can fit in a “short” blog post.

Here are some of the overall themes that emerged at TEDMED this year:

  • Watch your backs! Those entrenched in the current model of the healthcare system need to be innovating and disrupting themselves from within their own organizations, or else risk being out of business in a short number of years.  Lip service to change will not suffice.  There are many, many companies and innovators taking aim at current models of healthcare, and while most of these companies will fail, and while change may be slow and halting, it will happen.
  • Bottom-up innovation: Change in healthcare cannot come only from the ivory towers and healthcare professionals.  As a doctor at UCSF, I recognize that this means me.  America Bracho spoke passionately about how innovative ideas should come from within local communities in a bottom-up fashion rather than a top-down manner.  We in the healthcare establishment need not only to listen, but to include the people who are most easily able to identify their actual problems and the potential solutions.
  • Interdisciplinary problem-solving: As discussed by Tim Brown in Design Thinking, to creatively and successfully tackle a big problem, an interdisciplinary team is needed.  Five doctors sitting in a room are not going to solve a major healthcare problem.  We need engineers and patients, designers and artists, marketers and people in finance.  We need them to work together.  The cross-disciplinary problems in healthcare require cross-disciplinary attention.  I was encouraged to see how many talented people with backgrounds outside of healthcare are now turning their attention to solving healthcare-related problems.  While some are doing so with a Willie Sutton “that’s where the money is” philosophy, most are truly dedicated to innovating and solving important problems, and we need their energy and their ideas.
  • Courage: Have the courage to ask difficult questions that everyone else is afraid to ask, and to pursue the answers in ways that other people are afraid to pursue.

The popular themes among the startup companies at the Hive (or discussed in speeches):

  1. Medication adherence.  This was true at the mHealth Summit several months ago and remains true.  There is a lot of attention being paid to trying to track, measure, and improve medication adherence.  Some of the companies at TEDMED: AdhereTx, AdhereTech, GeckoCap, NudgeRx, RxAnte, and others.  There are a number of different approaches being tried, from “smart pill bottles” to reconciling claims data with EHR data.
  2. Crowdsourcing.  This concept is being applied across different fronts and in different ways.  Docphin is creating a social experience around reading medical journals, allowing clinicians to see what the most popular articles are in their field or across all fields.  Science Exchange is creating a TaskRabbit for scientific tasks, matching scientists who have a particular skill with those who have a specified task requiring that skill.  UpRise is converging all of the patient education materials that they can into one common platform for distribution to patients.  Crowdmed is applying the wisdom of the crowd to diagnosing diseases.  Roni Zeiger spoke about “networks of microexperts,” allowing patients to share their knowledge and best practices, announcing his company, SmartPatients.  Larry Brilliant spoke about infection monitoring tools for public health, like FluNearYou.
  3. Psychosocial and behavioral interventions.  The companies on this list included Empower Interactive, Healthify, Omada Health, and Sense Health.
  4. Digitizing the patient. (Slight tangent– Jay Walker made a great point that we don’t really have a word for what to call people in the healthcare context who aren’t sick, ie not “patients” in the traditional sense.  Do we just call them healthcare consumers?)  There is a ton of work being done in terms of capturing physical and biometric data to augment the clinical data available today, both expanding the scope of the type of data we currently collect but also expanding out into the home (shameless plug for my JAMA Internal Medicine commentary).  At MIT, they are developing a portable set of glasses that allow an easier view of the retina as a “window into systemic diseases.”  There are sensors for everything– oxygen, heart rate, falls– you name it, somebody is building it, and the data is most often now able to be transmitted wirelessly to somebody, somewhere (what we’re going to do with all of it workflow-wise is another question for another day!)

I would love to hear from others who were at TEDMED or following via Twitter or TEDMEDLive to hear your thoughts and opinions.  I’ll be blogging more later about other aspects of TEDMED…

 

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Asthmapolis: Why Can’t Inhaler Sensor Be Adapted For Diabetes and Insulin Pens?

April 5, 2013 Leave a comment

Asthmapolis, which launched in 2010, has been in the news the last few days after announcing a $5 million series A venture capital round of funding.  They are an innovative mHealth company that is focused on improving care of asthma through a combination of hardware and software.  They developed a small sensor that attaches to the top of an asthma inhaler and wirelessly synchs with your smartphone.  The data can then be tracked, viewed, analyzed, sent to a physician, used for clinical research, etc.  Anything you can imagine.  The frequency with which someone uses their inhaler is often directly tied to how severe their asthma is, and can predict which people are headed for trouble.  So, rather than each squirt of an inhaler being an invisible act lost to history, it can now be tracked and used to generate meaningful data to help patients (and for research).  This is exactly what mHealth is all about.  The innovators at Asthmapolis have developed a relatively simple and straightforward intervention that should add no additional hassle to a patient’s life but might be life-saving if it can serve as an early-warning system for worsening asthma.

