I spent a good chunk of last week at the Health 2.0 conference in Santa Clara. I intended to write a summary directly after, but I found I needed a few days to take it all in and mull it over. There was a large amount of information. Presentations ranged from nascent start-ups and incubators to large healthcare providers. Technology solutions ran the gamut from simple phone-based directories to machine learning-driven predictors of human behavior.
In spite of this diversity, there was a common problem, a common question running throughout. How does this all come together? There are almost 200,000 available apps related to health available online and many more in the pipeline. There are hospitals and healthcare systems individually building communication tools for patient-provider interactions. There are entrepreneurs building apps to guide consumers with healthcare decisions, which doctors to choose, scheduling, medical questions, and pricing. There are developing platforms to coach diabetes patients, mental health patients, to make healthy eating choices, for meditation and for exercise.
To me, it’s like inviting a bunch of guests to a dinner party. You hope that when they sit down at the table that they will talk with each other, and even more, that there will be a kind of synergy so that it takes the conversation to new places.
With digital health technologies, it’s much the same. Take the nearly 200,000 health apps –currently only abut 2% connect to patients’ electronic health records (EHRs). Where is all this data going? Are we losing valuable synergies without this interconnectivity? Integrating activity, diet, symptom data and continuous monitoring of physiological data could provide valuable insights for individuals. This integration could also be valuable for accumulating and analyzing population data to derive correlations for disease triggers and causation.
Like successful dinner parties, the integration of components (new and existing) for healthcare should take into consideration how to arrange everyone at the table and how to best sequence the event from arrivals and pre-dinner drinks to after-dinner cordials to get to the optimal level of conversations and synergies. The Health 2.0 conference highlighted some of these challenges.
Integrating into the workflow. The current “disruptive” label gives rise to the belief that new technologies will create all new systems for healthcare providers. But as pointed out by numerous presenters, technology needs to understand, integrate and more importantly, improve the current workflow. One example hit the concept home, that technology and data on its own is not enough. Imagine that Google maps told you there was a 37% chance you will turn left and gave you a distribution graph for the profile of traffic on the road. Really? So why think the same type of data output is going to help providers or consumers.
Hand-in-hand partnerships. The collaborations between healthcare providers and start-ups is a bright spot in addressing the integration/implementation dilemma. A number of providers showcased their models of working with entrepreneurs including UPMC, Cedars-Sinai, University of Colorado, Providence Health and University of California. These partnerships give the nascent companies a valuable window into the existing workflow and demands of healthcare, as well as access to clinicians who can test and champion the promising technologies. One question with these collaborations is whether the technologies will be too tailored for the specific provider-partner or whether they will blossom into a more generalizable solution.
Common Platform. Interoperability was an oft-used buzzword at the conference. And don’t get me wrong – it’s certainly an important concept. But understanding where we are headed in was a bit more difficult. A number of presenters talked about the standards needed for privacy and security. Others offered platforms for apps that might tie them together and bring them in sync with the EHRs. However, clarity broke down as to whether there is a single agreed upon manner to interweave the newly developed technologies or rather a diversity of providers each promoting their own solution.
Blockchain. The entrance of blockchain into healthcare came up in several guises during the conference. While generally most agree that blockchain could provide a secure storage system for health records, some of the challenges remained largely unaddressed. Some proposals include data stored off the block chain, but who would control access to this sidelined data was not discussed. Similarly, if blockchain places consumers more in control of their individual data, how will impact research use? Will permissions be required even for data that has been de-identified and assembled in bulk? This would suggest that consumers will have to opt-in their data to studies. Because opt-ins can skew the participating populations (as a lot of us are too lazy, ornery or otherwise don’t participate), this could impact the breadth and diversity of available data.
Who are we reaching? Not to be missed is the point that came mostly on the last day of the conference, that reaching people is not an easy task. This fell into two separable challenges. The first addresses populations that don’t have the economic means to the phones, data plans and broadband that is necessary to access these new technologies. This is not a healthcare-specific issue. However, when trying to reach these groups with new technologies, additional shared resources and community outreach may be required. The second challenge addresses whether even with access, consumers will utilize the new technologies. This applies to consumers across the board. Apps may be fun to try, but will we stick with them? This goes for apps promoting healthy lifestyles as well as those that are designed to reduce face-to-face time at healthcare facilities. Changing habits and behaviors and productively integrating human interactions with machine-driven responses will continue to challenge the industry.
In sum, after 4+ days driving to and fro between San Francisco and Santa Clara, it looks to me that we’ve got a large dinner guest list together in the healthcare arena. Now we are in the next stage of how to arrange everyone at the tables. Looking forward to seeing where we will be when we sit down to the next Health 2.0 conference in 2018.