Health 2.0 v.2013: Integration and Patient Outcomes Are Still Driving Health Technology – But So Should Empathy, Caring, and Communication

I attended my third Health 2.0 conference earlier this week, which was held for the first time in Santa Clara rather than San Francisco [agenda here].  Driving around the neighborhood reminded me that the Silicon Valley is thriving, with companies like Cisco occupying not just a single city block of offices, but miles and miles of office buildings.  It seemed fitting that a conference on health and technology move its venue into the geographic heart of where so much technological innovation is still happening.

At the first Health 2.0 conference I attended in 2011, I was absolutely blown away by both the range of demos I saw, and all the tech- and venture capital-speak I heard.  By last year, I had become more accustomed to both the products and the jargon and viewed the presentations with a much more critical eye.

This year, I was struck by the lack of any newsworthy “breakthroughs” but kept observing how everything has kept improving, at multiple levels.  User interfaces and data displays are cleaner and crisper (many now using infographic fonts and styles).  The form factors are more elegant and are taking advantage of improved Android and iOS display screens and functionality (although of course no one yet had an chance to program in iOS7, but I did see more and more taking pictures of slides with cameraphones as a notetaking technique).  There are more and more multi-function trackers for our quantified selves.  (Pew Research Center’s Susannah Fox reported that 7 in 10 Americans are tracking their own health or someone else’s health, but only 20% who track health use technology to do so, highlighting the enormous market potential in health tracking.)

There was at least one presenter who was planning to use GoogleGlass to deliver real-time health data (and a few others who just wore them as accessories).  SoloHealth’s consumer kiosks are now in big-name stores throughout the U.S., with 130,000 daily users and enough volume to conduct instant surveys and spot health status and health care utilization trends.  Home testing kits are easier to use (especially with health plan payments for preventive screenings).  The Blue Button has become a metaphor for easy patient access to personal health information.

The Nokia Sensing X Challenge had Hollywood-worthy production values (complete with preview videos, musical cues, and teleprompters) to showcase devices, often powered by smartphones, to use blood, saliva, urine, and breath samples for complex diagnostics.  Winner Anita Goel from Nanobiosysm Health RADAR summed up her motivation: “Google democratized information, cellphones democratized telecommunications, what will democratize health care?” Health 2.0 co-founder Matthew Holt reported that 1,500 of the 2,600 companies that Health 2.0 is now tracking have patient-facing products and services.

Products and services now were being presented with data and results from actual utilization rather than hypothetical use cases.  Some of the most impressive presentations were the mining and analytics of “big data” from newly-made public data sets such as the Centers for Medicare & Medicaid Services’ hospital pricing data, or from tens of thousands of actual (but still proprietary) electronic medical records.  One of the most intriguing questions raised was whether otherwise neutral “carriers” of data such as phone companies could access and mine the data they carried (including all text messages) – or routers made by Cisco?  Given the disclosures about U.S. national security agencies’ penetration of such data for anti-terrorism work raises new questions about where personal health information sits and who can access it in the digital cloud.

The most significant theme sounded by those at the leading edge, or those looking ahead, was “integration”.  Whenever a presentation or panel discussion became too physician-centric, or too consumer-centric, someone would say that it wasn’t a matter of either/or, of winners/losers – but that it was both/and – that we needed everyone to engage, to work together, to see their common goals and their common success.  Dignity Health’s Lloyd Dean summed up some of these themes by declaring: “the current health care system is not sustainable, we have to work together to change it…technology, innovation will change how health care looks in the future…but shame on us if we don’t seize this moment to change, to bring 41 million uninsured into health care.”

And that common success was defined as improved patient and population health outcomes, better health, not just better health care.  There was a chorus of consensus that unless a product or service could measurably deliver improved patient outcomes, it wouldn’t be worth talking about.  Many of the startups referenced the pressures on hospitals to reduce avoidable readmissions, on all providers to meet quality measures for value-based payments, and on Medicare, Medicaid, employers, and health plans to demonstrate population-level improvements in health outcomes (and reductions in health care costs).

Similarly, there seemed to be strong pitches by traditional health care industry stakeholders (especially the health plans) to be viewed as value-added partners with other stakeholders, with hospitals and health systems, with physicians, directly with consumers/patients.  Again the theme was “we want to work with everyone”.  Of course, many industry stakeholders are re-making and re-branding themselves as traditional payment and revenue models are pushed aside in an era of health care delivery reform, value-based purchasing, and accountable care.

