Posts Tagged ‘ehealth’

“A value proposition is a promise of value to be delivered and a belief from the customer that value will be experienced.” We, of course, are sure that the product or service we are offering provides value for our customer but, have we identified clearly who our customer is?
Let´s focus on the issue of identifying our customer since, if we don’t know who the customer is, how can we know what they are expecting?
Maybe we could find some answers in the AAL Joint Programme. In its web we find that “AAL aims to create better conditions of life for older adults.” So, our customers are “older adults”. But, is it really so clear cut?
For instance, «better conditions of life» is a broad aim that can only be achieved through a complex array of interventions. It requires the concerted effort of different stakeholders: what we call “Public Health”.
Public Health is “organized efforts and informed choices of society, organizations, public and private, communities and individuals”. With this in mind, the “older adult” becomes only one of the stakeholders expecting the “promise of value”. There are at least two other stakeholders. “What [should then] make a typical value proposition for AAL markets” has to take into account:
a) Payers (public or private organizations): They tend to be conservative minded. They expect new systems and processes to enhance existing infrastructures. They are looking for improvements in the efficiency of care resources.
b) Caregivers (physicians, social workers, informal caregivers): their main interest is to boost processes, leading to a smoother work-flow. They are aiming to reduce their work burden by increasing the efficacy of the care process.
c) Older adults: they are looking for trustworthy and friendly user processes, allowing for better contact with their surroundings, easy access to their data, timely feedback and guidance and, last but not least, the ability to manage their own lives without unrequested outside interference. In other words they are looking for empowerment.
Probably, due to the fact that attending to all those interests at the same time is not easy, AAL has not delivered as was expected when the European Commission launched the first call seven years ago. But don’t despair; the situation is exactly the same for other R&D programmes: «For many are called, but few are chosen.»
It is not only that these three main stakeholders are looking for different things; the real problem is that their interests diverge.
Although it is centred in mHealth, a study by PWC shows that divergence. According to this study, the main drivers in adopting mHealth for payers are:
Reduction in administrative time for medical personnel, allowing greater time for patients
 Improved quality of care and better health outcomes
 Lower overall costs of care for patients
As for professionals, they would be willing to adopt mHealth if it provides:
 Improved quality of care and better health outcomes
 Easier access to care for existing patients
 Reduction in administrative time for medical personnel, allowing greater time for patients
While end-users are driven by the following characteristics:
 Ability to access healthcare providers more conveniently and effectively
 Ability to reduce own healthcare costs
 Ability to have greater control over own health
One can easily see that the three stakeholders do not coincide in any single driver. But it is probably more telling that “Ability to take control over one’s own health” is not even a concern for payers or professionals, neither in the three main drivers nor in any of the other eight drivers included in the study. And it is precisely this empowerment that should drive most of our efforts for better care processes.
Of course, the objective of satisfying the three stakeholders at the same time is not new. Something very similar was launched by The Institute for Healthcare Improvement in the USA some time ago in “The Triple Aim” . The Triple Aim states that new designs must be developed that simultaneously pursue three dimensions:
 Improving the patient experience of care (including quality and satisfaction);
 Improving the health of populations; and
 Reducing the per capita cost of health care.
We could easily match each of the three aims to each of our three stakeholders: end-user, professional, and payer.
Seen in this light, we can identify a big problem when confronted with the difficulty of achieving that triple aim, or providing value for our three main stakeholders.
In our domain, R&D is driven mainly either by research or by ICT organizations. The presence of end-users leading consortia is anecdotic, as is that of care professionals acting as such. It is true that the EC is putting a lot of emphasis on fostering balanced consortia, but that does not mean that the project achieves that balance. What we see in forums and gatherings is that most consortia are strongly led either by research or by ICT organizations.
Is there an easy answer to this conundrum? Obviously not, we have to assume that people dedicating their lives to devising new processes aimed at improving public health are wise people and that if only a few have found the philosopher’s stone it is due to the difficulty of addressing the three fronts at the same time.
Nevertheless, there are a few rules that we should follow, the first being, who will drive the car of innovation. I strongly suggest that the end user is the one who should be at the steering wheel, if only because during all this years they have been in the back seat. If the trend is for the end user to assume more responsibilities in the care process, what we call the empowerment of the end user, then we have to design the care process according to their wishes and demands, thinking always of “Improving the patient experience of care” as the Triple Aim states. And who better than the end user will know how to improve the experience?
In the case of AAL there is an added problem with our end users. We are talking about “older adults”, so leading the consortia there should be any of the myriad of organizations of older adults.
Consider the typical AAL R&D project. Year One is the design of the proposal and the signing of the contract; Years 2 to 4 the development phase; with the following three years for the completion of the final product or service. In all, seven years for the product to be market-ready. If our end users were in the range 70-75 at the time of inception of the proposal, by the time the product or service is in the market they will be 77-82, probably too old to use what they thought was a great idea seven years previously. No problem, the end result is for people in the 70-75 range, those people who were 63-68 years old at the time of inception; nowadays almost a generation apart when it comes to ICT skills.
So, selecting the end-user leader is not so easy. The right mix of people has to be found, so that the care process and the tools to implement it go hand in hand thinking seven years ahead.
Now, let’s decide who the co-pilot should be. At this point I have to state that I may have a conflict of interest: I am an economist. But putting aside that conflict, I strongly believe that the co-pilot should be the payer. We may not like it and argue that money should not drive all our decisions, but the fact remains that “money makes the world go around” as the famous song from Cabaret tells us. We may be able to put on the market the most desirable item, but if there is not somebody willing to pay for it, we will have another Tucker car; the best but unmarketable.
And that leaves the back seat for, guess who, those who have been in the driver’s seat so far, the research and ICT organizations. They should accept the fact that they are tool makers serving end users with something that payers can afford.
If you are involved in R&D aiming at delivering value to your customer, take into account at least these 3 stakeholders: end user, payer, care giver, in that order. Otherwise, you will be doomed!