Asthmapolis TechCrunch Headline Apr 2013

Taking this one step further, we need to have such an add-on piece of hardware for insulin pens for use by people with diabetes. It is obviously not exactly the same: with an asthma inhaler, one press is one dose, whereas with an insulin pen, it would have to be able to capture the exact amount given; with asthma, an increasing use of an inhaler could be a sign of impending trouble, whereas with diabetes, daily fluctuations in insulin dose can often be a normal pattern.  However, there are enough important parallels that make this an invention that we need in the diabetes world.  We are always asking our patients to keep track of how much insulin they use, but it is an extra task for them in their already busy lives, one which could relatively easily be automated.  I’ve still yet to see a prototype of such a device for an insulin pen outside of the GluBalloon project from MIT about a year ago.  I hope that there is more to come in the near future for us in the world of diabetes.

GluBalloon Insulin Dose Tracker

Best of luck to Asthmapolis… they look to be poised to make a major difference in the lives of people with asthma.

 

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TEDMED 2013 in Washington DC

March 21, 2013 2 Comments

I’m very excited to be attending TEDMED 2013 in Washington DC next month.  I was fortunate to be chosen to go as part of the Front Line Scholarship program.  The speaker line-up looks to be full of interesting talks on secondary uses of health data, patient engagement and activation, precision medicine, and a number of talks that blend the humanities with the health sciences.  There will be around 1,800 attendees, so in addition to the talks themselves, there should be great opportunities to meet people and share ideas among a passionate and engaged group.  Should be fun, and should provide some great fodder for future blog posts from the event and in its aftermath!

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The Future of Diabetes Management: Social Networking and New Technologies

March 15, 2013 3 Comments

I gave a talk yesterday to a great crowd at the annual UCSF CME conference, Diabetes Update.  The slides from my presentation, “The Future of Diabetes Management: Social Networking and New Technologies,” can be viewed on Slideshare.

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From “Pull” to “Push”: A Transformation in Medicine

February 21, 2013 Leave a comment

Weitzman et al just published a very interesting article in JAMA Internal Medicine called “Participatory Surveillance of Hypoglycemia and Harms in an Online Social Network.”  They looked at using the online social network, TuDiabetes, as a method for surveillance for hypoglycemia.  You can read their very novel article here.

I was flattered to be asked to write a commentary on this article.  Below are the first few paragraphs of my commentary and a link to the full text PDF for download here: JAMA Internal Medicine, Feb 2013, Aaron Neinstein, From “Pull” to “Push”: A Transformation in Medicine: Comment on “Participatory Surveillance of Hypoglycemia and Harms in an Online Social Network.

 

Consider the words we use to describe what a physician does when she or he sits across from a patient to perform a history. Take. Obtain. Elicit.

These words all conjure images of physicians extracting information from patients. We pull information not just from our patients but also from our information sys- tems, calling up vital signs and laboratory results when we want them, on our time and our terms. However, this is rapidly changing, as information will be coming to us from the patients themselves to create “push” medicine. Are we ready? Not yet, but with some pivoting and some preparation, we can be.

CONVERGING TRENDS LEADING TO “PUSH” MEDICINE

Several synergistic technological and cultural trends are leading us toward “push” medicine. Increasingly ubiquitous technologies such as broadband Internet, smartphones, and cloud computing have created fertile ground. There is increased focus on patient-centered decision making. Patients are increasingly well-informed; nearly 60% of adults have looked online for information about health topics.1

Data are coming from many new sources. Mobile applications enable patients to actively create data, such as by answering symptom questionnaires, or allow wireless sensing devices to semipassively generate data like heart rate or physical activity. Other mobile applications use your calendar, text messages, and e-mails to passively generate meaningful health information, such as mood or quality of life.2 The realm of data collected in the home is expanding beyond blood pressure and glucose log books to tracking daily pain and functioning scores for rheumatoid arthritis. Patients are also contributing data through social networks and personal health records and by direct entry into the electronic health record. Patients are increasingly requesting their personal genomes—and to do so they need only curiosity, an Internet connection, and a credit card. These activities are increasingly common, and 27% of Internet users, or 20% of all adults, have tracked their health online.1