This year also had two major contemporaneous events looming large in the consciousness of both the presenters and the conference attendees.  Tuesday October 1 was the launch of the health insurance marketplaces under the Affordable Care Act (ACA), and while there was a plenary panel discussion about the marketplaces, few other speakers mentioned, let alone incorporated, the impact of 30 million newly insured health care consumers beginning next year, in the market dynamics of health technology.  Xerox’s Mary Scanlon did warn that it won’t be the technology on the health insurance marketplace websites that enroll the uninsured but navigators and in-person assisters that help individual applicants through the enrollment process.

The other unexpected current event was the shutdown of the federal government, largely over Tea Party and extreme Republican Party opposition to the ACA.  The unfortunate consequence for the conference was that all the scheduled federal government speakers from the Department of Health and Human Services Office of National Coordinator for HIT were recalled back to Washington DC, and prohibited from “working”, i.e. presenting at the conference.  While one shouldn’t make too much of the absence of a handful of federal government presenters, they also happen to be key policymakers who need to be continuously engaged with (and publicly accountable to) the diverse stakeholders represented at such a highly relevant national conference.

If one were to report on the moods during the conference, the emotional low was the surprisingly, self-admitted pessimistic keynote talk by Health 2.0 co-founder Indu Subaiya, who described what she labeled “7 Deadly Sins” in today’s health care delivery system “that entrepreneurial energy alone cannot fix”:

Sin 1: we do too much (wasteful, duplicative, unnecessary, defensive) diagnostic testing

Sin 2: hospital charges are gooey (rather than transparent or rational)

Sin 3: intermediaries (health plans) are bossy (and want to remain in control over physicians, hospitals, other providers, and members/patients)

Sin 4: no one understand pharmacy benefits managers (conflicts of interest with health plans, pharmacies)

Sin 5: EMRs don’t share (data) in order to protect (market) share (for EMR vendors)

Sin 6: it’s not quite my health data (patient control over health information is still illusory)

Sin 7: do not go gentle into the good night (too much spent on futile end-of-life care)

While Subaiya pointed to some examples of technology solutions to address or overcome each of these “sins”, her message was clearly that there was much more deeply entrenched and deeply wrong in our U.S. health care delivery system that a killer app, or software program, or even big data mining and the most sophisticated of data analytics, won’t solve easily.  Subaiya also noted that we might stop focusing on the $2.7 trillion “spent” annually on health care in the U.S. and instead ask who is “making” all that money, and what is at stake for each of them in the health care money-making industry.  It was a sobering reality check about how complex and how challenging making real, sustainable change will be.

On the other hand, the emotional high was the seemingly impromptu keynote by California Lt. Governor Gavin Newsom, who delivered quotable soundbite after soundbite about the impact of technology on the various generations that are now living side by side with one another: “remember when twitter was a sound, a cloud was in the sky, 4G was a parking space, and big data was a rapper?”…”today, it’s mobile and social, global and local”…“the millennials are digital natives, born and bathed in bytes”…”we who are older are digital immigrants”….”nations are models for democracy but cities and local communities are models for innovation”.  As an elected official, Newsom brought intelligence, charisma, and communication skills to the conference stage, with the tantalizing prospect of being able to deliver an equally convincing message on a future electoral stage (pushing the public policy levers that Subaiya was implying might be needed – as mayor of San Francisco, he implemented an innovative model of paying for health services for uninsured residents instead of providing traditional health insurance; to help fund the services, the city required employers to provide insurance or pay fees, much like ACA’s employer mandate).

Visually, the generational divide was brought home by Health 2.0’s Matthew Holt showing a 30-second video of his 2-year daughter logging into Holt’s Amazon.com account and accessing a streaming video of her favorite cartoon on Holt’s iPad.  All the tech-parents in the room groaned with recognition, while the non-parents (like me) gasped with amazement.

And in between, probably the most talked about and impactful session was, ironically, the always-popular “unmentionables” panel led by Eliza Corporation’s Alexandra Drane.  Drane illuminated the every day stressors of financial stress, relationships, and caregiving; Drane described the “magnifiers” of these “vulnerabilities” as being sad/worried, having trouble sleeping, and substance use.  On the other hand, “buffers” against these vulnerabilities are social support, spirituality, and exercise/physical activity.  She is now working with companies to quantify these factors and correlate them with health status and health outcomes.  Put simply, these are what make us healthy or unhealthy, and often in our control, if only we named (mentioned) them more explicitly.

Gabrielle Glasser, author of “Her Best Kept Secret”, then silenced the room of both women and men with her facts and stories about women drinking more, initially as a way to relieve the stress of work and/or motherhood, and then more problematically.  While we talk about substance use and abuse, we rarely talk (soberly) about alcohol abuse, especially at conferences with open bars.

