A blog covering the health/care ecosystem and people.

As we wrestle with just “what” health care will look like “after COVID,” there’s one certainty that we can embrace in our health planning and forecasting efforts: that’s the persistence of telehealth and virtual care into health care work- and life-flows, for clinicians and consumers alike and aligned. There’s been a flurry of research into this question since the hockey-stick growth of telemedicine visits were evident in March 2020, just days after the World Health Organization uttered the “P-word:” pandemic. Three recent reports (among many others!) bolster the business and clinical cases for telehealth in America in terms of: A

There’s evidence in this week’s JAMA of a dose-response relationship between peoples’ steps and lower mortality. In other words: more steps done daily is statistically significantly associated with death from all causes. Furthermore, step intensity didn’t make a difference in mortality rates, shown in the JAMA-published study, Association of Daily Step Count and Step Intensity With Mortality Among US Adults. The publication of this study is incredibly well-timed given the fact that hundreds of millions of people around the world are in lockdown, #StayHome lifestyles this week, and will be for many weeks to come. Going outside for fresh air

The Consumer Technology Association (CTA), collaborating with industry stakeholders, has ushered in a standard for artificial intelligence in health care.   CTA is the membership organization for companies that innovate, manufacture and market consumer-facing tech like big-screen TVs, slick new autos, video games and voice assistants. So what’s an organization like CTA doing with AI and health care? Let me connect the dots. Check out this graphic taken from my book, HealthConsuming: From Health Consumer to Health Citizen. This shows the ten categories of tech I revisit each year at CES, CTA’s annual mega-conference of new-new things in consumer electronics

Most employers and their workers see the benefits of digital health in helping make health care more accessible and lower-cost, according to survey research published in Health on Demand from Mercer Marsh Benefits. Interestingly, more workers living in developing countries are keener on going digital for health than people working in wealthier nations. Mercer’s study was global, analyzing companies and their employees in both mature and growth economies around the world. In total, Mercer interviewed 16,564 workers and 1,300 senior decision makers in companies. The U.S. sample size was 2,051 employees and 100 decision makers. There’s a treasure trove of insights

Physicians are evolving as digital doctors, embracing the growing role of data generated in electronic health records as well as through their patients using wearable technologies and mobile health apps downloaded in ubiquitous smartphones, described in The Rise of the Data-Driven Physician, a 2020 Health Trends Report from Stanford Medicine Stanford Medicine interviewed 523 physicians and 210 medical students and residents in September and October 2019 to assess clinicians’ perspectives on digital health topics for this study. The study title citing the “data-driven physician” is based on the key survey finding that doctors are preparing to embrace data, from both traditional

In CTA’s 2020 Consumer Tech Forecast launched yesterday at Media Day 1 at CES, Steve Koenig VP of Research, said that, “digital health is an ecosystem of ecosystems.” Health, medical and wellness trends featured large in the forecast, which brought together key trends for 5G, robotics, voice tech, AR/VR/XR, and the next iteration of IoT — which Steve said will still be called “IoT,” but in this phase will morph into the “Intelligence of Things.” That speaks to Steve’s phrase, “ecosystem of ecosystems,” because that’s not just “digital” health — that’s now the true nature of health/care, and what is

Next week, the Consumer Technology Association (CTA) will convene CES, the Consumer Electronics Show, where over 180,000 tech-minded people from around the world will convene to kick the tires on new TVs, games, smart home devices, 5G connections, 3-D printing, drones, and to be sure, digital health innovations. At #CES2020, exhibitors in the health/care ecosystem will go well beyond wearable devices for tracking steps and heart rate. I’ll be meeting with wearable tech innovators along with consumer electronics companies and retailers. I’ve also scheduled get-togethers with pharma and life science folks, health plan people, and execs from consumer health companies.

As technology continues to re-shape consumers’ experiences and expectations with health/care, retail, travel and work, peoples’ concerns about data privacy are also growing as observed by a 2020 consumer trends forecast from GlobalWebIndex, Connecting the dots. First, some overall context to the study. GlobalWebIndex “connects the dots” of consumers trends in 2020 including the topics shown in the first graphic including commerce and retail, gaming, travel, human touch, nostalgia, privacy and digital health — the first of these trends discussed in the report. Note that the data discussed in this post include responses from consumers residing in both the U.S.

