It’s not surprising, it happens to a lot of industries. Consumer devices and technology are making inroads where industry driven solutions are still struggling. People want access to health and fitness related data and so they are building their own solutions, outside of the provider-controlled walled garden. I suspect we’ll see a time when all of this merges together – consumer solutions, medical device makers, provider EMRs, etc. However, for now, it’s pretty clear that if you want to generate and control your own health related data, look towards the consumer space.
This announcement with Withings, maker of the popular Wi-Fi Body Scale (I love mine), highlights what is happening in the consumer world. Providers have been using sales sales with modem connected to your phone line to monitor weight gain in patients with congestive heart failure for years. They cost big bucks and the data goes into a seeming blackhole. The Withings scale is less than $150 and the data is available via API with existing interconnects to services like RunKeeper, FitBit, and now MedHelp (which is new to me).
We have recently discussed the Withings Health Cloud that allows users to import data from RunKeeper and Zeo into their Withings dashboard. The development of the Health Cloud however does not mean that we have given up our policy of making it possible for Withings users to export their data to other websites, quite the contrary. In the past weeks, we have added several new names to the list of our partners, both for the body scale and for the blood pressure monitor. Today, we’d like to shed some light on one of those partners: MedHelp.
via Withings and MedHelp have formed a new partnership | Withings blog.
This week, Apple released their latest disruptive innovation, iBooks 2 and iBooks Author. iBooks 2 is a free update to the iBooks app for iPads. iBooks Author is a free mac desktop application which enables anyone with some basic typing and drag-and-drop skills to create pretty amazing eBooks. eBooks can contain pictures, links, audio, video, rotating graphics, self study questions and more. This is the future of patient education, shared decision aids and pre and post visit care.
On the outset, the idea of combining text and video and pictures isn’t really that new. It’s been around since…well… the start of the web. But in the context of a book, there is something really strangely compelling about seeing a moving video in the middle of static text. I can’t quite describe it. After about an hour of tinkering with the app and pasting some images and text in from a keynote presentation, I had a nice little proof of concept. You can download it and see for yourself here.
There is something which draws you in when you see live action video playing within a frame of text. Adult education experts call this blended learning. We absorb more when we engage more of our senses.
So imagine this, your doctor tells you that you are going to need surgery. What’s that process going to be like? What do I do before hand to prep? What should I do when I get home, you ask?
“Well, you can just download my free eBook,” he says.
The book walks you through the pros and cons of surgery. It plays a video of the doctor outlining the procedure. A moving picture gallery shows you where to arrive, and what to expect the day of surgery. Another video shows you how to use the pre-surgical antimicrobial wash the doctor sent you home with. There are links to online communities from other patients who have been through the same process. There is even an embedded twitter search showing a real time discussion about your condition. Wow!
A few days after the procedure, you fire up chapter two. It shows a diagram of some basic stretching. The next page talks about nutrition. To make sure you understand the concepts, there is a short self test, don’t worry, it’s open book.
These tools are simple to create. They are easy to publish (for free). And, they are a tremendous value-add to patients. Apple has done it again. By disintermediating author from the publisher, they’ve given us all the ability to make robust patient aids. For that matter, patients could make them for other patients, and publish them on their blogs, or via the iTunes book store.
What are you waiting for, go publish your first eBook!
You can download my demo/work-in-progress book, Innovation in Healthcare: A Requirement For Success here. I’ll continue to update it after this post is live, however the point is not to provide a serious book about health reform and innovation tactics. Rather, the point is to demonstrate how the technology can be used in a healthcare setting (this book is more geared to the administrative types than patients).
The gallery below includes images and descriptions of features in eBooks.
