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Gaming Healthcare Delivery

May 4, 2012 2 comments
Patient Non-compliance: What is the Cost?

Do you take your medicine? It’s a very important question. When patients don’t take their prescribed medication the costs are enormous – not just to the patient but to the health system.

A 2011 study by Capgemini shows a 40% drop in refills for prescriptions after the first six months, resulting in more than $300 billion of unnecessary costs to the healthcare industry each year.   Studies conducted by the World Health Organization, the NIH and others support this result.

This is not a new problem, but with healthcare consuming almost one in five dollars in this economy, real solutions to patient non-adherence are necessary. One promising approach is making a game of medication.

How does gaming work? Three key elements work to engage the user:

  • The challenge to adopt healthy behaviors
  • win condition where events and accomplishments combine to enable success
  • Rewards and  feedback that reinforce positive feelings
Turning Diabetes Treatment into a Game

Let’s look at an example. Treatment of Type 2 Diabetes consumes over 25% of the world’s healthcare expenditure. Roughly 50% of patients fail to meet their blood sugar goals. The main reasons are failure to take their medicines and failure to change their behavior around diet and exercise. Glucose level monitoring and tracking is painful and boring. Diets don’t “feel good”, and wellness by itself is not a sufficient motive for many patients.

Proteus Biomedical from San José, CA is testing a new approach which uses technology to automate most of this process and gamification to create incentives for compliance.  Patients take a pill with a unique computer chip made from food ingredients. This pill senses the patient’s vital signs and transmits this data to a patch worn on the skin. Once the patient gets within 30 feet of their mobile phone data streams are captured and automatically and securely shared with the network of caregivers chosen by the patient. This might be family, friends or their physician – the people most influential in their care.

Proven Medications Plus Technology

This system, “Equa” enables tracking and display of summary and longitudinal data on the cell phone so that patients understand the relationship between behavior and health outcomes.  It uses the data collected and tracked on the phone to educate and motivate the patient. It’s a three-step cycle to frame what is known, prompt an action and reinforce the belief.

The games are Power Challenge Personal (PCP) and MedMatch.  PCP uses a system of tracking heart rate, fitness and sleep goals within a group of “contestants”. There are points earned, a leader board and prizes such as gift certificates to a sporting goods store for best in class accomplishments.  MedMatch uses altruism for adherence. Healthy behaviors result in charitable donation.  Every 20,000 steps walked results in donating a pair of shoes to children in need. Every six hours of sleep a night results in donating a blanket to a homeless shelter. Every medication pill taken on time results in donating a pill.

Are these approaches sustainable over the long term? Just ask anyone who has played and tired of a video game after a time. Social elements which share outcomes data with family and friends is key to maintaining interest. And hopefully the benefits of feeling better will keep patients engaged. But keeping games fresh and engaging will be a challenge.

This will be an interesting space to watch, and perhaps play in over the next several years.

What is your opinion? Is gamification a viable long term strategy to improve patient compliance and health outcomes? Or is it a fad? Click on comments link above to share your view.

Four Ways Personalized Medicine will Change Doctor-Patient Relationship

March 27, 2012 10 comments

A slight mutation in the matched nucleotides c...

Personalized Medicine Gains Traction

Since completion of the Human Genome Project  in 2003, the promise of personalized medicine (PM) caused many to consider its effect on bio-science, pharma and healthcare delivery.  Physicians contemplate a future in which patients enter their office equipped with symptoms and a list of the genetic variants they posses and questions about what they mean.

The problem hasn’t materialized because  the cost of discovering and developing drugs customized to the needs of a sub-genetic group have been prohibitive. Today however,  IT frameworks like Hadoop deploy massively powerful, inexpensive processing power. Now the huge genomic database becomes a more accessible resource to develop medications that are effective for targeted patient populations.

These new drugs offer improved cost-effectiveness over blockbuster drugs  for conditions like high cholesterol or hypertension.  Physicians will spend less time and money in trial and error to find which drugs work for which patients.

Disruption in Healthcare

In my last post, I raised the question, “Will Personalized Medicine have a disruptive influence on medical practice?” Those familiar with Christensen’s theory of disruptive innovation understand that market leaders focus resources on product development for advanced users who don’t care about cost. Often products contain features and benefits that don’t matter to most users. This leaves room for competitors to develop new technologies and business models to meet the needs of average consumers and “disrupt” the market leader’s business from the bottom up.

