My review of NYC PILOT health day 2013 – 10 interesting companies

On June 26th, I had the privilege of going to PILOT Health day 2013. For those of you not familiar with the program here is a link that will give you more information: http://www.pilothealthtechnyc.com/overview.php.

Basically, it was an initiative by NYEDC, Blueprint Health, Startup Health and Health 2.0 to help early stage digital health companies connect with leading NY healthcare organizations and carry out pilot projects, with the goals being cost reduction, patient engagement and improving quality of care. 10 companies each won $100,000 and the ability to pilot their tech at partner health organizations.

One of the things that JL of Health 2.0 mentioned at the start of the day was that one thing that companies were looking for was market access. Having floated around the digital health world for the past year, I agree. I think that this program was great because it gives innovators the opportunity to talk to health care professionals about their products and health organizations the opportunity to talk about their needs. True collaboration is key in building great products as both parties benefit from new ideas, tools and the ability to understand each others nuances. Overall, I am a fan of pilot projects in general because they are real world applications of the products. You learn a lot about what works, what doesn’t, what people like, what they hate and how long it takes to actually get something done. It’s also a way of ironing out the kinks before a massive rollout which is always helpful and prudent.

I went as a digital health enthusiast and as a physician looking for tools that I will bring back with me when I go back into practice.
So without further ado the 10 companies:

1. Sense Health and University Behavioral Associates (Montefiore)
https://www.sensehealth.com/

Technology that will help case managers deliver support to high utilization substance abuse patients via mobile technology (text messages in between visits).

I see this as a tool that supports what happens in between visits and may become really popular with not only case managers but with health coaches. I liked that it will be used in mental health and substance abuse because that is an area that comparatively doesn’t seem to get as many tools as others.

2. Vital Care Services and Pace University
http://www.myvics.com/

Telehealth solution for monitoring patient vitals. Pace technician would take a patient’s vitals and the data would be sent to a remote Pace RN.

I see this as a tool that would help keep people relatively independent and out in the community rather than in a costly center. I liked that the data would be reviewed by an RN that is designated to receive and review the data. (One of the questions I often have about generating health data is who will be reviewing it especially if there is a lot of it. Also the reviewer needs to understand individual baselines vs abnormal vs machine artifact).

3. Starling Health and VillageCare
http://www.starlinghealth.com/

Nurse call and bedside communication tool using tablets piloted in a rehabilitation SNF (subacute nursing facility, pronounced “sniff”).

I really liked this one and mentioned a need for something like this in a previous post. It fills a need in terms of receiving, accepting and tracking requests. As a person who loves design, I really liked the flow and the icons. Simple and easy to understand. This would be interesting to have not only at a SNF but maybe even in an inpatient setting or well even have as an application in a hotel. Can you imagine hitting a button and boom, you get extra towels?

4. Adheretech and Weil Cornell
http://www.adheretech.com/

Wireless smart pill bottle that will help with med adherence for people living with HIV/AIDS.

It’s a pill bottle that knows how many pills (or even liquid) is in the bottle. It lights up when you are supposed to take your pills and if you missed a dose and connects to the cloud and you get a call if u do miss it. I think that this is a great partnership because adherence is such a big issue in general but specifically for this population, missing doses can affect viral load and can lead to drug resistance. What I also like is that like the Square of glucometers, the technology is so cool that instead of being “sick” you are the person with the cool technology.

A word on the team. I met all 3 co-founders last year while visiting Blueprint and they are great and it’s not just educational background and experience, which BTW is top notch. They were friendly, they listened, they let me ask questions (ummm I ask A LOT of questions), and we had a whole discussion about the product, its uses, who could be helped, what could be improved. (They also showed me their Makerbot printer). I really respect health tech entrepreneurs who listen and who are looking to improve their product to better fit the needs of the people they want to help.

5. Biodigital and Memorial Sloan Kettering
http://www.biodigital.com/biodigital-human.html

3D interactive map of the body that will be used to facilitate patient understanding of complex health topics.

I actually saw a demo of this a couple of months ago when I was at a NY Academy of Sciences trends in healthcare conference (will blog about that at a later date) in relation to teaching medical students anatomy. This is like Netter’s Atlas of the Human Body come to life. What I like about it is that you can peel away different layers and show people normal anatomy as well as pathology. This will help patients understand their own normal anatomy, where a cancer is located, and what abnormal looks like. I was excited to hear that they will work on individual personalization soon too. Also, it beats the drawings that I draw to help explain things to patients (Patient: Doc, is that a lung or a heart? Doc: Errr…let me start over, j/k). I would like a timeline function so that I can show patients ok here is normal, here is where you are, here is what happens if we do X, here is what it looks like if you continue to do Y). Or maybe in the future, there will be a 3D hologram version a la Star Trek (a girl can dream).