In 1984 my aunt, Phyllis, was the best female equestrienne in the world. That summer, she represented the U.S. in the Olympics in Seoul Korea. Phyllis has all the motivation in the world to ride. It’s her passion, it’s her profession and her reputation. Clearly, she also has the ability. And, she has Grandma Grace. When it comes to support, Grandma Grace, her mother, my grandmother, is a tour de force. What ever you are into, you’d be so lucky as to have her in your court. Grandma broke out her chain saw and tractor and built a cross country course on the family farm – jumps, water obstacles, galloping paths – so Phyllis could train. Where other U.S. riders had million dollar facilities and sponsors, Phyllis had Grandma Grace. She built a barn. Herself. Nuff said.
In 1984, Phyllis finished better than any other rider on the U.S. team. Support clearly matters.
It goes to 11
Lambs neck tortellini, see what I mean?
On a scale of one to ten, my carnorvosim went to eleven. If it had blood coursing through it, there’s a good chance I tried to cook it, or would have. And I’m not talking about being a steak and potatoes guy either. I was a fried pancreas, brains and eggs, deviled kidney kinda carnivore. I always thought I had a pretty decent diet, all things cosidered. We buy mostly whole foods and I ate veggies with just as much enthussim as I did a side of beef. But you know the punch line already, in September of 2011, Susan and I made some dramatic changes to our diet – we switched to a (mostly) vegan diet. It started as a four day expirement, then a week, and a month. In December I converted a wine refrigerator dedicated to dry curing sausages and other salty porcine parts back into, well, a wine fridge. It’s prominent place in our kitchen should give you an idea of how much meat was a part of our lives.
The costs of healthcare in the US are increasing at an unsustainable rate.(Although interestingly, the rate has slowed over the last two years). The problem, though, is cost means something different to each constituent. To the consumer (hint: that’s us, the patients) costs are co-pays, deductibles, and pay check deductions (premiums) for insurance plans. If you get insurance through your employer, then they are, in fact, the ones really footing the bill. If you are a provider – hospital, doctor’s office, clinic, etc, and you read about the “cost curve”, your thoughts turn to fixed and variable costs. Implants, food, meds, gauze, overtime, the CEO’s salary, debt financing, consultants….it’s all part of what goes int the infamous $15 aspirin.
So what’s all this got to do with meat?
Yours truly, clocking in at 215 on Jan 1, 2011
In January of 2011 I weighed 215 lbs. I’m 5’8 (on a good day…with shoes… leave me alone). You don’t need a BMI chart to know that’s too much Nick to be healthy. I was active. I’ve had a life-long obsession with extreme skiing and, in order to maintain some semblance of ability, I’ve tried to keep in reasonable shape. I have a trainer at the gym – going 3 days a week – and could probably have run a mile. Who knows, I hadn’t tried in a long time.
If any of this sounds dire, let’s recalibrate. I’ve always liked the term bon vivant, it says it all about someone who loves the good things in life. Sure, I was carrying around some extra pounds, but I was still skiing double blacks; and if I could do that on a diet of veal tongue, brussels sprouts, and red wine, what’s not to love? The side effects are always in the fine print.
In 2004 my doctor diagnosed me with mild hypertension, high blood pressure. I freaked out a bit, I’m way to young for that! So he ordered a stress echocardiogram. A stress echo is a test that involves, at least my my case, shaving your chest, sticking some electrodes on and running on a treadmill while the cardiologist plays the name game to see if you work with any of the other docs he went to school with. The pronouncement: hereditary hypertension, there’s nothing I can do about it but take my meds. “You’ll be fine,” he said, “just take the pill and it’s nothing to worry about.”
The pill costs me $20 a month. Not bad, right? My insurance covers the remaining $30, which comes directly out of my employer’s coffers. Still, not a huge price to pay, all things considered. But, something in the back of my mind told me I was too young to be on BP meds; at this rate, what’s next?
The case for support
The last meaty thing I ate was an extremely large – and, I’ll add, quite tasty – pulled pork sandwich from a food cart outside the Petaluma Market in Petaluma, California. I remember it vividly, including my sauce covered fingers working to stuff the thing into my pie hole. It was damn good! I was on my way to pick up a vegan coworker at the airport and intended to adopt his diet as an experiment for the next few days. What was I going to do to stash the evidence?
