innovation Archives | G2 Communications Inc.-Medical Practice Marketing

Jul 21 2014

Leveraging Community for Successful Aging in Place: Q&A with Martin Entwistle, Part 2

I recently introduced you to Martin Entwistle, Executive Director of the David Druker Center for Health Systems Innovation at Palo Alto Medical Foundation (PAMF). The Innovation Center team is working “to create disruptive solutions that tackle the pressing health challenges of our time,” Entwistle explains. “We think through real problems, build prototypes to address them, and develop solutions at the enterprise level for wider deployment.”

One such pressing issue is the impact of aging on seniors, their families and the wider community. Here, Entwistle offers a closer look at linkAges and its potential for activating communities to better care for and support aging individuals. He also shares insights into PAMF’s process for discovering and refining innovative solutions to our most pressing healthcare problems.

What does the PAMF innovation process look like?

We innovate by human-centered design which means peeling back the onion of the problem. For example, in evaluating the issues faced by seniors, we may identify access to transportation as the problem, but this is a solution to one part of a bigger problem. The real underlying issue is isolation and loneliness, which is multi-dimensional and requires solutions that provide a more systemic approach than just providing transport.

Our approach is heavily informed by ethnographic studies of the people who are the subject of our solutions. We use this approach to provide an in-depth understanding of the issues people face in their day-to-day lives, in this case seniors and their caregivers. This process helped us understand the importance of community and community-level support to address the issues of successful aging, and to begin to develop solutions that would directly tackle the identified underlying problems.

Further careful planning and execution is required. Solutions need to be designed and tested, typically through a process of prototyping, and sometimes these prototypes don’t get the expected results. In innovation you try something and you might have to throw it away, but even when you do create a successful prototype you have to think about how to deploy it, build it out and scale it, all the while making sure that the various components fit together and work as a seamless system. Going from prototype to actual deployment is one of the hardest steps in the process.

How is the Innovation Center approaching health care for a growing aging population?

As described above, our analysis of the barriers to successful aging identified the need to create a community of support for the aging process, and to enable people to grow old and remain valuable in society. How do you get the support of the community when there is a lack of neighbors helping neighbors and your family is scattered across the country? The experience was succinctly described by one of the participants in the ethnographic studies who reported “in older people their world dies before they do.” They’d like it to be bigger and more expansive–have more people and hobbies in their lives, or simply be able to go to the store. We realized the solution needed to be community focused and address social context and behavioral issues, including access and the ability to interact with others. It’s all about life continuing to be meaningful as people age.

It appears that many of the issues older people experience are driven by loneliness or isolation. The focus of our linkAges program is to address these challenges and help people age in place successfully.

In what ways is linkAges innovating to change the current healthcare model?

Healthcare providers have extensive and in-depth information about the medical issues faced by patients, but frequently more detailed and current social information is lacking. There are significant direct and indirect opportunities for use of such social information; identification of people who have difficulty getting to appointments or to the store for food, alerting an individual’s physician that her patient is largely unsupported in their day-to-day life.

In linkAges we want to identify the people in need of interaction and activate community in a way that enables them to get support from other people.

One barrier for aging seniors could be their inability to pay for things. How do you access services if you don’t have money? Our solution to this problem is time banking. Time banking creates an interconnected community of people who support each other with offers and requests for services where time, not dollars, is the currency. Could someone come and cook a meal or mow the senior’s lawn, while the senior may offer to give knitting lessons or teach younger people skills like wood-working? A key idea is to actively links across all ages in the community, not just seniors.

Another innovation component of linkAges is to try to identify people who are declining and provide support, before an adverse event happens. Can we build a detection system that tells the caregiver if a senior’s pattern of living is different? We put out a developer challenge: how do you identify patterns and get alerts that something is not quite right with the senior? We’re working with a company called Vevity. They had the idea to use utility smart meters which can tell you about energy usage within a household. We could use that information to determine if the stove or lights are going on and off and use these patterns of activity to tell caregivers when the normal pattern of daily living habits has changed.

Finally, seniors have difficulty activating resources. Google and Yelp are typically well tailored to the specific needs of seniors. For example, a senior may want to know if a restaurant is wheelchair accessible, or which pharmacy will spend time to help them find just the right cane to help their mobility. If they can’t find that out they won’t go. If we start a database for this kind of information how do we maintain it? Can we get the community to support this? We’re using our own internal team to do the analysis and find out if this is another part of the system we should tackle.

Conclusion

There’s a fundamental thirst for some kind of new community engagement for the aging population. Society has an appetite to address this challenge but it hard for organic solutions since communities are more and more fragmented. Even in younger people there’s a great desire to interact with older people. They want to be part of giving; there’s a level of altruism. It isn’t all about profiteering. There’s a great interest in linkAges and it is very exciting to be creating a community model that could scale to significant size and have a major impact on successful aging, one of the most pressing issue of our time.

