In a recent Datica Healthcare Innovators Podcast, Datica interviewed Joe Kvedar, MD, Vice President, Connected Health with Partners HealthCare. Last year, he wrote “The Internet of Healthy Things,” which is packed with real-world information that will help entrepreneurs, innovators, and investors drive the disruption of healthcare delivery. Dr. Kvedar has long been a proponent of personalization in healthcare and is known as one of the greatest HIT influencers in our generation.
“There are still some technology problems to be solved. Chief among them is the ability to normalize the data from all of these wearable sensors so that it makes sense.” -Joe Kvedar, MD
The connected health journey
Some aspects of connected health are in play already today and we’re only likely a few years away from reaping the full benefits of this connected health journey. Dr. Kvedar described that journey unfolding in three major phases:
- The future is here today in terms of technology. The majority of the technology is ready for this connected, internet of healthy things world, but some roadblocks prevent clinical providers from leveraging some of this new information. Dr. Kvedar offers, “There are still some technology problems to be solved. Chief among them is the ability to normalize the data from all of these wearable sensors so that it makes sense.” With wearable technology such as a Fitbit, for example, we can already measure steps and calories, but does that tell us a useful story? Dr. Kvedar explains, “They don’t tell a story because no one has been able to translate that data into something that is normalized. So that’s a gap.”
- Data analysis will become more personal. The second step in the connected health journey involves the ability to take all those data feeds and analyze them effectively. “One thing that is most exciting about those data feeds is that they do represent a unique digital fingerprint for each of us, because we do those things all uniquely, whether it is the way we travel with our phones, or our step counts.” Dr. Kvedar says. “The next technical challenge is to be able to harness all of that data and create a unique profile.”
- Business engagement. The final part of the connected health journey is the engagement with the consumer to propel action, for example, motivating them to make a healthier choice. This third level is just starting to happen today despite both technical and business model hurdles, although Dr. Kvedar says the business model hurdles are starting to break down. “For instance, United Health Group now offers 100,000 insured people a smart wearable device. If they achieve three kinds of fitness goals during a day, as measured by that wearable device, they get $4.00 added into their health savings account.”
Some parts of the healthcare industry seem to embrace the connected health journey faster than others. “Companies like Walgreens are embracing this idea of taking in wearables’ data and giving consumers something back in return. They are all seeing improved outcomes as a result,” comments Dr. Kvedar. On the other end of the adoption scale are doctors and hospitals. “Docs and hospitals are used to making a living by taking care of sick people and we haven’t quite figured out how to reward clinicians for keeping people well or how to reward hospitals for keeping people out of hospitals.” Those business model challenges are happily being worked on,” Kvedar explains.
Roadblocks to interoperability
Even though the technology is just about there to enable connected health for consumers, there are still major industry changes that need to occur in the area of interoperability. Dr. Kvedar described these biggest impediments to interoperability:
- Proprietary technology. Interoperability doesn’t seem to be in anybody’s financial best interests. Take a look at technology vendors, for example. “If you are an IT vendor, almost all of them, up and down the stack, whether it’s telecom all the way down to database, or even hardware, all of them want to bring you in and upsell you new things. They can only upsell you if they build barriers to others entering their space, and that means that they are doing something proprietary to keep you as a customer,” explains Dr. Kvedar.
- Fear of losing patients. On the hospital side of things, resistance to interoperability is primarily driven by the fear of losing patients to competitive hospitals. Dr. Kvedar comments, “From a pure business perspective, why would my hospital want to make it easy for patients to take their data to another hospital and get their care done there? To implement interoperability costs a lot of money. If there’s no revenue reward or efficiency award on the business side, why would you do it?” Dr. Kvedar sees one possible way hospitals might get on board with interoperability. “The only way I could conceive of having interoperability become the norm is to have a demand from government purchasers that if you are going to be a government contract, you have to have a certain set of open standards. I don’t know if that will happen under a Trump administration, but they certainly are signaling that they wouldn’t view the world that way. So, I don’t see it happening soon, unfortunately.”
