Monday, April 30, 2012

Virtual nurse received better than real nurses

This article from MIT Technology Review explains how a hospital experimenting with cartoon nurses on a computer screen providing discharge instructions were received better by patients than real nurses. Patients not only liked the virtual nurses more than real nurses, they also bonded more with the virtual nurse! Click on the link to see the video. For an hour long video explanation, click here. What this experiment underscores is the difficulty that health professionals, such as nurses and physicians, have in communicating effectively with patients. Not only is there a vast knowledge and experience gap, but there's also the issue of patient embarrassment and provider impatience. A patient robot is better than an inpatient medical provider, in the patient's eyes.

Saturday, April 28, 2012

Healthbox - Healthcare Innovation Incubator Expanding To Boston


After first starting a healthcare innovation startup challenge in Chicago earlier this year, according to a post in Innovation Daily, Healthbox will be launching at additional healthcare innovation program in the Boston/Cambridge area. Healthbox offers not only seed capital ($50,000 in exchange for 7% equity), but also provides the networking, contacts, and collaborative work environment that entrepreneurs need to flourish.
Applications to the Boston program close "mid-June", and the program will run from August through October, 2012. Click here for more details.

INOVA Heart and Vascular Institute Cardiovascular Symposium 2012

Dr. Merdod Ghafouri, CEO of Virginia Cardiovascular Associates, this weekend is hosting the second annual INOVA Heart and Vascular Institute Cardiovascular Symposium with keynote speakers, former Vice President Dick Cheney and Dr. Jack Lewin, the CEO of the American College of Cardiology. With some of the biggest names in cardiology in attendance, the focus is not just on treatment, but more specifically prevention, of cardiovascular disease.

“How should you treat coronary artery disease - medication or revascularization? Perhaps a more interesting question is whether we can identify patients at  risk and prevent the disease.”  
— D r.   M e r d o d   G h a f o u r i   
Dick Cheney and Dr. Jack Lewin, CEO of the ACC

Dr. Merdod Ghafouri, CEO of VCA
Dr. Alireza Maghsoudi, Nina Totenberg (from NPR), and Dr. Alex Mohseni in attendance at the Symposium dinner

Tuesday, April 24, 2012

Telemedicine helps dialysis patients in rural India


Vijay Govindarajan, on the Harvard Business Review site, explains in his piece, "Telemedicine Can Cut Health Care Costs by 90%," how using cell phones and digital cameras, end-stage renal disease patients in India are able to monitor their peritoneal dialysis (PD) effluent. PD patients have to be very vigilant to recognize and respond to any sign of infection in their peritoneum. Having a reliable and simple method to communicate with their physicians, more patients were willing to use PD instead of hemodialysis, which is much more expensive and resource heavy.

Not only was remote monitoring cheaper, "rural patients performed well on PD and had significantly better survival rates than did their urban counterparts."

78% of consumers are interested in mobile health solutions

Floatlearning has a great  infographic on how mobile health innovation is poised to explode.



Monday, April 23, 2012

Healthcare innovation conferences

Upcoming healthcare innovation conferences:

2012 Apr 25         Stanford Healthcare Innovation Summit
2012 May 14-15   Health 2.0 Spring Fling Boston
2012 May 17-18   World Congress Leadership Summit on Clinical Integration and Care Coordination
2012 June 7          Medical Society of Virginia, Health Care Innovation Conference
2012 Sep 9-11      Transform2012 (Mayo): iSpot Competition
2012 Oct 7-10       Health 2.0 San Francisco
2012 Nov 6-7       Health 2.0 Berlin
2012 Nov 7-9       IEEE Healtthcare Innovation Conference

Designing healthcare innovations from the patient's perspective

The book on healthcare innovation


Clayton Christensen's book, "The Innovator's Prescription: A Disruptive Solution for Healtch Care", is a must-read for anybody interested in understanding how the complicated healthcare system can and will be disrupted. No need to rehash a review here, when there are several accurate ones on Amazon.