6. Ecaring and Pace University
http://ecaring.com/

Web-care based management and monitoring system for chronically ill patients at a multicultural retirement community. RN’s will track health resource usage as well as disease management.

I actually have seen Ecaring before at the first Startupalooza event (he won) last year. What I like is that I have seen the evolution of the product a year later. What I also like is that the founder really took the time to make the system easy to use. You can use the system even if English is not your first language and if you are not very computer literate. I like that it is sophisticated enough to look at chronic disease management.

7. RipRoad and VNSNY
http://riproad.com/

Text messaging platform for patient engagement for Medicaid population and will look at patient communication and have data analysis on appointments and med adherence.
I think that text messaging and smartphone capabilities, basically mobile, are the way it’s going to be and tools that leverage that will be helpful because there is less barrier for use in terms of cost, it’s accepted as part of daily life, and the proliferation of the technology as well as the ubiquity of devices.

I also just wanted to add that I have had really great experiences with people from VNS while I worked in the hospital. They were professional, really thorough and on point with their work and pleasant to talk to. (Thanks 🙂

8. Biosignal Group and NY Methodist
http://www.microeeg.com/
Micro-EEG (basically electrodes that we hook up to see electrical brain activity, it is painless) connected to a network of teleneurologist to help patients who come into the ED with altered mental status (person who is confused, unconscious, not themselves, speech is altered etc).

I also really liked this. AMS can be a lot things (toxins, electrolyte abnormalities, brain tumor, brain bleed etc) but you often wonder if it is due to stroke vs seizure. A brain scan is usually done in the first 20 minutes as part of stroke protocol but an EEG would be helpful to determine something called status epilepticus which is like a prolonged electrical storm in your brain and that requires you to be moved to say an ICU or area where you are monitored round the clock. It also would be helpful in the ICU because of the design elements (less cords) and cuz seizures can happen even if that is not the original reason someone came in. I like the micro aspect of it as well because there is a trend for smaller, portable, wireless tools and that’s cuz they make life easier. (Think: carrying a 1990’s desktop computer with modem wires vs your sleek Ipad).

9. Opticology and the NY Eye and Ear Infirmary
Pen-shaped device that tests your sugar (glucose) by using a pen-shaped devide and touching it to tears that run in the lower part of your eyelid (the touch part is disposable). Pilot study will correlate glucose in tears vs glucose in blood.

I think that this is an interesting way to test glucose levels. Diabetes affects many people and testing their sugar levels is the way we diagnose, manage and treat. If your sugar is not well-controlled we need to check those levels out more often and frankly yes, it is a painful drag to have be stuck repeatedly for blood and you have to pay for alcohol swabs, lancets, and test strips. I also think that a quick painless way of testing blood sugar would be helpful in the ER setting as well because depending on your symptoms, getting a quick sugar level would be helpful.

10. Flatiron Health and Continuum Health Partners
http://www.flatiron.com/
Software that helps collect, aggregate and sort clinical cancer data. It will be used to obtain metrics related to outcome, quality, operational and even financial data.
Clinical data is collected and stored by researchers and HCP’s but this taps into data that patients collect which is 9x more plentiful and sometimes clinically richer. I think that the idea of crowdsourcing data is interesting because it helps use the wisdom of the crowd to help individuals. Sourcing a lot of people amplifies the result or brings forth results that would not have been seen or mentioned if not as many people were involved. Basically, if we are talking statistics this helps increase your n.

I think that actionable analytics are great because it’s not just about having data to have it, it’s about being able to improve outcomes and quality of life.

I think that the organizers and judges did a really good job. The event started on time and all 10 companies did very well presenting their products with lightning speed. I also think that the companies chosen were a good representation of trends like cloud, mobile and Big Data but more importantly they fill real needs. I think that what will be most interesting to me is to see the results of the PILOT project a year from now in terms of published studies, but most of all seeing the evolution of the products and services and the people who make them. Health care is unlike any other field because you can literally change and save lives and that is both an awesome responsibility and an inspiration.

Good luck.

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Design in medicine (STEAM-power)

This blog reflects my own opinions and not necessarily that of my affiliations.

I’ve been a fan of STEAM (Science, Technology, Engineering, Arts, Math) education for a long time. Choosing science vs. art is like choosing between wearing your right sock or your left sock- you need both. Also, they all exist in nature as inseparable units anyway so why do we separate them?