Patients searching online for health information and health care provider reviews is mainstream in 2019.  Digital health tracking is now adopted by 4 in 10 U.S. consumers. Rock Health’s Digital Health Consumer Adoption Report for 2019 was developed in collaboration with the Stanford Medicine Center for Digital Health. Rock Health’s research has tracked peoples’ use of telemedicine, wearable technology, digital health tracking, and online health information since 2015, and the results this round show relative flattening of adoption across these various tools. Rock Health’s top-line findings were that: Patient-generated health data creates opportunity, and potential challenges Online health information is

“Every company is a tech company,” Christopher Mimms asserted in the Wall Street Journal in December 2018. Connectivity, artificial intelligence, and automation are now competencies every company must master, Mimms explains. This ethos underpins Humana’s decision to join CTA, the Consumer Technology Association which hosts CES every January in Las Vegas. If you read this blog, you know one of the fastest-growing “aisles” at the annual conference is digital health. Humana joined up with CTA’s Health and Fitness Technology Division this month. Last year, Humana hired Heather Cox in the new post of Chief Digital Health and Analytics Officer, reporting directly

As patients continue to morph into health care payers, they’re increasingly expecting value-for-money, transparency, and customer experiences that show respect, bolster trust, and deliver quality services. Is that so much to ask from health care providers? Sure is, as it turns out, based on this year’s annual report from Kaufman Hall, the 2019 State of Consumerism in Healthcare: The Bar is Rising. For several years, Kaufman Hall have developed an Index of healthcare consumerism based on several pillars that, together, gauge health care providers’ performance on consumer health engagement. Providers fall into one of four tiers, ranging from Tier 1

Of the $401 billion that will flow through retailers for consumer technology products, many of the fastest-emerging categories will play a role as platforms for health and medical care at home and in wearable tech. This is my tea-leaf read from reviewing the projections in the report, U.S. Consumer Technology Sales and Forecasts, July 2019, from the Consumer Technology Association (CTA). [CTA is annual convener of CES, the world’s largest consumer electronics meet-up.] Along with artificial intelligence (AI) and fast 5G networking, the forecast also quantifies growth prospects for smart speakers, home robots, wireless earbuds, smartwatches. and in-vehicle technology —

Most U.S. healthcare providers are spending more time, effort and capital with an eye to engaging with patients-as-consumers, a trend quantified in the report, the 2019 State of Consumerism in Healthcare: The Bar is Rising from Kaufman Hall, summarizing results from this year’s healthcare consumerism index survey conducted among about 200 healthcare providers. “Legacy organizations will need premier-level consumer capabilities to compete in today’s increasingly consumer-centric environment,” Kaufman Hall recommends. Providers identified the key capability gaps for consumer-centric care as improving the consumer experience, offering a variety of facility-based access points, utilizing digital tools for health engagement, providing price transparency,

At least one in three people who have tried out virtual health care have done so because they use technology in all aspects of life and want to do the same with their healthcare. This data point has informed my vision for self-care and the home as our health hub, bolstered in part through the research of Accenture from which this first graphic comes. A common theme at health care meetings these days is how and when health care will meet its Amazon, Apple, or Uber moment? Lately, one of my speaking topics is the “Amazon Prime-ing” of health consumers,

“ATA” is the new three-letter acronym for the American Telemedicine Association, meeting today through Tuesday at the Convention Center in New Orleans.  Ann Mond Johnson assumed the helm of CEO of ATA in 2018, and she’s issued a call-to-action across the health/care ecosystem for a delivery system upgrade. Her interview here in HealthLeaders speaks to her vision, recognizing, “It’s just stunning that there’s such a lag between what is possible in telehealth and what is actually happening.” I’m so keen on telehealth, I’m personally participating in three sessions at #ATA19. On Monday 15th April (US Tax Day, which is relevant

Seeking health information online along with researching other patients’ perspectives on doctors are now as common as booking dinner reservations and reading restaurant reviews, based on Rock Health’s latest health consumer survey, Beyond Wellness for the Healthy: Digital Health Consumer Adoption 2018. Rock Health has gauged consumes’ digital health adoption fo a few years, showing year-on-year growth for “Googling” health information, seeking peer patients’ physician and hospital reviews, tracking activity, donning wearable tech, and engaging in live telehealth consultations with providers, as the first chart shows. The growth of tracking and wearable tech is moving toward more medical applications beyond fitness