That night we ate at white table cloth, rather high end vegetarian restaurant in the Mission district of San Francisco. “What do I order?”
“I’m having the tamales, they are totally vegan”
“That’s what I’ll have too then….”
I had the ability, we were in the birthplace of the fresh food revolution in America. I also had the motivation, I was excited to try a four-day experiment. Four days of eating in the Bay Area with an established vegan might be the best way to recalibrate your diet ever. It’s also all about support: the restaurants, the menu, the coaching, the lack of pressure since we were both on the same page food-wise…
When I got home, I told Susan about the trip and diet. “Here, let me cook dinner tonight, I’ll show you the kinds of things we ate…” And with that, I had one more day under my belt. And, more importantly, I had another notch in my support belt. Susan was eager to try her own experiment with diet change and together we could be mutually accountable. We could also cook for each other and not worry about having two separate menus.
There are also other, less obvious forms of support. The privilege of eating a plant-based diet of whole foods hasn’t been lost on me. It’s sadly more expensive to buy a grocery cart full of veggies, grains and legumes in this country than a cart full of subsidized corn-based processed foods. Having the financial support to make substantial diet change is not something I take lightly.
See what I mean? Support, particularly in any behavior change, makes a world of difference.
In part 2…
- Self Tracking
- Data
- My cost curve
- And the big reveal
It was a classic childhood scene, a mom pulled her young daughter in a cherry-red wagon. Both had smiles as broad as a their faces would allow. When they made the a turn to the left, a young lady stooped down to the daughter’s eye level and said something that put them both in a fit of laughter. There was something really special about how much fun they were having. It’s a simple thing really, but aren’t wagon rides kind of a childhood rite of passage? That wagon can be anything – a pony, a space ship, a semi truck or just a plane red wagon.
The young lady stood up, adjusted her scrubs and went back to the nursing station. Mom and daughter turned the corner for another lap down the hospital floor hallway.
Have you ever stayed in a hip, boutique hotel? You know that cool thing they do with glass walls and bright lights? Well, that’s pretty much exactly what I was not expecting when I stepped off the elevator at the University of Minnesota’s Amplatz Children’s hospital. My friend, J, was giving us a tour. He explained each floor has a story teller character, some animal who’s image is repeated as a design theme throughout the floor. The wall was bright orange and yellow glass. If there had been club music I would have assumed we were, in fact, in a W hotel.
“The whole place was designed with onstage and offstage spaces,” J explained. An onstage space is patient facing, it is their space where staff are expected to play the role of compassionate caregivers. Fred Lee, author of If Disney Ran Your Hospital, would be proud. Offstage spaces are where staff congregate, or push noisy carts – the kinds of things which wake patients up at night or remind you that you are in a hospital. The idea of onstage and offstage goes deeper than having a separate hallway for food service delivery. Being onstage reminds staff they are, in many ways, a guest in the space. Families, particularly in a children’s hospital, settle into their rooms and the surrounding environs. Being onstage means always playing the part of someone who loves children, and serves families, and provides care, and doesn’t mind getting a cup of shaved ice for the third time that hour. Need to huff and puff about it? Take it offstage.
“You know, it’s funny, everyone thinks I’ve gotten into IT… I haven’t, I’ve gotten into connecting people and making the experience for these kids a little less scary.” J played a considerable role in the design of the hospital. One of his many contributions is the design and implementation of a state of the art video conferencing system. The system, available in about half of the rooms, consists of a wall of video monitors, including a 42″ screen, and a motion tracking video camera. From a bedside touch panel, kids can dial up family members who may be hours or many miles away. Some kids have even been able to attend school using the video linkups. “It’s a way to maintain some sense of normalcy and connection, ” J told us. Amplatz is a regional draw, servicing a wide swath of the midwest. Video conferencing can enable the dad who can’t take off work to talk to his child several times a day. Doctors can plug in a computer on wheels and do a split screen between the patient, the parent and the medical record, effectively hosting a virtual care conference. How cool is that?