If you look at snowflakes, honeycombs, flowering plants, even human hands there is a definitive beauty, geometry and purpose to them. If you listen to music, there is a beat, a rhythm, a certain level of engineering of notes that come together to create something spectacular. If you look at great works of art, there is often a triangular composition to them that draws our eye to key points of the work.

Medicine itself is often said to be both an art and a science. (Some people think that it is more one than the other but I think that those percentages are variable based on each individual). Medicine is an art in that it has variations to it and like painters, providers have a framework and body of skill and knowledge but they also have leeway in its presentation and sometimes even in its practice. Medicine is also heavily people-based and people are the X-factor. It doesn’t matter what the latest literature says about a study or a certain drug or a certain behavior, if the patient doesn’t want to take it or do it, then it’s just not gonna happen and honestly, they have every right to say no, as long as they are fully informed.

Medicine is a science in that there is a body of knowledge that is passed down. That we as providers collect data and analyze it -it’s all very scientific method sometimes. Or I often liken it to being a detective, where you search for clues and always ask witnesses and get a back story. Medicine is a science because we are supposed to come up with solutions and decisions based on evidence. The thing is, you are limited by the amount of evidence, the way it was gathered, and sometimes its specificity to a particular population.

Given the the recent interdisciplinary collaborations and atmosphere of innovation in digital health and medicine, I think that now is a great time to think about design in medicine on an individual, systems and environmental level. In doing so I would like to share some of my favorite quotes on design:

“Design makes what is complex feel simpler, and what is simpler feel richer.” -John Maeda

“Design is when beauty inspires, simplicity empowers, and quality grounds trust.” -John Maeda

“Design is not just visual, design is efficiency. Design is making something simple. Design is epic. Design is making it easy for a user to get from point A to point B”.-Jack Dorsey

“Design works it it’s authentic, inspired, and has a clear point of view. It can’t be a collection of input.”-Ron Johnson

“Design is not just what it looks and feels like. Design is how it works”.- Steve Jobs

Design on an individual level
I think that design comes into play when designing tools that patients and providers will use. I think that a lot of the backlash that comes from tools developed in the past is that they didn’t fit into people’s workflow and they were often lofty, complicated, uninteresting and so heavily invested in that there was no impetus for change or innovation. If you invest millions of dollars in something and it might cost you millions to take it out, you kinda have to make do unless you make the bold move of replacement.

I think that the development of mobile devices and their ubiquity will change the landscape of medicine and I think that people developing products really need to focus on that. I also think that it’s important to really talk to the people you are building products for.You really need to be able to understand the nuances of their lives and their workflow and be willing to listen. An example of this is that in the past, all we had were desktops. What I didn’t like about them is that as a doc you were tied to the desktop or a desktop on wheels. If you are seeing patients on different floors of the hospital you have to keep running back and forth to the computer to do stuff. If you were in an outpatient setting, the computer was a divide between you and the patient. The reason why the Ipad mini is so popular is because you can use it on the go or rest it comfortably on your lap as you talk to someone. Although, some of the amendments I would like to make would be some sort of skin or something that would make it easy to clean and not get damaged in case of contact with water or body fluid as well as more privacy settings or precautions. I mean if you lost it, it doesn’t necessarily need to automatically detonate the information in it or something but at least more precautionary measures are needed.

In designing physicians tools, I also think that people forget that we are consumers and regular people too and we appreciate something that is beautiful, well made and made to last. Also, it’s strange to not have the same kind of technology you do at home at work as well. And it’s definitely something that patients notice. I remember one time a patient was like “Doc, how come you guys still use pagers, isn’t that so 1980’s. You know that joke right, only two kinds of people carry pagers, drug dealers and doctors hahaha”. That was funny and it was also highlighted by the fact that the patient had the latest Iphone and was reading the NY Times on an Ipad. But, it was really a moment when I was like wow, that’s so true, why is there such a disconnect? Or well, the whole thing where I read an article recently that Dropbox was being used for resident sign-outs. You’re not supposed to do that but it highlighted how people are gonna bring their consumer electronics to work and how certain work technologies need to be integrated into our professional environments because they make things more efficient. Though at the same time this must be balanced by not having information and tech overload like too many boxes to check or screens to go to when it would’ve been easier just talk to someone or *gasp* write it down on a piece of paper. And I think that’s where design comes in, having a process of thinking, imagining and creating something that strikes the right balance.

In designing tools for patients, I think that input from the people you are designing for is really important. What you think they want, may not be what they really want or they tell you something you have never even thought about before. I also think it’s important to know that patients, like doctors, are not a homogenous group. People have different levels of hearing and sight. People have different levels of literacy and health literacy. People have different needs.