Most consumers would be willing to try an FDA-approved app or online to treat a medical condition, as well as receiving hospital care at home if would be less costly. We’ve reached an inflection point on the demand side among consumers for digital health options, PwC suggests in their report on the New Health Economy coming of age. The report outlines health/care industry issues for 2019, with a strong focus on digital health. Whether a menu of care options including virtual health to access specialists across the U.S., post-hospital virtual visits, or hospital care at-home, a majority of Americans supports

Self-care is the new health care as patients, now consumers at greater financial risk for medical spending, are learning. At #CES2019, I’m on the lookout for digital technologies that can help people adopt and sustain healthy behaviors that can help consumers save money on medical care and enhance quality of life-years. This week’s heart-and-food tech announcements at #CES2019 coincide with an FDA recall on a popular drug prescribed to treat hypertension (high blood pressure). Using food and tech as medicine can help people avoid going on medications like statins and others for heart health. An important example of this self-care

Today is Boxing Day and St. Stephens Day for people who celebrate Christmas, so I share this post as a holiday gift with well-wishes for you and those you love. The tea leaves have been brewing here at THINK-Health as we prepared our 2019 forecast at the convergence of consumers, health, and technology. Here’s our trend-weaving of 4 C’s for 2019: costs, consumerism, cyber and care, everywhere… Health care costs will continue to be a mainstream pocketbook issue for patients and caregivers, with consequences for payors, suppliers and ultimately, policymakers. Legislators inside the DC Beltway will be challenged by the

From culture to travel, food and drink to retail and beauty, health will be baked into consumer goods and experiences in 2019. Welcome to The Future 100: 2019 from The Innovation Group at JWT. In the 100 emerging trends across ten categories, the future is clearly health-driven, according to the tea-leaf readers at JWT.a Health is all over, Culture Tech and innovation Travel and hospitality Brands and marketing Food and drink Beauty Retail Luxury Health (as a category itself) Lifestyle. I’ve mined this report in previous years – you can review my findings from the 2017 report here in the Health

  American consumers are now viewing their phones an average of 52 times daily, with 39 percent of consumers believing they use their smartphones too much. In fact, 60 percent of 18 to 34-year-olds admit to smartphone overuse, the highest level of any age group. However, 63 percent of the respondents reported trying to limit their smartphone usage, roughly half succeeding in cutting back. Smartphones also are helping blur the lines between work and leisure with 70 percent of respondents using personal smartphones at least occasionally for after-hours work. Furthermore, voice technologies are “making noise,” according to Deloitte in A New Era

There’s a shortage of medical providers in the United Kingdom, a nation where healthcare is guaranteed to all Britons via the most beloved institution in the nation: The National Health Service. The NHS celebrated its 70th anniversary in July this year. The NHS “supply shortage” is a result of financial cuts to both social care and public health. These have negatively impacted older people and care for people at home in Great Britain. This article in the BMJ published earlier this year called for increasing these investments to ensure further erosion of population and public health outcomes, and to prevent

When I asked my longtime colleague and friend Robert Mittman, with whom I collaborated at Institute for the Future for a decade, how he managed international travel and jet lag, he said simply, “The time zone you’re in is the time zone you’re in.” This lesson has stayed with me since I received Robert’s advice over twenty years ago. Over the next two weeks, as I work alongside colleagues and clients in the EU and soon-to-Brexit UK, I am in time zones five and six hours later than my home-base of US Eastern Time. But the time zones I’m working

People dealing with chronic conditions are keener to share personally-generated data than people that don’t have a chronic disease, Deloitte’s 2018 Survey of U.S> Health Care Consumers learned. This and other insights about the patient journey are published in Inside the patient journey, a report from Deloitte that assesses three key touch points for consumer health engagement. These three patient journey milestones are searching for care, using new channels of care, and tracking and sharing health data, Deloitte maps. What drives people to engage on their patient journeys has a lot  more to do with practical matters of care like convenience,

Using digital health tech is a new normal for U.S. consumers, including Seniors, found in the 2018 digital health consumer survey from Deloitte. The title of the report, “Consumers are on board with virtual health options,” summarizes the bullish outlook for telehealth. That’s the consumer-demand side of the equation. But the tagline begs the supply side question: “Can the health care system deliver?” For a decade or longer, we’ve noted the slow uptake of telehealth and digital health tools among healthcare providers. But the consumer pressures, along with evidence-based self-service options for health – both for “care” and for wellness,

