What are the most difficult health problems facing communities today? Many speakers at the 9th annual Health 2.0 conference in Santa Clara last week pointed to the basics: safe streets, clean air and water, secure housing, nutritious food, companionship and access to primary care.
All affect health outcomes. And as providers increasingly are held accountable for the total health of their patients, new approaches, including “population heath management” technology, are playing a bigger role.
While many said technology can be helpful to improve lives, some remain skeptical that digital innovators are aligned with patient and provider needs.
In a keynote address at the conference, U.S. Surgeon General Vivek Murthy said that in his travels around the country he hears “a sense of disempowerment that is deeply disturbing to me.” Technology has the potential to help create a culture of prevention by giving people the tools to help them regain that lost power over their lives, he said.
“I believe that technology can actually help us tackle so many problems in health that we see as insurmountable,” Murthy said.
The key challenges for those in the health innovation space, Murthy said, are:
- Making healthy choices more compelling and accessible;
- Developing ways to reduce health disparities; and
- Designing tools so the pursuit of health is a “team sport” to maintain motivation and reduce emotional isolation.
HHS, AMA Jump on Health 2.0 Wagon
HHS is seeking innovative ideas to solve some of these problems as well, said Susannah Fox, CTO at HHS.
“I am here to recruit you for a tour of duty with the government,” Fox told the audience. HHS has an entrepreneur in residence program, a one- to two-year commitment to work toward solving health problems from the inside.
The American Medical Association, too, is getting in on the act. AMA officials said in January they will formally announce the opening of a health technology incubator in San Francisco. For the first time this year, the AMA was a chief sponsor of the Health 2.0 event. The California HealthCare Foundation, publisher of California Healthline, also was a sponsor.
Steven Stack, president of the AMA, said in an interview that technology can be helpful in health improvement, but it is not a panacea.
“We’ve got to make sure we don’t lose the human component,” Stack said. “This conference is a skewed look at the world, and reasonably so, because it is at the cutting edge of technology. It is not broadly representative of the typical patient seeking medical care.”
The average patient wants to know three things, Stack said, “What’s wrong with me? How do I get better? And how can I afford it? Once they are feeling better, they move on and disengage with the health system.”
Disparate Categories in Health 2.0 ‘Ecosystem’
The so-called “Health 2.0 ecosystem” today includes many different categories: data management; EMR integration; diagnosis support; virtual visits; wearables; consumer knowledge tools; social networks and crowdsourcing, to name a few. Venture funding in the space in 2015 is $3.4 billion so far, according to the conference organizers, and is on track to top last year’s record of $4.6 billion.
Some companies are seeking to solve problems within the existing health system. Acupera, for instance, is a platform for provider population health management that assists in care transitions. Caresync integrates a patient’s disparate electronic health records, documents and medication histories to one accessible place, and also helps with provider billing. Medalogix is a home health analytics company that developed a program called Bridge that identifies and manages patients who would most benefit from hospice care.
Other innovators are seeking to be so-called disruptors. Heal, billed at the conference as the “Uber of health care,” is a telemedicine app that connects participating local doctors with patients in real time. Like Uber, patient credit card numbers are kept on file in the application for ease of payment. Heal has been live for five months in select California cities and will accept some types of insurance starting in December.
At the conference, the Robert Wood Johnson Foundation showed short videos of youth struggling with the basics that can lead to health problems: safety from violence in their communities, physical activity, clean water and air and a stable home environment.
“What are the most important drivers in health? Where we work, live and play,” said Michael Painter, senior program officer at RWJF. “Too many of us have so many obstacles that better health is out of our reach.”
Brian Sivak, entrepreneur in residence at RWJF and former CTO at the HHS, said, “There are roles that technology could potentially play.” For instance, one video showed a girl whose father is incarcerated and her struggle to find a stable home without him. Sivak suggested that technology could link incarcerated parents with their children to fortify their bond and improve communication.
A number of companies at the conference are seeking to improve communication and information-sharing via smartphone apps that allow patients and families to check in with providers and track progress towards goals. Conversa Health’s Digital Checkup, Vida Health and Noona Health are three examples.
It is still unknown which direction the sector will go, said Health 2.0 CEO and co-chair Indu Subaiya. “Are these technology innovations in service of an existing industry or is it a new industry?” she asked. The audience was split on the answer.
Is Digitization Generating as Many Problems as it Solves?
Robert Wachter, professor and interim chair at the Department of Medicine at UC-San Francisco, made a strong argument that digitization of the health care industry is creating as many problems as it is solving.
“Digitization changes the nature of the work,” Wachter, author of The Digital Doctor, said in a keynote. “Doctors are no longer in the wards. They are in the computer room doing their digital work.”
He cited the example of the switch from film to digital imaging about 15 years ago. Back when film was used, doctors would make rounds to the radiology department and stand around these films talking about diagnoses and treatment paths.
“These rounds always spurred rich discussions about the patient,” Wachter said. “These discussions don’t exist anymore. Radiologists now are completely disconnected from frontline care.”
Some are tackling this problem of physicians data-entry workload. The startup Augmedix is fitting doctors with Google Glass devices to link them to a scribe in another room who can take notes on patient exams and fill in the EHR fields for the physician. Company founders say this approach reduces provider computer input time from eight minutes to 45 seconds per patient. The system is being tested in seven health care systems.
Chelsea Clinton, the opening keynote at the conference, expressed her optimism that technology could help public health. The foundation’s No Ceilings project, with funding from the Bill and Melinda Gates Foundation, has aggregated data on the status of women and girls worldwide. Health 2.0 entrepreneurs “have enormous catalytic creative power” to tap into these resources and help solve the basic problems facing women and girls worldwide, Clinton told the audience.