Datica Podcast

February 20, 2017

Joseph Kvedar, MD, Author of "The Internet of Healthy Things"

Dr. Kvedar responds:

On connected health and who will be last to board the train: "The slowest to come on board from a business model perspective are docs and hospitals because we are used to making a living by taking care of sick people – we haven't quite figured out how to reward clinicians for keeping you well and how to reward hospitals for keeping you out of hospitals."

"As I said earlier, doctors and hospitals are going to be dragged along to the party without question. Health plans, pharmacy, pharmaceuticals, and other industries are getting in ahead of the curve because they have more to gain in the short term. It's happening – doctors and hospitals are very slow to change."

On the current state of digital health: "Digital health is now adopted by more than 50% of U.S. citizens or something like that. While we are trying to celebrate the consumerization and the adoption... there is still a very significant chunk of folks — most of them with chronic illness who cost the system a lot of money — who are reticent."

Kvedar, 'The Internet of Healthy Things' book cover

On the biggest impediments to interoperability: "Sadly, it is in no one’s financial best interests."

"If you are an IT vendor – almost all of them up and down the stack, whether it's telecom, 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. Almost always that involves some sort of unique dataset or some sort of unique way of sharing data. On the vendor side, it seems hopeless."

"On the hospital side, 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. You have to build interfaces and interfaces are complicated."

On what will get us to interoperable healthcare: "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."

On retail and its guiding light to healthcare: "Other examples have come up that I think are equally interesting, such as, if you buy an item from J.Crew online and, if you have their app on your phone, go into their mall store, the app will signal you to go to a table that has matching accessories to the thing that you bought online. A very interesting application."

On the wearable market downturn: "I think one of the reasons we are seeing a slump in the market is that there's a shiny new toy aspect to any new technology and we've gone through that phase with many wearables."

Kvedar, 'The Internet of Healthy Things' Symposium presentation

"[Wearables] largely were designed by engineers for engineers, and by quantitative people for quantitative people. I fell in love with all of them initially. A friend of mine who is not a quantitative person pointed out to me that 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."

On the future of the wearable market: "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... They are all very exciting and we are going to look forward to a rebound in the space because people will be much more responsive to insights rather than just numbers."

On artificial intelligence in healthcare: "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 in how you frame it."