With the acquisition of GreatCall, a mature player in the aging-tech space, Best Buy is doubling down on consumer health technology@retail. This week at Best Buy. the electronics retailer,  it’s out with CDs and in with technology for aging at home. The company announced that it would buy GreatCall for $800 million. A snippet from the announcement from Best Buy’s press release is shown in the first diagram, noting that GreatCall’s membership is approaching 1 million subscribers who use mobile phones and connected devices, “providing peace of mind to their loved ones.” Beyond the obvious “falling and I can’t get

  Consumers are more bullish demanding virtual and digital health tools from their physicians than doctors are in providing it, based on the research findings in What can health systems do to encourage physicians to embrace virtual care? from Deloitte. One-third of physicians have concerns about using virtual care services, such as medical errors that may result, access to technology, and data security.               One in two U.S. consumers are now tracking health via digital tools, and one-half of these share the data generated by their apps. That sharing is limited by doctors’ ability to

Design-thinking has come to health/care, finally, and Amy Cueva has been beating this drum for a very long time. I’m delighted to be in her collegial circle, speaking at the conference about the evolving healthcare consumer who’s financially strapped, stressed-out, and Amazon Primed for customer service. I’m blogging live while attending HXD 2018 in Cambridge, MA, the health/care design conference convened by Mad*Pow, 26th and 27th June 2018. Today was Day 1 and I want to recap my learnings and share with you. Amy, Founder and Chief Experience Office of Mad*Pow, kicked off the conference with context-setting and inspiration. Design

What a difference a couple of weeks make…. On 1st March 2018, two over-arching issues remained with me leaving Las Vegas and #HIMSS18: the central, recognized role of cybersecurity threats in healthcare, and the growing use of consumer-facing technologies for self- and virtual care. Eighteen days later, we all learned about Cambridge Analytica’s misuse of 50 million Americans’ social network data posted on Facebook. We who work in healthcare must pose the questions: going forward, how trusting will patients, consumers and caregivers be sharing their personal health information (PHI)? Will people connect dots between their Facebook lives – and their

As I wrote here in April 2017, telehealth and virtual healthcare are mainstreaming. This week at the 2018 annual HIMSS conference, telehealth is playing a mainstream role in discussions about right-sizing and right-placing healthcare.     The evidence for telehealth’s tipping point is rooted in new research published today by Accenture on Patients + Doctors + Machines, Accentures’ 2018 Consumer Survey on Digital Health. I sat down today with Dr. Kaveh Safavi who leads Accenture’s healthcare practice to discuss the results of this study into peoples’ atttudes toward healthcare technology and innovation. Three in four consumers in America say technology is

It’s February 1st, which marks the first of 28 days of American Heart  Month – a time to get real, embrace, learn about, and engage with heart health. Heart disease kills 610,000 people in the U.S. every year, equal to 1 in 4 deaths in America. It’s the leading cause of death for both men and women in the U.S. Knowing your blood pressure is an important step for managing the risks of heart disease. That hasn’t yet been available to those of us who quantify our steps, weight, sleep, food intake, and other health metrics. In 2017, Hugh Langley

Journalists and industry analysts from around the globe have come to Las Vegas which, this week, is the mecca for new-new electronic things that companies think consumers will be keen to buy. On media day 1, I spoke with a colleague from the Netherlands who covers audio, a sector that’s certainly in disruption; an automotive analyst from India covering autonomous vehicles; and, a mobile tech guru based in Dubai, to identify just a few of my media friends who have gathered here to research and write on their respective beats. In these conversations, there are some common buzzwords floating around

The pharmaceutical industry is facing a multitude of political, regulatory, and financial uncertainties in and beyond 2018. But there’s one thing I know for sure about pharma’s morphing business model: it’s that patients are playing a growing role in the industry’s future well-being. That is, if the industry can meet health consumers where they want to be met. Patients want more communication and support from pharma companies, a new study from Accenture found. In fact, over one-third of patients tell their health care providers about pharma patient-service programs: this chart from Accenture’s study illustrates the top seven ways providers hear