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Today, almost 100.000 health and mobile apps are available for Android and iPhone. That means over 4.000.000 downloads a day. 300.000 of those are for paying apps. Obviously, people are willing to pay for health apps. We’re not only talking about fitness and diet apps. Some purely medical apps and Internet platforms are being very successful. Doximity, a collaboration network amongst doctors, is used by 25% of all MD’s in the USA. And Epocrates, an app giving clinical information on medication, is used by half of them.
But one thing is commercial acceptance, and another is scientific validation. After all, we don’t always spend money on things that are healthy for us! Medical opinion seems to be positive towards the use of apps. 93% of American doctors believe that the use of apps can improve patient health, and 40% that these can reduce the number of visits to the doctor. However, it is early to make a sweeping evaluation of medical apps in general. As with all technology, apps are a tool, and have the potential to change the face of healthcare. But the content created for this platform can be good, or it can be not so good. Most of all, it is extremely varied.
Let us examine what types of apps are being created at this moment. In the United States, platforms such as Carecloud and Practicefusion are being widely used for electronic health records and medical billing. However, European regulations, which are much stricter than American ones, make it unlikely they will be available, or even legal, here.
Most apps are designed to improve patient’s and caregiver’s lives. Mangohealth sends reminders of when to take medicine, and warns of any dangerous interactions with the meds. ZocDoc helps consumers find and schedule doctors’ appointments online in real time. It was recently the first health app ever to make it to iTunes most downloaded apps list.
Apps such as Serious Game et Maladie d’Alzheimer, developed in France, or Lumosity, use gamification techniques to stimulate cognitive skills. Others, such as SuperBetter, help us design our goals for healthier living, whether recuperating from an injury or living with a chronic condition. SuperBetter focuses on mental, emotional, social and physical health. Other apps such as Mobicare, in Canada, offer support and information for families and caregivers, of Alzheimer’s patients in this case.
Telemedicine is another area where mobile technology is starting to make an impact. The Mayo clinic is using smartphone cameras to remotely evaluate stroke patients.
Augmented reality is also beginning to be applied to healthcare, thanks to the use of tablets. Fraunhofer recently created an app thanks to which a doctor performing surgery can hold an iPad up to a patient’s body to see a digital overlay of key blood vessels, so as to avoid accidentally cutting them. The new Google Glass will also be useful for augmented reality apps, as well as for educational purposes. In Spain, a doctor recently wore his Google Glass for surgery, sending out images to 150 students worldwide.
Apps can also be used for data collection and analysis. Crohnology does this with Crohn’s disease patients, who record their treatments, lifestyle and health situation on an app. This data is crunched anonymously so that more is understood about this disease. Ginger.io works similarly for Diabetes type II, adult ADD and certain heart conditions. Another award-winning platform, Magpi, can be used to easily design health surveys and collect data through smartphones.
One of the great revolutions that mobile technology can bring about is thanks to how widespread mobile technology is in the Third World. Text to Change has been extremely successful by engaging patients through SMS to tackle issues that range from ensuring healthy pregnancy in Tanzania to following up malaria cure in Uganda.
As you see from this brief overview, there is a huge variety in what health apps can offer. Now, how can I, as a normal consumer, separate the wheat from the chaff? In a recent interview Cardiologist Eric Topol form California says “these days I am actually prescribing a lot more apps than I am medication”; this is probably the key for unlocking the bundle. Doctors are responsible for spreading the use of mHealth in general and apps in particular.
Let’s go quickly over very important issues in designing successful apps. To start with, they should be able to run on at least three different operating systems: iOS, BlackBerry, and Android. They should also be optimized for different mobile and tablet devices. Then there is the issue of data privacy regulations. And, all things going well, some form of validation should be performed. Now we will concentrate in the financing of the above process.
A recent study by PWC shows how conflicting interest can jeopardize the adoption of mHealth tools. Topping the list of drivers for adoption of mHealth among individuals are 1) improved access to health care providers; 2) reduced health care costs; and 3) increased control over one’s health. As for doctors, the drivers are 1) improved quality of care; 2) improved access to health care providers; and 3) reduction of administrative burden. Finally from the payer’s perspective the main drivers are 1) reduction of administrative burden; 2) improved quality of care; 3) reduced health care costs.
The outcome is that those who should prescribe apps, and most probably the ones driving their design, do so for reasons that do not always coincide either with the patients who have to use them nor with the interests of persons who have to pay for them. Just as an example, empowerment, which ranks third among patients’ priorities, ranks only sixth among doctors and payers.
The question is then, how can we convince anybody to finance a tool designed by somebody who is not thinking about the expectations of the end user and that will be paid for by a person who is looking for something else? The answer probably lies in designing for the customer; nothing new since that is what all successful consumer industries do.
Despite the hurdles, I think that it would be silly not to explore a massive new medium available to us. Cellphones mean mobility, connectivity, information and communication. All of this can help empower patients and caregivers, make more informed doctors and even help researchers. It is an exciting time to be involved in mobile app development, because there is so much to do. In the world of health, mobiles can contribute to finally bring about a change of paradigm through information sharing, both horizontally and vertically. Patients can teach doctors and doctors can teach patients, therefore making the health processes more efficient and user-friendly.
Given at:
European Knowledge Tree Group
Norrköping (Sweden), 24th September 2013