Also, I think that now is a good time to look at re-designs of the tools that we have used forever. Stethoscopes can record heart sounds that can be played back so I can teach you the patient what your murmur sounds like. The patient gown has been re-designed so that there is more privacy. We soon will have bloodless blood drawing. What about other things? What about ambulances? Or the bed pan? Or IV systems?

I also think that looking at what is happening in the developing world is really interesting. Sometimes, it just makes more sense to go sort of high tech low tech but above all low cost. For example the way SMS is used in rural areas in developing populations. It’s like melding the ideas that necessity is the mother of invention and that innovation is often the product of limitations.

Design at a systems level
Sometimes it’s just easier to do something when there aren’t too many hands in the kitchen. Healthcare is a complex system with many different players who may have different expectations, wants, needs and motivations. How do we design a simpler, more efficient system? How do we identify problems before they start, or before they multiply? How do we measure and enact real change? Honestly, I don’t have a complete and comprehensive answer for that but I’m open to suggestions.

I think that designing a system or re-designing a system starts by looking at what has worked and not worked. I also think it might be a good idea to look outside of our field or our local geography. I think that it also helps to get someone who is outside of our immediate field to take a look around and share their opinion, a third set of eyes.

The other question to ask is do we even need a system, why can’t it be independent networks? Or if we do need one, how do we mitigate inefficiency, redundancy or the system getting in the way of things -an example being going to a meeting and the only end result of that meeting is to set up the next meeting.

Another question that is food for thought is are we a healthcare system, a sick care system, or both?

Design and our physical environment
Some people say that with the advent of technology, we are even more connected. We can text, message, call, video call, hangout, etc Or some say that we are more disconnected because there are instances where you don’t have to see or talk to a person face to face anymore or well I’ve even seen people text each other from across a a dinner table.

When I think of design in our physical enviroment I look at Nature as architect. There is this profound marriage of form and function. There is also a sense of wonder and beauty that can be healing. It’s how we feel when we look and smell flowers, breathe fresh mountain air or look out at the sun setting over the open ocean. How can we incorporate design into our health spaces?

I think about Florence Nightingale and her call for cleanliness, warmth, light and air. I think about urban garden design, about solar panels and renewable sources of energy that are not only often beautiful to look at but environmentally friendly. I also think that the funds that used to be appropriated for fuel could be spent on resident and patient education or a budget for patients that have difficulty affording their medications.

I think about the incorporation of technology.What if you could Skype to see how your grandma is doing in her hospital bed at a hospital in East Asia? What if you as a patient had a personal panel deck and it told you who was seeing you today and there was a notepad that you could write questions you had down? What if we incorporated fall sensors in the bathroom and near the bed? What if you could see pics of the MRI you had last night? Or if you had a noisy neighbor, what if could put up a cocoon of darkness and soundproof walls with a do not disturb sign? What if you are far away and someone you really care about is in their final moments and they can hear your voice for the last time or they can hear yours, all enabled by technology.

I have always looked at technology as a tool and a blend of art and science, but the main drivers of it are the people who create it and the people who use it. We too as people are art and science. We are biological beings made of cells but we are also beings capable of thought, creation and design. Time is our only limitation, so I ask, if not now, then when?

My thoughts on the upcoming NYS patient portal

All content on this blog reflects my own opinions and not necessarily that of my affiliations.