As 2018 approaches, consumers will gather healthy New Year’s Resolutions together. Entering the New Year, most Americans are also dealing with concerns about healthcare costs, cybersecurity, and caring – for physical health, mental stress, and the nation. Healthcare costs continue to be top-of-mind for consumer pocketbook issues. Entrenched frugality is the new consumer ethos. While the economy might be statistically improving, American consumers’ haven’t regained confidence. In 2018, frugality will impact how people look at healthcare costs. 88% of US consumers are likely to consider cost when selecting a healthcare provider, a Conduent survey found. Physicians know this: 81% of

THINK: money and love. To find health, working-aged people seek financial stability and good relationships, according to the Consumer Health POV Report from Welltok, meQuilibrium, and Zipongo, featured in their webinar broadcast today. The online consumer survey was conducted among 2,000 full-time working U.S. adults in August 2017, segmented roughly into thirds by Boomers (37%), Gen Xers (32%), and Millennials (31%). Much lower down the priority list for healthy living are managing food, sleep, and stress based on the poll. Feeling stress is universal across most consumers in each of the three generational cohorts, especially related to work and finance.

Most consumers access the Internet for health information before they ask their doctor for the same information. But virtually everyone who goes online for health information would trust a website recommended to them by their doctor, according to the dotHealth Consumer Health Online – 2017 Research Report. This survey was conducted on behalf of dotHealth, an internet registry company channeling “.health” domains to organizations in the broad health and healthcare landscape. [FYI, both Health Populi and JaneSarasohnKahn are also registered with .health domains, having availed ourselves of this service at launch]. Six in 10 consumers who have used the internet in the

As we look for signs of stability in U.S. health care, there’s one stakeholder that’s holding firm: employers providing healthcare benefits. Two studies out this week demonstrate companies’ commitment to sponsoring health insurance benefits….with continued tweaks to benefit design that nudges workers toward healthier behaviors, lower cost-settings, and greater cost-sharing. As Julie Stone, senior benefits consultant with Willis Towers Watson (WLTW), noted, “The extent of uncertainty in Washington has made people reluctant to make changes to their benefit programs without knowing what’s happening. They’re taking a wait-and-see attitude.” First, the Willis Towers Watson 22nd annual Best Practices in Health Care Employer

U.S. consumers consider Consumer Electronics to be the most innovative industry they know. But people believe that Health & Wellness should be the most innovative sector in the economy. Welcome to the 2017 Klick Health Consumer Survey, which focuses on health innovation in the context of peoples’ hopes for technology to improve health and healthcare. 1 in 2 people say that technology has had a positive impact on their health and wellness, skewing slightly more toward younger people (although 45% of people 55 years of age and older agree that tech positively contributes to health. 41% of consumers say they’ve

We have entered an era of insecurity in healthcare in America. While major attention is being paid to healthcare insurance and service insecurity, food insecurity and financial insecurity, there’s another one to add to this list: medical device security. As more medical devices have moved into the digital internet-connected mode, the risk for malware, ransomware, and overall hack-ability grows. This increasing and challenging risk is covered in the report, Medical Device Security: An Industry Under Attack and Unprepared to Defend from Ponemon Institute. Ponemon Institute has been tracking information security across industries, including healthcare, for several years. In this survey, sponsored

Did you know that the Echo Dot was the top-selling gift on Amazon in the 2016 holiday shopping season? The family of Amazon’s Alexa devices was the most popular product across all categories on the ecommerce site. As patients morph into health consumers, and consumers buy into wearable technologies and smart home devices through the growing Internet of Things (IoT), the home is becoming the new medical home. Most healthcare leaders believe that the Internet of Health Things (IoHT) will disruptive the healthcare industry within three years, noted in the Accenture 2017 Internet of Health Things Survey. But only one-half

As the annual meeting of the American Telemedicine Association convenes this week in Orlando, there’s a lot of telehealth news to curate. The topline of it all: virtual healthcare is mainstreaming, with more providers, payors, and patients aligning in support of virtual health care delivery. Three-quarters of providers have some form of basic telemedicine or telehealth in place. One-third of healthcare providers use some flavor of virtual care technology in their workflow, according to research from KPMG and HIMSS Analytics summarized in the first graphic. KPMG sees virtual care options — remote patient monitoring, enhanced portals, and web interactions for patient-provider