I’m with J, the people aspect is by far cooler than the enabling technology. And the technology is impressive to be sure. The design aesthetic is also – and I say this with no hyperbole – the best design I’ve ever seen in a care space of any kind. But what really stands out at Amplatz is the atmosphere, the total package. It’s not the iPod docks, rainbow walls, x-box enabled video conferencing onstage touch screen dohickies…. it’s the utter selflessness that working around sick kids demands. You simply cannot bring your own baggage onto a floor where a family is fighting for what could be their last hours or months together. Kids level the playing field. Check your ego at the door.
Why does it work so well at Amplatz? I’m not entirely sure. There is undoubtedly some combination of culture, training, design and technology which enables the care environment. There is attention to design, particularly around experience. Hospital committees met and drew the initial brush strokes. A parent’s council then came in and refined the ideas. The ultimate decisions, however, were made by a council of children patients. It’s pretty hard to get the typical non-patient-centric committee compromises when patients get the final review. Clearly, you also have to give staff room too. I don’t mean physical room, but rather latitude to be empathetic, personable and compassionate. I didn’t get to observe the culture long enough to understand how Amplatz enables culture, although it is clear they do something right for their staff.
Every healthcare provider has a responsibility to be as good as Ampltaz. Here are some of my key takeaways from our short visit:
- Patient centered design with patient input and review
- Onstage and offstage spaces
- Give staff permission to be empathetic (here’s an example, at Ampltaz, any patient care conference supersedes staff conferences. If staff are in the conference room for a meeting and a provider wants to discuss care with a family, the staff all leave and reschedule their meeting…wow!)
- Enable connections, relationships and remove fear – that will drive your IT choices rather than letting them drive you
- Don’t be afraid to have fun – the space was fun. There were games everywhere. Each room had an Xbox! Why do we paint hospitals in muted tones and use dim lighting? No one wants to convalesce in a depressing cave.
The University of Minnesota Amplatz Children’s Hospital is a joint venture between UMN and Fairview Health System.
You can follow Amplatz on twitter here.
It was the best of times, it was the worst of times.” Dickens wasn’t exactly talking about graduate school, but he might as well have been. After two long years, Susan graduated top of her class in 2010 from The American University with a Master’s of Science in Organization Development. In 2011 she was invited to become faculty in the program, giving her more opportunities to visit Toni and George (Susan’s parents). In January 2011, Nick started an Executive Master’s of Hospital Administration through the University of Minnesota. Somehow, we’ve still found time to have some fun.
Susan traveled for work: England, Ireland and Spain. Nick was asked to speak a few times: Colorado, Las Vegas, Palo Alto, Chicago. Together we skied everywhere that had snow and a hill.
The early cold months of 2011 gave Susan time to perfect her passion for brewing. In January, she began Suze Brews – a very limited release of some seriously premium beers.
Summer gave us an opportunity to come together. George (Nick’s dad) was diagnosed with a tumor on his common bile duct. After a complicated surgery, with his strength and your thoughts and well wishes, he’s doing great!
Between papers, dog training, and half marathon training, we’ve also found time to keep our 1973 Series III Land Rover on the road. This summer, we tackled the Mid-Atlantic Land Rover Rally with our friends, the Thews. It was four days of mud, Rovers and fun in the wilds of central Virginia. Ippa had a blast!
In the fall, Susan and Rosemary (Nick’s Mom) finished the Richmond half marathon with record times. Nick is training for the Monument 10K in 2012. Together, we started this vegan thing in September. Collectively, our belts are looser, steps lighter and hearts happier. What a year!
Thank you for being a part of our life. Here’s to seeing you more in 2012!
Nick , Susan, Ippa, Turley & Sydney