Healthcare is not like other businesses. The role of payers and policymakers as well as the interests of public health intervene and create barriers to natural market forces.  These factors slow the rate of disruption. Yet there will be fundamental change in the way physicians and patients interact as PM gains traction.

Four ways PM will disrupt healthcare delivery

#1 Predictive, not reactive:

  • Rather than waiting to treat symptoms of a disease that occur, physicians can predict which diseases a patient is susceptible to.
  • The physician develops a personalized health plan to prevent or detect these diseases early.
  • Patients will become a true partner in the delivery of healthcare, monitoring their progress and reporting results to their caregivers.
  • Home testing may replace testing in the doctor’s office.
  • Fewer office visits, less face time with the PCP is less expensive, but is it better medicine?

#2 More information on more treatment options:

  • Physicians  prepare to answer patients’ questions about new genetic tests and the treatments for their sub-group.
  • Continuous access to up to date, peer-reviewed medical information will increase dramatically.
  • As more options for care become available, will the patient’s trust in the sources of clinical information and outcomes begin to erode?

#3 New ethical and moral obligations: 

  • What is the physician’s role with patients on the moral and ethical questions surrounding access to genetic tests?
  • If one family member wants genetic testing and another doesn’t and a serious disease potential becomes known, what is the physician’s obligation to inform?

#4 Physician’s role in decision to test:

  • Should patients have their own testing done without supervision of a physician?
  • Should tests be offered for genetic disorders for which no treatment is available?
  • Who pays for development of testing and treatment for small sub-groups of patients?

What do you think? Will PM disrupt or enhance healthcare delivery?

Why is Health Information Exchange so Hard?

March 13, 2012 1 comment

US Healthcare Information Technology is still paper based

Fatal Communications Breakdown

Josie King died at Johns Hopkins Hospital in 2001 – age eighteen months. She did not die from her condition but from dehydration coupled with non-indicated use of narcotics. She died from poor communication and coordination of care at one of the best hospitals in the world.

Every year, almost 100,000 people die from medical errors in the US. The Joint Commission‘s Annual Report on Quality and Safety 2007 found that inadequate communication between healthcare providers, or between providers and the patient/family was the root cause of over half the serious adverse events in accredited hospitals. The instantaneous movement and sharing of information is part of daily life in the US. The lack of the same capability in our healthcare system is appalling.

Interoperability: the Biggest Challenge

The US has a private medical system. Healthcare delivery happens locally and regionally. IT implementation grew organically in that model and today is a crazy quilt of antiquated incompatible systems. The US is building a healthcare IT infrastructure to connect these systems together. IT Infrastructure is the central nervous system, a conduit for medical information to flow from anywhere to anywhere. Interoperability is an enormous problem in a fast-changing world of wired and wireless devices.  Standards committees work on two-year timetables while our innovation economy pours new devices into the marketplace at a dizzying rate.

Glacial Progress

The priority for HIT gained traction in 2004-2005, but since then progress has slowed to a crawl.

  • 2004 – H.R. 4880 The Josie King Act introduced to spur growth of national HIT infrastructure – bill died in committee.
  • 2004 – HHS Secretary Tommy Thompson launched the “Decade of Health Information Technology“.
  • 2005, IBM announced it was investing $250 million in R&D to design a national IT infrastructure.

It took until 2009 to enact meaningful legislation.The HITECH act invested nearly $30 billion in health IT to improve the quality, safety and efficiency of health care. Most of this money went to the CMS for incentives to healthcare providers to accelerate implementation of electronic health records (EHR). Widespread adoption of EHR’s  in the healthcare system is a key enabler to achieve cost and quality reforms.

Three years after passage of  HITECH, less than 20% of the healthcare is delivered electronically in the US. According to Charles P. Friedman, CSO for the Office of the National Coordinator for Health IT, adoption of EHR’s will become more or less “national” in 2019 when penetration will hit 80%. Can we wait that long?

The pace of change will remain glacial unless health IT is given the national importance it deserves. The effort to create a robust interoperable health information backbone deserves the same urgency that built the interstate highway system or US space program. Instead the popular political dialog focuses on the health insurance mandate.

We lack the threat of Russian ICBM’s orbiting the earth to motivate us in this goal, yet our need is urgent. Efficient healthcare information exchange will not only improve patient safety, it will improve outcomes and cost-effective care. Without it, access to care may one day depend on one’s ability to pay for it.

Please let me know your thoughts by clicking on the “Leave a Comment” link at the top of the post.

 

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