Placing more care decisions in the hands of consumers and personalizing that experience is a major theme in health application and product development today, as evidenced at the eighth annual Health 2.0 conference, held in Santa Clara last week.
However, providers, payers and government regulators may tap the brakes on this trend, as they continue to worry about patient safety and privacy in the new digital realm.
A survey by Medscape and WebMD released at the conference indicated that while the majority of physicians and patients (63% and 64%, respectively) agree that the smartphone can be a useful diagnostic tool in regards to blood tests, just one-third of physicians said they would use a smartphone to perform an ear or eye exam and about a half of patients would do so. The survey included 1,102 patients and 827 physicians.
Additionally, 91% of physicians surveyed said giving patients access to detailed electronic health records could lead to anxiety about results and 84% said it would lead to unnecessary requests for medical evaluations. But 93% of patients said EHR access would allow them to better manage their health.
Eric Topol, editor-in-chief of Medscape and chief academic officer at Scripps Health, in a keynote address at the conference said that “there is a growing understanding among physicians that patients have greater access to care and cost information and that is giving them greater voice in the decision-making process.”
Giving patients a voice in health care decisions is clearly a priority for mobile health companies, with a convergence of mobile health and virtual visits to diagnose common conditions. There is today a crowded field of smartphone applications that link patients with providers to diagnose an illness, set up an in-person appointment and also pay for that visit in advance. Products that focus on this “triage” aspect of care include iDoc24, Cognoa, Symptify, Zipnosis and Hale Health.
Even Walmart, which has launched 20 in-store retail clinics in three states, is seeking to use virtual solutions to enhance access. “We’re heavily involved in ways to use technology to enable a customer to manage their health directly,” said Marcus Osborne, vice president of health and wellness for Walmart.
Hardware devices that attach to your smartphone for diagnostics and tracking are also coming to market. San Francisco-based Cellscope created Oto, an optical attachment to the smartphone for diagnosis of ear infections in children. Parents attach the device to their phones to take a picture of their child’s inner ear and then send the photo via an app to a participating pediatrician in California.
Virtual care and home-based care are primed for growth, according to Nirav Desai, principal health strategist for Mobiquity, a mobile professional services company based in Wellesley, Mass. “You may not get the treatment at home, but you will certainly get the diagnosis,” said Desai, who moderated a panel on digital diagnosis. “Also driving this is the smartphone. There is an opportunity to innovate here when you see all the things you can leverage on phones.” This includes GPS, the camera, video and audio and chat functions.
FDA has released some guidance on how it will regulate medical devices versus clinical decision support tools, which has created a gray area for developers.
“The fact that the FDA has not issued clear guidance has scared off some investors,” said Connor Landgraf, co-founder and CEO of Eko Devices, creator of a smart stethoscope.
The Health 2.0 space has moved dramatically from its beginnings as virtual libraries or data storage software to a focus on dynamic personalization and interconnectivity, conference attendees said.
“In previous years, everyone wanted to be the Mint.com or the Facebook of health,” said Brent Vaughn, CEO of Cognoa, which uses smartphone video and questionnaires to help providers diagnose children with developmental delays. “We are getting away from superficial engagement and starting to solve real problems.”
A continued puzzle is how to make products and applications the most useful for consumers, providers and administrators of health care. Many companies that demoed at Health 2.0 offered up compelling data visualization elements to allow stakeholders to better manage and interpret the vast amounts of data available at their fingertips.
Examples include Synapse, which offers oncologists a data display of patient treatments, results and care options, and Predilytics, which organizes data on 140 million households to help insurers determine how receptive consumers will be to their plan offerings. Meanwhile, Iodine Health purchased Google surveys of 100,000 patients to develop a searchable website on consumers’ experiences and reactions to medications, displayed in graph and visually appealing ways.
Bernard Tyson, chair and CEO of Kaiser Permanente, in a keynote address said that “technology will continue to encourage and move that level of innovation out into the hands of consumers who can make different choices” about their care.
However, Tyson cautioned that technology will never replace in-person caregiving. “There will always be the need for the human touch, human capabilities housed inside an individual,” he said. “In my vision, hospitals and health centers will have tech-enabled apparatus to help human intelligence make the right choices.”
Providers are in pursuit of perfecting that tech-supported human environment.
Providence Health and Services, a not-for-profit Pacific Northwest health system based in Renton, Wash., has recruited top talent from Amazon to improve the patient experience. Providence also is spending $150 million over five to seven years to invest in companies that focus on patient access, care coordination, wellness, data analytics and chronic care management. Aaron Martin, who spent nine years at Amazon, is heading up the innovation fund.
Providence Health and Services runs an accountable care organization with Boeing employees. Martin said at the Health 2.0 conference that talking to Boeing employees about their desired health care services and preferred communications methods was important to improve access and engagement. “Boeing wasn’t used to doing business this way, but we did it and we got a better product in the end.”
Open application programming interfaces (APIs) are critical to move to the next stage of development and improve efficiencies, Martin said. “It’s going to change the way we deploy technology,” he said, citing Allscripts API. “It is something we demand” from our partners.
Allscripts’ open platform, called Unity, is spurring new ideas in health care, agreed Stanley Crane, chief innovation officer at Allscripts. He calls it an “innovation surface” for others to build on in order to improve care and patient experience.
“We are asking, how do we systematically and as the normal course of business open the door so developers can build exactly what they want to and customize it,” Crane said. “So more and more, the electronic health record recedes into the background and you have special purpose apps doing their special things and then sharing data behind the scenes with the family doctor.”
Whether it is an app, a wearable device, an analytics tool or a wellness platform, Health 2.0 is becoming a more mature ecosystem — and drawing big names. “New entrants into the health care space is a major trend,” said Yasmine Winkler, chief product and innovation officer at UnitedHealthcare, noting that 24 out of the 38 Fortune 50 companies with a major stake in health care are new arrivals in the past three years, and 24 health care incubators have launched more than 500 new companies since 2011.
“Who is going to survive all this change?” she asked.
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