What we're thinking about

November, 2014

New Office

I hope you've all had a wonderful Thanksgiving. While we're all enjoying our leftovers and some down time with family and friends this weekend, I wanted to reflect on what my team and I at Klio Health are thankful for. Here are the top 6:

1. Feedback from our pilot users and partners. We continue to be amazed by the quality of the input from our users and partners. Your positive comments boost our confidence and validate our work, but it's the constructive suggestions that really help us make a better product. Keep the comments coming!

2. Our tenure as MassChallenge Alumni-in-Residence. We were very sad to move out of the MassChallenge office space last week, but are so grateful to the wonderful time we had there and for all the fantastic people we met as part of the MassChallenge community. 

3. A smooth transition to our new office location at the Harvard iLab. It was raining when we moved last week, but thanks to efficient team work and not-as-bad-as-predicted weather, we moved into our new digs with nary a hitch. See our smiling faces in the photo above.

4. Great people to work with. I think we often take our team members for granted, so here's a shout out to all the smart, creative, and hardworking people who make up the Klio Health team. Thank you for striving to make the company better every day.

5. Those days when the Boston MBTA cooperates. At our new office, we will no longer contend with the Red Line to Silver Line shuffle in our commutes, but we much appreciate (with nostalgia) those times when we disembarked the Red Line at South Station to find the SL2 waiting for us. Hooray for good transit connections!

6. Supportive friends & family. We're ever thankful to all our wonderful friends and family who lend us support through the ups and downs and hard work of running a young company. We couldn't do this without you!

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Ebola Map courtesy of blog.biowebspin.com

The Ebola outbreak triggered a nationwide panic attack. Ebola, like the swine flu pandemic in 2009, largely brought out the worst in us – the irrational, the paranoid, and the racist.

While fears spiralled in first world countries, the World Health Organization reported on Oct. 25 that there have been 10,141 cases in eight countries and 4922 deaths. Of those 10,141 cases, only five are from developed countries.

The focus needs to be on how to efficiently alleviate the cases in Guinea, Liberia, Sierra Leone, Mali, Nigeria, and Senegal. While grassroots efforts of organizations like Doctors without Borders are key to addressing immediate medical needs, healthcare information technology has also played an important role in helping researchers glean useful data to predict Ebola spread patterns.

French-African mobile phone carrier Orange Telecom gathered data from Senegal in 2013 from 150,000 phones. That data was given to Swedish nonprofit organization Flowminder to analyze. By assessing patterns in how Ebola spreads, health workers know which areas need support more urgently than others.

Also using mobile technology to help with the Ebola containment effort is Dr. Aydogan Oczan at the University of California, Los Angeles. Dr. Oczan has invented 3D-printed microscope that can be attached to a cellphone, effectively turning the cellphone into a low-cost diagnostic tool.  His technology means that blood tests can be administered nearly anytime and anywhere.

These examples illustrate a bigger picture - the utility of healthcare information technology in enhancing workflow, collecting data, and analyzing that data. By developing technology that enables medical professionals to gather and interpret data, useful insights about disease progression and transmission can be extracted from large health data sets.

While it will still be some time before the data collected through Klio Health will be large enough to derive epidemiological insights on a global or even national level, we are already helping healthcare providers discover patterns about the population of patients under their care. 

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HealthCamp Boston wall

I spent yesterday at HealthCamp Boston at the Microsoft NERD. Here are what I felt were the top three discussions I participated in:

  1. How can patients be engaged between office visits?

    This discussion revolved around what tools can help patients be involved with their care during the majority of the time they are not in the clinic. Self-tracking, wearable devices, telemedicine, and social media support tools were all offered up as solutions, but those are hardly new. Perhaps what was new was the recognition that there must to be value delivered to the patient in the form of feedback, support and better care, as well as the conversation about utility to providers.

  1. How do wearables fit into the equation? 

    With all the excitement about wearables and sensors improving the ease with which health data can be monitored, the bigger question is how all that data can be made actionable. Unless that information is contextualized to be relevant to the specific health concerns of a patient, then it really has little immediate value. Knowing my daily number of steps isn’t useful to my provider, but knowing my general levels of activity before and after a procedure can help my provider and I see how I am tracking towards full recovery so that we can alter my treatment plan accordingly. There is an opportunity for services that can use data from wearables but put them into the context of a patient’s care plan.