 

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The Tools That I Use For Productivity, Creativity, and Research

February 1, 2013 2 Comments

As an early-adopter and a bit of a productivity nut (I am a big believer in David Allen’s Getting Things Done), I use a lot of different tools in my day-to-day life.  Friends, family, and colleagues know this, and often ask me what I use and what I like.  So, here it is, my list of the digital productivity tools and medical tools that I use and like (I put them into categories but there is some overlap):

** Please note that I have no financial stake or conflict of interest related to any of these companies… I’m just passionate about useful tools and these are the ones I happen to use.  To cement that point, I am purposefully not providing links to these sites so that you can be sure that I am not getting any kickbacks or free space from clickthroughs!

Tools for Personal Organization

Evernote, multi-platform: A Swiss-army knife of a productivity tool.  This is my peripheral brain, and I use it for just about everything.  I use it for taking notes (or photographs of hand-written notes), clips from web pages and blogs, saving important emails and receipts, travel documents, favorite recipes and bottles of wine, magazine articles, and a whole lot more.  Everything is taggable and searchable (including characters recognized within photographs you import) so I can always find it later.

Omnifocus, Mac and iOS: What I use for task management and to-do lists.  There are a lot of other good ones out there like Asana, Nirvana, and Things, and they all have their strengths and weaknesses.

Workflowy, web and iOS: The newest addition to my suite of tools.  Useful for outlining, as in preparing a lecture or article.  Useful for shared task lists and brainstorming.  It is fast, lean, and an incredibly flexible tool.

Tools for Content Creation

Google Drive, multi-platform: Collaborative document creation and editing.  If team members are going to be editing a document simultaneously, this is the tool to use, where Dropbox fails in this regard.

Dropbox, multi-platform: File sharing of all types among a group.  Collaborative document editing that allows you to use a more formal and powerful tool like Powerpoint or Word than does Google Drive.  Cannot simultaneously edit documents, however.

WordPress: For writing this blog!

Tools for Content Consumption and Discovery

Pocket, multi-platform: I have a friend who, before leaving home for the airport, always opens 25 web browser windows with different articles to read on the plane.  Pocket solved this problem (sadly, not for him, because he doesn’t use it).  Any time you find a blog, article, video, etc on the web that you want to read later (the company used to be called ReadItLater), you just send it to Pocket and it is there for you to read at your leisure.  A lot of people also like Instapaper, which does essentially the same thing.

Reeder, multi-platform: A nice cross-platform tool for browsing and reading items in your Google Reader RSS feed account.  If that sentence was in another language for you, go to Google Reader and sign up and then come back.

Docwise, iOS: Despite being an early adopter, I had not owned an iPad until last month.  The feature I really wanted an iPad for was to be able to collate articles from all the different medical journals I like to read into one place.  I heard about Docwise, and then I bought an iPad.  Docwise allows you to mark any number of journals as your favorites, to browse articles from those journals and add them to your reading list, and then to come back when you want and read the items in your reading list.  Note that you still need your institutional library EZProxy or VPN to get access to full-text articles, though you can do this inside Docwise if you have such access.

Instacast, iOS: A very simple and straightforward iOS app for downloading and organizing podcasts.

Much of my web content discovery is done through Twitter and an increasing amount through LinkedIn.

Research Tools

Papers, multi-platform: A few years ago while in the midst of a research project, I purchased and tried using EndNote to manage my references.  It was a pretty miserable experience.  Luckily, a friend suggested Papers, and I have not looked back.  The easiest explanation is that it is like iTunes for your academic PDFs (without so many headaches as iTunes).  You can tag and store your journal articles here, and add annotations like notes and highlights.  This is really great on the iPad.  Their newer version really blew everything else out of the water because it allows you to insert citations and references from your Papers library into any document and it will create footnotes and a reference list for you.

Google Scholar, web: A great tool for starting a literature search.  I always use this in conjunction with Pubmed (below).  I find this to be more “sensitive” than Pubmed, ie the search results might be less relevant, but you get more of them.  An especially nice feature is the “cited by” feature, which shows you the list of articles that have cited the article you are looking at.

Pubmed, web: A must-use for any literature search, I use this in conjunction with Google Scholar (above).  I find this to be the more “specific” of the two tools, ie if you don’t use the proper search term you might find nothing, but if you have better search skills, you will be much more precise in what you find.

 

I hope some of you find this helpful, and if there are any tools out there that you use that I did not list, I would love to hear about them!

 

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