An important take-away from the book: there can and will be innovative disruption of the American healthcare system as long as the morass of government regulations don't get in the way. This is an important point, as healthcare is highly regulated in its current state. Innovation requires freedom to experiment, struggle, fail, and evolve.  

Omachonu frames healthcare innovation. ZocDoc matches unfilled need with unfilled capacity.

Authors Vincent K. Omachonu and Norman G. Einspruch of the University of Miami offer a detailed framework for understanding healthcare innovation in their paper "Innovation in Healthcare Delivery Systems: A Conceptual Framework": What is innovation? What does it look like in healthcare? Who are the stakeholders? How does innovation come about?

There's a great paragraph in their paper:
There are at least three stages to the maturing of a services industry. First, it creates a service that the market needs. Then it improves the service  to meet what the market wants and demands.  [Beckwith (1997)]. According to Beckwith, this is usually the stage where most services companies assume they have reached the goal. But some rare companies move beyond stage two, they innovate and devise services that would never even occur to a customer to ask for. They create ―the possible service. This kind of service can not be created by asking the question ―what do my customers want? but rather ―what would they love? This underscores the idea that services innovation is not always driven by customer input.
They go on to say:
The answers tend to lie in ... applying a new technology to new service ..., new technology to an existing service ..., existing technology to existing service ..., and existing technology to a new service.... 
ZocDoc, the online scheduling site for doctors' appointments, founded by Cyrus Massoumi and Oliver Kharraz, is the application of "new technology to an existing service." How they have figured out how to integrate with hundreds (if not thousands) of different physician scheduling systems is extraordinary. But what is really incredible, for me, as an emergency physician, is how many appointments are available within the next 48 hours. Many patients come to my ER simply because, in their own words, "the doctor couldn't see me for 2 months." What ZocDoc does, in the simplest terms, is match unfilled need with unfilled capacity. Both parties win. If you were to calculate how much money ZocDoc has saved the healthcare system by helping prevent ED visits, it would be a tremendous number. For all the details about ZocDoc, check out this interview on ThisWeekInStartups.

Wednesday, April 18, 2012

Atul Gawande: "The Hot Spotters". Healthcare's version of Cash for Clunkers.

In this fantastic piece in the New Yorker, Atul Gawande explains how a community physician in Camden, NJ saved his local hospital millions of dollars by providing very focused free medical care to the patients who were most frequently admitted. Here in DC, the well-to-do pay upwards of $1500 annually to be part of a MD-VIP program, where their primary care physician is available to them 24-7 to address their medical needs. In Camden, the "most dangerous city in America," this physician was able to provide an MD-VIP type of service to some of the poorest and most at-risk patients in America, with astounding results. Gawande writes:
The Camden Coalition has been able to measure its long-term effect on its first thirty-six super-utilizers. They averaged sixty-two hospital and E.R. visits per month before joining the program and thirty-seven visits after—a forty-per-cent reduction. Their hospital bills averaged $1.2 million per month before and just over half a million after—a fifty-six-per-cent reduction.  
What are the keys to reducing costs in healthcare? Focus on the small population of uninsured who have many chronic medical conditions, and who frequent the hospital the most. One study showed that "frequent users comprise 4.5-8% of all ED patients but account for 21 to 28% of all visits." These are the patients where a relatively small amount of free but focused preventative care can result in a dramatic reduction in medical complications and healthcare costs.

I call this idea "healthcare's version of cash for clunkers" not to deride patients, but to emphasize where our efforts need to be most focused. When the US government wanted to reduce auto emissions, they realized that removing a single inefficient polluting old car from the roads had the same impact as trying to make marginal efficiency improvements in 10 newer cars. The conclusion was clear: it's efficient and logical to spend your money where you will have the most impact. The same applies in healthcare. Managing the chronic conditions of our poorest and sickest patients with focused caring preventative care costs much less managing the complications of those conditions.

My piece on my experience with the healthcare system as an Emergency Medicine physician

My piece on the challenges and failures of the US healthcare system is being featured on the front page of Medium today. Would love to hear...