  1. How does innovation get into the healthcare system? 

    There was a great deal of hand-wringing over the conundrum of getting new, untested ideas into the hands of providers so that products could be iterated and proven at the seed stage. In our experience at Klio so far, we’ve seen that it is vital to get feedback and early adoption from providers who can conduct early pilots to gather initial data and validate the value proposition. Of course, none of this is easy or fast but the good news is that provider organizations are starting to recognize the importance of trying new technology, making it ever easier to collaborate with providers.

My key takeaway from the day was that none of the discussion topics were new (I imagine that in previous HealthCamps, participants also spoke about care coordination, patient engagement, and the perils of innovating in healthcare), but what was different about the discussion yesterday from similar conversations I had 12-18 months ago was the fact that the providers at the table  recognized that the new services and tools may actually help them improve patient engagement and outcomes. This shift is what is really going to change the speed at which new solutions can be tested in the clinic. I'm looking forward to seeing how things move over the next year. See you all at HealthCamp Boston 2015!

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How standards proliferate - http://xkcd.com/927/

Before getting into Healthcare Information Technology, I spent considerable time in the world of wireless communications and medical devices. I now find that I am coming across similar challenges as I did in my prior life. Back in 1999, we were talking about interoperability in wireless systems and creation of new standards to solve that disconnect. Fast-forward to 2014 and I Hear talk of interoperability with Electronic Medical Records (EMRs) and Health Information Exchanges (HIEs) and creation of new standards to solve the inability of these systems to share information.

Interoperability is an age-old problem - it has a long and cultured history dating all the way back to Homer and The Iliad! The mythical Chimera solved its interoperability problem by having the head of a lion in front, the head of a goat in the middle and the head of a snake for a tail. Of course, there are more recent examples from industrial domains such as in communication, computers and software and even the military.  What we can learn from solutions for interoperability in these other fields is to not try and solve the problem of interoperability through new standards.  I cringe when I see the term “interoperability” in close proximity with the term “standards”. Interoperability is about working seamlessly. I might even say that it is not a technical problem at all! Interoperability is an organizational issue caused by poor processes, bad assumptions and negative attitudes.

In a lot of ways, interoperability issues in Healthcare IT are further perpetuated by how one of the leading bodies in our industry, Healthcare Information and Management Systems Society (HIMSS) defines interoperability as existing at three levels – foundational, structural and semantic. Using this encompassing definition, it is not hard to see why our industry wants to marry the two terms together. And every failed effort leads to the desire to start-over; to follow this definition with a new (or evolved) set of structures - standards. By the time we get done with that, we lose steam to tackle perhaps the most important piece – the real meat of interoperability.  The key goals of interoperability should be in making sure that there is full understanding of context, sender and intended recipient. In addition, the focus really needs to be on measures to make sure that both sides can actually understand each other rather than just ensure they speak the same language - which is what standards do.

Now, lets put all this into the current context of the media coverage around lack of interoperability and the dialogue that has transpired around that in the last couple of months. Some of it has been overblown in terms of blaming entities as being solely responsible for this. I would say that the Healthcare IT industry as a whole needs to feel responsible for this. We need to stop creating an environment which perpetuates this problem - creating new silos (other umbrella standards) such as CommonWell which includes Cerner, McKesson, AllScripts, athenahealth and Greenway, and Carequality which includes UnitedHealth Group, Walgreens, Surescripts and Kaiser Permanente. These kinds of activities take us further from our goal. Instead, we should assess what needs to be done post Meaningful Use (MU) II and really focus our efforts on establishing certificate authorities that would provide the recipe for interoperability testing.

If we are going to get an ATM for the healthcare industry, the MU III mandate has to be focused on interoperability and we have to curb our desires to add or extend standards. In line with that, I wholeheartedly support the recommendations made to the ONC by the Health IT Standards Committee.  

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