Wearables and chronic illness management prevention
With the data available to consumers wearing health technology devices, the potential exists for not only managing chronic illnesses but also helping to prevent them. Dr. Kvedar cites two important considerations:
- Wearables provide a feedback loop. “I like to talk about conditions that don’t result in symptoms, like high blood pressure, high blood sugar, high cholesterol, visceral fat — all of those which portend bad outcomes down the line and don’t really, on a day-to-day basis, make you feel particularly poorly. In that context, you can think about connected health as feedback loops and motivation.” Wearables provide feedback loops since they are giving you data about your life. With a Fitbit, for example, if you haven’t hit your step goal for the day, you may be motivated to walk on a treadmill in the evening.
- Raw numbers don’t always motivate a lifestyle change. The other part of making feedback useable is motivation. “It turns out there’s a bit of paradox at play. A big part of our population doesn’t care about numbers. They care about other things. So if you are not a quantitative person, or you are not particularly motivated to change whatever the feedback loop is sending your way, it quickly becomes background noise,” Dr. Kvedar explains. That could be why the market for wearables is seeing a decline in activity.
He continues, “The good news is that there’s a crop of devices coming out now in the wearables space that give insights rather than just numbers. One of them is the Spire device that tracks respiration but doesn’t tell you your respiratory rate; it tells you whether you’ve been focused or stressed because we breathe differently under different conditions.” We may see a rebound in the wearables market as data becomes more meaningful to people with insights rather than just numbers.
How does all this data into a clinician’s workflow?
Clinicians today are inundated with data, most of it today within the EHR. Clinicians spend too much time clicking, finding, charting, and checking boxes to document the in-person encounters or manage a workflow. It’s hard to imagine connected health data fitting within the clinician’s already data-heavy process. Dr. Kvedar suggests this particular journey will unfold in two steps:
- The current state: Innovation practices exist but are not mainstream. Dr. Kvedar sees connected health in play today, but primarily in medical homes. “We have quite a few examples of that in our system, where we are heavily at risk and a lot of our primary care practices are patient centers or medical homes as part of our population health management structure. In those practices, there is someone whose responsibility is the burden of hypertension, just for instance. We will provide that person with a home monitoring for hypertension toolset for the patients that are either difficult to control or newly diagnosed. In any given practice it is not enough of a burden if this one person, typically a nurse and sometimes a pharmacist, is assigned the burden of data. It isn’t high enough that they can’t afford to get their work done. They check in a couple of times a week and the software flags the patients that are out of parameter and makes it a little bit easier to sort through. Then they involve a doctor if it is a medication change or something that really needs a doctor’s input.”
- The future state commands an AI layer. Most industries today are already using intelligent analysis software and data science that creates meaning and actionable information from a vast state of data. Dr. Kvedar describes how this might take shape in healthcare. “We are really at the beginning of a new era. Let’s say someone has high blood pressure and you’ve been tracking their blood pressure for the last two months. We should be able to give you a dashboard view that shows what blood pressures are normal when they go up, why they go up. Do they go up at night? Do they go up during the day? Do they go up after a meal? That would give you some real insight into how to care for that patient.”
Dr. Kvedar cautions that seeing this all become a reality with physicians is dependent on solving more than just the problems of data overload and dashboards. Here are two other important dependencies to be aware of.
“If you call it decision support, maybe you can sell it. Artificial Intelligence sounds scary.” - Dr. Kvedar
- The timing of value-based reimbursement. “We sort of had a rhythm going under the Obama Administration. Will that change? Not sure. Medicare has produced a plan that 50% of payments by two years from now will be value-based. So they seem to be on that curve. Many plans are now doing this but the rate is to be determined. As that happens, the reason we did medical home across our system is because of value-based payments and it makes much more sense in that context.”
- Physician resistance to the idea of AI. “On the one hand, we do this in the EMR with decision support. So if you call it decision support, maybe you can sell it. Artificial Intelligence sounds scary. It sounds like you are trying to take my job away from me, so I think it is how you frame it. And, of course, there’s the liability issue that goes along with that and how you convince docs into a state where they are not afraid they are going to get sued because there was a data point that they didn’t see that didn’t go right in the algorithm.”
How far off is the future?
Dr. Kvedar concludes, “The pieces of connected health are here today, but we still have to put them together. Some of that will be technical. A lot of it will be business model. Some of it is even societal.”
Make sure to listen to the complete podcast interview with Dr. Kvedar for many more insights about connected health, including a look at telemedicine and artificial intelligence.