Pew Research Center’s Susannah Fox also provided heart-wrenching data on the physical and emotional burden of caregiving, observing that 4 in 10 adults in the U.S. already are caring for either an aging parent, or child, or for the sandwich generation, both.  Based on her data showing worse health, more high cost health care utilization by caregivers, Fox wondered “whether caregiving should have its own diagnostic code”.  Fox ended her remarks by focusing on the “love that is beamed” between caregiver and patients, and noted that the most important trend in health care is people talking with each other.

Former Zappos consultant Jenn Lim now has the unique title of “Chief Happiness Officer” at DeliveringHappiness.com, preaching the gospel that happiness can be measured, and what can be measured can be changed.  She said that her company “sucks the fluffiness out of happiness” and quantifies it, measures its change.  Lim noted wryly that happiness at work “is not free Red Bull in the fridge and a ping pong table” but that the formula for happiness is “be true to our (weird) selves, and be true to our values, passions, and purpose”.

And of course no unmentionables panel would be complete without talking about sex, in this case, getting tested for STDs and sharing your results when you “unzip”, courtesy of the charming presentation by Ramin Bastani from Hula (the only male presenter on the panel), and MD Anderson Cancer Center’s Leslie Schover discussing sexual functioning among cancer survivors.

Summing up, Drane concluded the “unmentionables panel with the following mantra:

Health is life.

Care, completely.

Empathy always.

It wasn’t surprising that many founders of the start-ups presenting at the conference, and even a few health care industry veterans, shared their personal motivations for doing what they do – their own experiences with health care, with a disease or condition, or the experiences of someone close to them such as a family member, roommate, or co-worker.  Health care is personal.  Health is personal.

I was gratified to see a full room for the pre-conference roundtable on digital health and the underserved.  One of the panelists, David Wong from DirectDermotology.com, described how he almost inadvertently stumbled on his initial partnership with community health centers to pilot test his telemedicine application but how that partnership has not only opened up customer markets but also leveraged private foundation funding because the community health centers are not-for-profit organizations. Sajid Ahmed from the re-booted Martin Luther King, Jr. Community Hospital in Watts described how health technology is at the heart of the vision and operations of the new community hospital.   Roundtable moderator University of California San Francisco’s Urmimala Sarkar noted that paying attention to an issue like (low) health literacy makes information more accessible and understandable for all. I would add that this application of universal design principles can be applied to all health technology development.

Finally, the panel on the future of health technology showcased some amazing developments.  There was a “virtual human” developed by the University of Southern California Institute for Creative Technologies to engage with patients about mental health issues, with the programmed “counselor” continuously responding to biometric readings and facial expressions using facial recognition technology.  One of the best laugh lines of the conference was that the virtual human had the most difficulty engaging in small talk (because the range of potential subjects is so broad and therefore difficult to program for).  So do many of us socially awkward real life humans.  There was a “mental joystick” developed by BrainControl.com that uses brain waves to send up to twelve commands.  And the winner of conference attendee-voted Launch! demos, OMSignal.com, has embedded a sensor in a t-shirt that measures pulse and heart rate (the black t-shirt did look cool).  The founder/CEO of the company showed a dashboard that displayed the current pulses and heart rates of his executive team, almost like a monitor at a nursing station in a hospital.  Maybe a little too much information for your boss to see?

But perhaps fittingly in carrying forward and highlighting the messages of care-giving from Susannah Fox, empathy from Alex Drane, and happiness from Jenn Lim, the conference ended with the ever-humble and soft-spoken Health 2.0-India’s James Mathews reminding us to “use simple tools to do great things” (channeling Susannah Fox’s challenge in 2008 to always communicate simply, with only seven words or less). Mathews’ mantra was seemingly antithetical to all the whiz-bang technology on display for the past three days.  Mathews then showed an amazing video from KidPoweredMedia.com, “Mad About Khan” made by and for children in India about the importance of handwashing and hygiene (OK, they had a little help from Bollywood).

Beyond the feel-good humor, entertainment value, and objective effectiveness of the health education intervention was a subtler message that a simple video camera, and the imagination and creativity and talent of seemingly uneducated children living in dire poverty, was all that sometimes is needed to “do great things”.  It also was an even subtler reminder to the predominantly U.S.-based conference attendees that while we legitimately want to cure cancer, reverse obesity, and control diabetes, and get better value for that $2.7 trillion we spend each year on health care, that for many millions in the world, something as basic as improved sanitation means an effective health care intervention, and improved health.

Health is life.

Care, completely.

Empathy always.