What we're thinking about


MeHi Digital Health Cluster Event

Just over two weeks ago, I had the opportunity to speak at a dignitary-filled event organized by MeHI and the Mass Tech Collaborative which heralded the launch of a new Digital Health Cluster initiative in Massachusetts. The initiative is a public-private partnership intended to spur the development and growth of digital health companies in Massachusetts in much same way the $1B Massachusetts Life Sciences Strategy has contributed to the growth of the local life sciences sector.

No funding commitments have yet been announced in relation to the Digital Health Cluster project, but I do feel that the announcement is a step in the right direction. It’s good to see commitment from the state and industry to assert Massachusetts as the leader driving digital health innovation, especially in the face of competition from the Bay Area and New York City. What remains to be seen are the specifics of how the initiative will actually help startups.

A few reporters asked me for my thoughts immediately following the event (see coverage from WBUR and The Boston Globe), but as I’ve reflected on the announcement and have spoken to other healthcare startup founders, I’ve come up with a few thoughts what is needed to help fledgling companies succeed

1. Help startups do customer development

For those of us following the ‘Lean Startup’ methods, we intend on ‘leaving the building’ to do customer development by speaking with users and potential customers. For healthcare startups, what often happens is that we leave our own buildings but find ourselves locked out of the buildings housing our users! And if we do get in, we still don’t get in often enough to obtain the variety of viewpoints needed to validate (or invalidate) our ideas. The Digital Health Cluster initiative could have a strong impact if it can facilitate access to partner healthcare organizations (hospitals, health plans, health IT vendors) and the people to work in them.

2. Inform healthcare organizations about innovative solutions

Lack of uptake of new technology is not necessarily because healthcare organizations do not want to innovate. Often, they simply do not have the access to information about new solutions - this is a problem of market inefficiency. Faced with a problem to address, healthcare organizations may attempt to build the solution in-house instead. Wouldn’t it be better if the healthcare organization collaborated with a startup that is already working on solving that problem by offering its clinical expertise? By promoting new solutions to healthcare organizations, the Digital Health Cluster can drive further efficiency in the local digital health economy.

3. Support early collaboration

Some of the biggest hurdles for healthcare technology startups are being able to demonstrate their value propositions and operationalize their solutions in a live healthcare setting. For many, this means gaining entry to a hospital system, healthcare insurer, or a larger healthcare IT company - all organizations that can be difficult for early stage companies to access. The Digital Health Cluster initiative could be game-changing if it can help guide, fund and support pilots of new technology to provide infrastructure that encourages early-adopter organizations to experiment with startup solutions.

If the initiative can truly improve the success of local digital health startups, then it will also help spur the growth of more established healthcare technology players through M&A activity. And, with a deeper pool of healthcare innovation talent in the region, Massachusetts will be able to attract more health tech companies to establish operations here. There is a lot of potential but little time to waste if we want to pull ahead of the Bay Area and New York City. Let’s hurry it up!

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patient questionnaire

In early October, the National Coordinator for Health IT Karen DeSalvo announced that the ONC (Office of the National Coordinator) will develop a policy framework for identifying best practices, gaps, and opportunities for the use of patient-generated health data (PGHD) in research and care delivery. Then, last week at the Health 2.0 conference and at events surrounding National Health IT Week and Boston HUBWeek, there was more excitement and discussion about the wonderful world of patient-generated health data, which includes data coming from patient self-tracking applications as well as passively-collected information from wearable devices and sensors. So why all the fuss?

Behind the hype and likely inflated expectations about the speed and ease of implementation of uptake in the use of patient-generated health data to revolutionize healthcare, here are a few real reasons why PGHD deserves such attention.

1. Earlier detection of issues drives more proactive management. Tools that can process patient-reported or passively collected data from patients and alert care managers to concerning trends when the patient is not in the clinic help providers recognize issues before they escalate. Dr. Mark Groshek of Kaiser Permanente talks about how patient data helps providers in Physicians Practice.

2. Greater involvement of patients. Applications that help patients understand their health data with respect to their treatment plans and their actions can drive engagement of patients in their care, which in turn can improve dialog between patients and providers. Dr. John Halamka wrote in Healthcare IT News about how he has used PGHD to help him manage his own care.

3. Utility of data. As care moves towards further patient-centricity, there is increasing interest in further understanding the patient experience from several angles, e.g., outcomes, satisfaction, quality-of-life, and preferences. This new source of patient data can be used to further investigate comparative effectiveness of therapies as well as refine patient stratification models. Accenture’s Healthcare Technology Vision 2015 report stated that 73% of provider organizations reported positive ROI from the adoption of technologies that supported the collection of patient-generated health data.

With interoperability and workflow integration issues impeding the speed at which provider organizations can deploy and utilize patient-generated health data solutions, EMR providers, patient application developers, wearable manufacturers, and analytics solutions providers will all need to collaborate in a meaningful way so that the promise of PGHD can truly be met.