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Traditional health care is directed towards the treatment of acute health problems and, to a lesser degree, chronic conditions. This bias against preventive medicine is reflected also in most of the eHealth solutions that are being developed.

A person who develops a chronic disease is faced with the shock of suddenly having to make drastic changes in lifestyle. Then the same person confronts another shock:  having to deal with an array of devices supposedly geared to help in the treatment of the health problem using eHealth solutions.

On top of the necessary adjustments involved in incorporating periodic controls and check-ups, medicine intake, diets, etc, the person will have to learn how to use and live with an array of gadgets. These may vary from the less intrusive sensors to computers and the like, of which a normal older person may know next to nothing.

A more rational approach would be to follow the path of preventive medicine. Just as preventive medicine identifies target populations that have to be monitored, why don’t we provide the healthy person, within a target population, with those gadgets designed to prevent the deterioration of health. This way, eHealth becomes an integral part of   preventive health care, with the person directly involved in the process.

As the process of deterioration continues, so will the person´s health care and eHealth requirements. But if we involve people in the process of preventive health care early enough, we help them ease the transition from a healthy person to a not so healthy one helped by preventive medicine and what we could call preventive eHealth.  An additional asset to this approach is the increased efficiency of health care derived from the use of prevention instead of relying mainly on acute care.

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In one respect, underdeveloped countries are well ahead of developed ones. This is in the use of the simplest of ICT devices for enhancing people’s access to healthcare: the traditional mobile phone.

ICT developers are forcing developed societies into using the latest technology; maybe those with bigger benefits by any chance?. This could be the reason why telephone developers are trying to introduce, and very successfully, I have to say, sophisticated devices that, by the way, can even be used to call your friends and relatives! But, it is a fact that traditional mobile phones are cheap to produce and easy to use.

And there are plenty of examples, from India to Kenya, of very basic applications that are used to save lives. Yes, of course there are thousands of applications for – guess what? – the IPhone, smartphones running Android, or the Blackberry. But there are very few applications for the kind of device that a person in his or her 70’s will feel comfortable using.

And, isn’t the ageing of our societies the big problem that drains almost all of our Governments energies and resources? Isn’t the cost of taking care of those growing numbers of citizens the cause of the disintegration of the socio-health system as we know it? Why then not imitate India, Kenya and others and use simple cheap solutions for simple problems instead of the most expensive alternatives?

I certainly wouldn’t like to think that it is because industry as opposed to civil society, is the one calling the shots.  Or maybe it is?

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It is a fact, as far as I know, that the only available project manager in the process of healing is oneself. To be sure, specific support is provided by some of the organizations involved, aimed at helping the project manager to ease the burden along the process, but such support is limited to the area in which the organization is directly involved.

However, the system relies on the ability of the subject to understand a very complex process, with multiple organizations involved, with professionals in those organizations who care more about efficacy than human behavior, and that have a very limited connection with the organization that will follow up the continuous process of healing.

If we are aiming at promoting a long, safe and fulfilling life at home for our citizens in general, and our elderly in particular, the least society can do is to provide some kind of tool that enables them to manage their life efficiently.

Probably, in an ideal world without any kind of budgetary restrictions, this tool would be a social worker. This professional, through permanent contact with all socio-health providers, would be able to assume the role of project manager.  Such a figure would inevitably be, in most cases, a very intrusive entity and will be rightly resented: who wants somebody permanently interfering in one’s life?

The conclusion is that, except in cases of incapacitation, the best available solution is for us ourselves to manage our lives. For most people, having the proper tool that facilitates the chore is enough. An agenda has been such a tool for most of our lives, but as the project gets more complicated and the inputs get more complex, the tool has to evolve into something more sophisticated. I believe that an Electronic Health Record enhanced to include social care related events, constituting a veritable Electronic Socio-Health Record, based on an off-the-shelf third generation mobile phone could prove to be such a tool. This will represent moving from eHealth to a more comprehensive eSocioHealth.

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