The truest form of health reform and consumer-directed health care isn’t in a high-deductible health plan or a health savings account, and it doesn’t come out of Washington DC or your employer’s health benefits office. It comes from you in the form of self-care and DIY healthcare. In this case, think “inspired by sport, powered by you.” I’ll be participating on a panel at this weekend’s South-by-Southwest Festival in Austin, Texas, along with three wellness innovators: Nick Buettner of the Blue Zones project, Mary Liz McCurdy of Google, and John Wilbanks from Sage Bionetworks. Together, our quartet will brainstorm the

We are all Amazon Prime primed as consumers now. So it should not surprise healthcare providers, plans and suppliers that consumers expect just-in-time convenience for their healthcare, Accenture has found. Mind the gap: 8 in 10 U.S. patients would welcome some aspect of virtual healthcare, but only 1 in 5 providers is meeting that need. The consumer demand for virtual care is palpable for: Tracking biometrics, among 77% of consumers (say, for measuring blood pressure or blood glucose for people managing diabetes) Following up appointments, for 76% of people after seeing a doctor or being discharged from hospital Receiving reminders

Digital health innovations were fast-proliferating at CES 2017. The bad news is there are so many of them, it’s dizzying and fragmented. The good news is that there are emerging health data ecosystems that will streamline consumers’ user experience so that people can derive knowledge, actionable advice and value out of using these tools. Walking miles of aisles in the Sands Convention Center in the first week of January 2017 can be a dizzying prospect, with hype and best-faces-forward in every single exhibitor at the show. In the health segment at CES, there’s a long list of digital tools to

Health citizens in America will need to be even more mindful, critical, and engaged healthcare consumers in 2017 based on several factors shaping the market; among these driving forces, the election of Donald Trump for U.S. president, the uncertain future of the Affordable Care Act and health insurance, emerging technologies, and peoples’ growing demand for convenience and self-service in daily life. The patient is increasingly the payor in healthcare. Bearing more first-dollar costs through high-deductible health plans and growing out-of-pocket spending for prescription drugs and other patient-facing goods and services, we’re seeking greater transparency regarding availability, cost and quality of

Several market forces are converging that boost patients’ ability to engage in their health and self-care, including peoples’ growing adoption of smartphones, demand for self-service and DIY lifestyles, and Americans’ growing responsibility as health consumers. Health consumers are using a growing array of self-health tools, enabled through digital technologies. However, these tools aren’t yet engaging some of the very people who need them the most: high-need, high-cost patients. Research into this situation is discussed in the December 2016 Health Affairs article, Many Mobile Heaath Apps Target High-Need, High-Cost Populations, But Gaps Remain, published in the December 2016 issue of Health Affairs. For

This post was written to support the upcoming meeting of the PCHA, the Personal Connected Health Alliance, to be held 11-14 December 2016 at the Gaylord Hotel in greater Washington, DC. You can follow the events and social content via Twitter using the hashtag #Connect2Health. Have you visited your local Big Box, discount or consumer electronics store lately? You’ll find expanding shelf space for digital health technologies aimed squarely at consumers. 2017 promises even more of them, aimed at helping people accomplish health tasks once  performed in hospitals and by healthcare providers, or tasks not yet delivered in today’s healthcare

About 1 in 2 patients in the US are accessing their electronic health records in early 2016, according to Accenture’s 2016 Consumer Survey on Patient Engagement, Patients Want a Heavy Dose of Digital. This post is based on a presentation I attended by Accenture’s Dr. Kipp Webb yesterday. Accenture conducted survey research with consumers in seven countries for this study. The data and insights shared in this post are based only on the survey results from 2,225 US patients. The proportion of US health consumers accessing their health records grew from 27% in 2014 to 45% in 2016 — an increase of

Here’s a new definition of “wearable” that’s Old School stuff: a baby onesie. But this onesie doesn’t just look cute and keep baby’s bum warm. The onesie helps teach caregivers baby CPR. This health education project was sponsored by Tesco in collaboration with St. John Ambulance, one of the largest health charities in the United Kingdom. Tesco ranks among the biggest retailers in the world (after Walmart, Costco, Kroger, and Lidl), operating in the UK, Ireland, Asia and Europe. Watch this video and get charmed by adorable, telegenic Baby Lucy – your CPR model. Tesco held live CPR classes at over