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We’re excited to announce the launch of Klio Assessments and Klio Engagement which join our existing Klio CarePlan solution. We have listened to our customers and now provide them with the ability to integrate with one or all three products to work with their existing Electronic Health Record, population health, or care coordination solutions in a truly vendor agnostic manner. Here is a brief overview of our solution set:

Klio CarePlan: generate personalized care plans for patients based on medical record information and quality metrics reporting requirements, such as:
- PQRS (Physician Quality Reporting System) and CMS (Centers for Medicare & Medicaid Services) measures (e.g., for National Quality Strategy domains such as care coordination, patient/family engagement and population/public health)
- ACO (Accountable Care Organization) and HEDIS (Healthcare Effectiveness Data & Information Set) measures (e.g., for diabetes, coronary artery disease, congestive heart failure)

Klio Assessments: easily configure patient diaries and standardized survey assessments which support active patient self-reporting or passive data collection through wearables and third-party apps

Klio Engagement: create rules for pushing alerts, feedback, and educational content to both patients and providers based on the specific needs of a cohort of patients

Interested in learning more? Click here to request a product demo.

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ACA photo, courtesy Reuters

The Supreme Court’s ruling in favor of upholding the Affordable Care Act last week was of course a victory for the Obama Administration, but what’s in it for us and the ecosystem of innovators who are working to improve healthcare? Here’s what I see as a few key impacts of the ruling:

  1. Elimination of uncertainty. No matter the early impacts of the ACA over the past few years in terms of shifting of incentives, payment policies and access to care, more recent fear that the Act may not survive created a cloud of uncertainty for innovators, our investors, and our customers. Would Accountable Care Organizations continue? Would people lose their insurance coverage? What alternatives would emerge if the ACA failed? For the many innovators whose value propositions are staked on aspects of the ACA, the Supreme Court ruling to uphold the Affordable Care Act, is not only a relief but a boon. The SCOTUS ruling in favor of the law not only removes any potential industry paralysis that could have occurred, but the true impacts are felt through the policies the Act supports.

  1. Benefits to hospitals and health care systems. With more Americans having health care coverage, hospitals and health care systems have the opportunity to capture more revenue. Of course, this opportunity comes with the challenge of scaling services such that costs of delivering that care can be contained. For those organizations who are now risk-bearing and have aligned their objectives to improve quality while reducing costs, the ruling affirms their trajectory. With any uncertainty behind them now, these healthcare organizations can accelerate their Quality Improvement initiatives, including the implementation of new tools and methods. Innovators who have healthcare systems as their customers will only gain. 

  1. Incentives for quality & cost reduction. A key facet of the ACA is the alignment of incentives to ensure that healthcare providers are compensated on the basis of quality of care delivered rather than quantity. While the transition to a truly value-based system is still very much in progress, this shift in mindset has provided opportunities for the new tools that Klio and our peers are creating that help providers either improve the patient experience, enable the management of patient populations or reduce the cost of care. Innovations that help health care delivery organizations meet their Triple Aim objectives through enhanced patient-provider communication, data analytics, or medication adherence are now in increasing demand as providers seek new ways to improve their performance.

I’d say that this is a win. There has probably never been a better time to be creating new tools improve healthcare. Now that the handwringing can stop, it’s time to really get to work!

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Everyday, more patients and providers are making use of tools ranging from patient portals to disease management applications. Despite growing traction, one common stumbling block for various patient engagement tools is actually just advacing past square one: getting a patient through the first step of creating an account and logging in. In technology and design circles, this process is known as ‘onboarding’, and there numerous articles and blogs discussing the challenges of doing so. See this piece from Intercom outlining approaches that popular services and applications use.  

Aside from navigating the basic roadblocks of onboarding, creators of patient-facing tools in healthcare face other unique challenges such as HIPAA compliance, patient consent processes, and identify verification. As the Klio team has iterated our product and processes with feedback from our users, we’ve learned a few things along the way about how to reduce the friction for onboarding a patient - and most are not necessarily about the technology itself. Here are three key factors in ensuring patient onboarding success:

1. Clinician buy-in. This is critical. If the physicians, nurses, and other clinic staff who are interacting with patients do not promote the tool and tell their patients about its benefits, no slick interface or mind-blowing functionality will make a difference to patient uptake.

2. Physical artifacts. Part of helping the clinician properly present the tool to the patient is to give the providers support for doing so. A card or handout gives the clinician a physical prop that can aid in that discussion. In addition, a well-designed handout that easily guides the patient through the process also assuages any provider concerns in having the patients take the next step.

3. Onboard in the clinic. Where at all possible, make sure the patient can get onboarded before he or she leaves the clinic. I myself once lost the PIN code to my patient portal and as a result didn’t setup my account until my next visit months later. The clinicians we’ve worked with have supported in-clinic onboarding by setting up a tablet in the clinic for patients to use to sign-up. It’s at this point that good design can make a big difference - make it easy, quick, and show value immediately.

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