Health Care Everywhere at the 2014 Consumer Electronics Show

20140110-101905.jpgWhen the head of the Consumer Electronics Association gives a shout-out to the growth of health products in his annual mega-show, attention must be paid. The #2014CES featured over 300 companies devoted to “digital health” as the CEA defines the term.

But if you believe that health is where we live, work, play, and pray, then you can see health is almost everywhere at the CES, from connected home tech and smart refrigerators to autos that sense ‘sick’ air and headphones that amplify phone messages for people with hearing aids, along with pet activity tracking devices like the Petbit.

If you take on the expanded definition of health, this means logging at least 20,000 steps a day (tracked by my trusty device) to cover the behemoth Las Vegas Convention Center, along with relevant exhibitors and discussions at the Venetian, the Cosmopolitan, and Mandalay Bay.

3 smart people I encountered this week at CES inform my health takeaway from the meeting: Dr. Joe Kvedar of the Center for Connected Health at Partners Health System in Boston; Abbe Don of athenahealth/Epocrates; and Dr. Samir Damani of the young company MD Revolution.

Dr. Kvedar, as both a health provider and researcher in the real world, provided a rational approach to the topic of health, everywhere, saying we’ve come a long way but the fact is that point-of-care (POC) is not everywhere…yet. There are a plethora of technologies: plenty of them. The question few asked or answered at the Digital Health Summit was “how fast are we going to get ‘there?’”

To answer that topline inquiry, Joe pointed out 3 things driving POC everywhere:

1. Health insurance exchanges (HIXs) are a powerful force to engage consumers in conversations about health care. The reality of the Affordable Care Act is getting folks to think about choices and costs, which will help move toward health delivered in attractive settings at lower prices and with greater convenience. So this point is not about whether Health Insurance Exchanges are “working” — don’t let yourself get into those weeds.The point according to Joe (with which I strongly concur) is that the launch of the HIXs is prompting conversations and awareness. This is not trivial for a population who doesn’t like talking about (1) health and (2) money.

2. On the flip side, Joe said, are new payment models for providers, such as shared risk and accountable care, which are already making a difference on Joe’s home turf in Massachusetts where “doctors’ minds are open to” care outside of traditional office and institutional settings.

Finally, point #3: the CES itself. Joe said to look around, and see telecomms companies and tablets bringing familiarity and comfort with using technology. He noted that the phenomenon of grandparents Skyping with grandchildren lays a foundation for older people gaining competence using the platform techs that can enable healthcare to the home and on-the-go.

With those three enablers laying the table for care, everywhere, the next necessary condition is to “make health addictive,” a mantra that Joe and his team at the Center for Connected Health have been working with for many years. “People check their smartphones 150 times a day, but it’s hard to get a patient to do a healthy behavior once a day. Can we slip health messages in there?” Joe asked.

What we do know via the Center’s work, and Abbe Don’s experience in user-centered designing through her many years working with IDEO’s clients and now at athenahealth and Epocrates, are 3 strategies to bolster health engagement:

1. Make it about life – not about sickness or health, but whispering the underlying question, “what do I want to accomplish?” in my every day life.
2. Make it personal, like Madison Avenue and highly engaging consumer companies know how to do.
3. Use social connections, which bolster peoples’ ongoing sustained engagement in positive health choices.

Abbe shared her experiences with user-centered designing in health, starting with her work at Apple in 1988. She learned about the power of storytelling using dynamic data, and now sees patients beginning to “hack together their own data,” she observed. It’s not all that elegant yet – “what comes out of BlueButton looks initially like DOS,” she illustrated with a slide image capturing mashed-up black type on a white background with no graphical summaries or pictures. “This is not easy to act on,” she realized, calling the multiple platforms and formats engaged health consumers hacking a “fluster cluster of care coordination.”

What’s beginning to corral the “fluster cluster” are patients/consumers and pioneering providers coming together for shared decision making and self-care outside of the provider’s office. Exhibit A for this point is Dr. Samir Damani, whose company MD Revolution has the tagline “Harnessing the Power of Digital Health.”

Samir saw patients purchasing WIthings blood pressure cuffs, and streaming him data that suggested they needed a dose of medicine at night. He learned from his patients, some of whom began to substitute more sedentary behavior with gardening-as-exercise.

MD Revolution built a lab to “generate scientific rigor,” a kind of mobile health “bar” not physician-centered but instead bringing patients together with technology folks to learn how to curate the best, most appropriate apps and right-sized health devices for the individual. The team will be publishing a paper soon describing 112 patients who have achieved statistically significant outcomes through this strategy. For example, some patients have been able to disband the use of statins by modifying their lifestyle behaviors. “Engagement happens when you build the right system,” Samir is learning.

Health Populi’s Hot Points:
While mainstream press covering the 2014 CES is focusing coverage on shiny new things for measuring body mass indices, which wristband has the slickest new design, and how Google Glass could benefit health, the question about pace-of-change in health care must be squarely and soberly faced.

The underlying forces that Dr. Kvedar points out, coupled with the design learnings of Abbe Don and Dr. Damani’s early learnings, give us an indication of how mainstream people could find an on-ramp to using the (best of the) shiny new things.

There is an abundance of fitness trackers, adding in more sleep and heart functionality — which are both very good metrics to add into the self-tracking sensor data. Those companies that recognize and work with the larger health ecosystem of providers, payors, employers, and retailers will have a greater shot at building a sustainable business model.

This successful model won’t be based on the technology: it will be which device can help the user change their behavior, commit to that change over time and, as the case with the statin – develop a mindfulness of making good choices that may allow the person to disband use of the device. In that way, consumer health electronics companies should learn from the lost opportunity of Big Pharma, whose lack of sound portfolio strategy 101 – that is, the ongoing management of stars, cash cows, question marks, and dogs – led to short-term thinking.

Health and engaging people in self-care lives on a continuum. Work with it. It’s such a great opportunity, and the time is finally here to make it happen. The photo attached to this post was not taken in the Digital Health hall – it is a motto from a global consumer electronics company. But it surely the mantra for those of us looking to leverage technology to benefit peoples’ health.

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