I am really excited for the NYS patient portal and as are many people who I have spoken to in the last few months. You can see people’s eyes light up at the exact moment they realize the implications of a connected statewide network, “that is HUGE!”, they say. Or well…they also say “this is a long time coming” and “hey, will this be national?”. They also tell you stories about visits to various hospitals and doctors offices.
So why is it so important? Why is it so monumental? Why didn’t this happen sooner? Why isn’t it national?
Why is it important? Why is it monumental?
I think it’s important because as a patient, medical information often feels like this esoteric thing that is sometimes hard to obtain.You rarely get to see your information unless you requested copies and that was a process in and of itself. You have to get the medical release form either by fax or go directly to an office and sometimes you have to work certain hours and can’t make it and sometimes the fax machine doesn’t work and sometimes the papers can’t be found and sometimes the copier jammed and sometimes the receiving office never received them. Then for many people, there is difficulty reading the medical jargon or reading the information period (insert doctor’s handwriting joke).
Since the portal will be digital, it will be available 24/7. That puts things on YOUR time schedule. It also will be portable -you will be able to access your information from pretty much anywhere with an internet connection. Also because most records will be in print, it will automatically be legible.
Besides the ease of access to the information, I think that it will help improve the lives of patients. I think of it as a doorway to their information. Knowlege is power and I think of it as a great tool for patient empowerment because all of their information will be in one place and they can see and document their progress in real time and over time. Above all, patients will be able to see trends for themselves and potentially take action on what they see.
As a physician, I love the idea of a patient portal. We only see patients for short periods of time, sometimes even only once a year or ummmm once every few years due to re-location and more frequently, insurance changes. You the patient are with yourself every single day. I am only one scene or potentially a recurring character or hopefully a helpful coach/partner in the movie of your life. I also may be one among a few MD’s you are currently seeing and the portal serves as a hub of information that puts you at the center of it all.
I think that the portal will be very helpful when seeing new patients in the outpatient setting in terms of getting a quick snapshot of who you are, and potentially helping to save your life in an emergency situation or in the event you are unable to speak to me. Also seeing the information yourself helps you help me verify information and change anything that is inaccurate. Having been an adult caretaker and babysitter in the past, I know how important it is to be able to have records, especially allergies and medication lists.
What I also hope for is that people will also use the portal as an opportunity to upload documents like health care proxies, emergency contact information and living wills. I can’t emphasize how important having such information ahead of time is because it helps me act in accordance with your wishes and also eases the pain that friends and family members feel when having to make a decision for you…especially if they are not sure… It’s the kind of pain and anguish that breaks your heart…
Why didn’t it happen sooner?
I think that the technology just wasn’t there yet in a critical mass kind of way. It’s only been in the last few years that almost everyone has a computer or a smartphone or tablet/ipad of some sort. I also think that the health care and health tech ecosystem as it is now is more open and collaborative than before; it’s a really interesting time to be in healthcare because we are in a point in time where what we do will affect the future of generations to come.
Why isn’t it national?
I think that it will be in my lifetime. I think that there are many great systems out there and I think that this atmosphere of collaboration and innovation will persist for some time, because simply, it must. We can’t continue to operate in such a high cost, marginal outcome, disconnected kind of way. I also think that it is something that people frankly will refuse to accept.
I also think that time is needed to pilot such an undertaking, to work out the kinks and bugs and to see what works and what needs to be scrapped before something is released in such a broad scope.
Why am I so passionate about a NYS patient portal? Why did I decide to take the risk of working with a small startup, like Mana Health?
Because the reason I became a doctor was because I wanted to help people. I think that being a part of this, being in the milieu of it all, is a way that I can help patients on a larger scale. I promised myself that I would use my time off wisely and that anything I learned I would bring back to my profession to help people. I was actively looking for tools that would help  patients and help me be a better doctor in a one-on-one setting and at a systems level, and if I couldn’t find something I really liked, I wanted to help develop it in some way. “Be the change you want to see in the world” is a quote that resonates with me and I wanted to be that change by helping to build something great.
I am also a native New Yorker and participating is a way of paying it back and paying it forward. This city, this state, helped me become who I am today. I went to public school my entire life. I went to P.S. 236 in Mill Basin, CIG at Andries Hudde IS 240 in Brooklyn, and Stuyvesant High School in Manhattan. In terms of my medical education I went to a CUNY school, the Sophie Davis School of Biomedical Education and graduated from SUNY Downstate Medical school and completed residency at Lenox Hill in Manhattan. From 18 to 28, I learned so much and was given amazing opportunities. I learned how to write a community health assessment. I was able to work in outpatient, inpatient, and critical care settings all over the city and met so many people, from all different walks of life and reflective of the melting pot that is New York. I also was able to actively see patients and go out into the community to teach and participate in health fairs.
I have been taught by amazing teachers, attendings and patients and what I have learned from them I carry with me. I also carry my memories and experiences of New York with me.
In thinking about the portal, I thought about my friends, my family, patients I’ve seen and the people I see every day. I thought about the guy who works at my laundromat, the bus boys at restaurants, the moms and dads you see playing with their kids in the park, the elderly ladies I have met on line at a few live talk shows, new immigrants, and all the people I ride the train with. How would they use a portal? How could it be customized to better serve their needs? What information is critical for them to have in an emergency situation? What information would I like to have as a doctor on the receiving end? These are all questions that come to mind.
Besides the immediate future and immediate needs, I also think about the long-term. This is something that will be a legacy to our children and grandchildren and what a better legacy than an ecosystem that is open, collaborative and focuses on networks and community?
I am excited for what’s come. It may not be a perfectly smooth ride, but it’s definitely one worth taking.