Photo: PAMF

Mar 04 2014

Kate Schafer’s HIPAA programming guide for mhealth engineers

Most of us are familiar with HIPAA, the law that requires healthcare providers, insurance companies, health plans, etc., aka covered entities (CEs), to protect the privacy of patients’ health information. The law has been around since 1996. But last year the Department of Health and Human Services (HHS) made sweeping changes to HIPAA.

Under the Final Omnibus Rule, a new set of provisions have been laid out that strengthen the HIPAA Privacy, Security and Enforcement rules for protecting patient health information. Some of the updated HIPAA Privacy Rule applies to business associates (BAs), the companies that provide services to CEs, which typically involves handling patient information.

Previously a BA was only required to sign an agreement assuring that it would safeguard patient health information on behalf of a CE. But as of September 2013, both CEs and BAs became liable under the Omnibus Rule and are now subject to HIPAA audits which are about to ramp up. And the definition of BA has expanded to include organizations that merely store or transmit patient data, even if they don’t touch it. CEs and BAs in violation of patient privacy rules could face stiff penalties.

Meet Kate Schafer, founder of Innovative Healthcare IT. I met Kate at a recent Health 2.0 Silicon Valley Meetup. A room full of developers looked at the latest batch of mobile health apps designed to help us lead healthier lives. That’s the good news. But if they’re getting their hands on patient information and not following HIPAA rules in the process they may be shut down before they say “click on our icon.”

That’s where Kate comes in. She brings startups the trifecta of security technology, product development, and regulatory compliance with a focus on HIPAA, and advises them on building security and encryption layers into their platforms. I asked Kate to tell me what she does and why healthcare startups should care.

Tell me about your work and the services you provide to startups?

I have a long and varied background in technology and product development, combined with regulatory compliance and a focus on HIPPA. It’s that technical foundation that really resonates with potential clients and convinces them to work with me. There are numerous audit firms that can do what I do – most coming from the financial industry – but they don’t really provide healthcare startup support. I offer a “let’s roll up our sleeves and get it done” service where I work together with each client to craft a compliance strategy that works for their staff and for their budget. I can help healthcare startups get from prototype to industrial strength and scalable, and I make myself available for ad hoc questions any time a former client needs advice.

Companies come to me at various stages. A lot of my clients are just starting their first pilot. The product may have been developed offshore and they’re trying to bring it in-house. Or they may have just signed up a healthcare provider or a hospital for a pilot of the product, and their customer is asking for assurance of HIPAA compliance.

By law, healthcare providers must ensure that anyone who handles protected health information on their behalf (a business associate) complies with HIPAA before sharing any patient data with them, so non-compliance is a deal-breaker for these startups. That’s when they call me.

What is the primary sector of healthcare that your startup clients are creating solutions for?

There’s a range, but most recently the startups I’m seeing have a focus on the communications between providers and patients, particularly pre-op and post-op or at some other transition of care. For example, apps that focus on maintaining communications during recovery from surgery. The patient will go home with information they can access from their smartphone or tablet. These apps enable two-way communication, with metrics on rehab going back to the healthcare provider. Secure telemedicine enables real time feedback. Surveys and questionnaires provide feedback on the patient’s experience and can be fed into the product enhancement loop.

I’ve also got clients doing research and analytics on population health data and clients using mobile devices for healthcare decision-making. Those apps often also need to be FDA compliant. I also have clients from the VC community who are looking for an assessment of the security and/or compliance risk profile of a startup they’re considering investing in.

I don’t work with a lot of “quantified health” firms. Often people assume that quantified self apps (where an individual chooses to store their protected health information on their smartphone, for example) need to be HIPAA compliant but that is not the case. Healthcare providers must comply with HIPAA; individuals may do whatever they want with their personal health information. For some of these applications the patient is collecting information they might give to their doctor. But the doctors don’t always know what to do with it, may not trust it, or may not want it because they just don’t have the bandwidth to deal with it. This has created a new market for companies that can solve this problem with data aggregators and other solutions.

At what stage do healthcare startups typically bring you in for consulting?

When the startup is ready to recruit beta testers and pilot sites that’s where I come in. At that point if they haven’t already thought about security and HIPAA compliance, they are behind the 8-ball. At that point I can provide a range of services from a simple assessment of compliance gaps to a full remediation project that gets the startup fully compliant. I interview all the stakeholders and we talk about the big picture. I look at the technology stack, which refers to everything from the hardware up – all hardware and software components.

I look at all the security layers and identify where they could do better. On top of the pure security aspect, HIPAA requires documented policies that describe how each HIPAA requirement has been met. Most startups are far from having the volume of documentation required to meet HIPAA compliance.

What are the biggest challenges or obstacles facing your startup clients?

They are resource constrained and tend to focus on product development and getting pilots lined up, rather than security. They don’t have people on staff who understand compliance, so it gets handed off to somebody who’s already got a full plate. Getting compliant is a big job, and staying compliant is a lot of ongoing work. Without dedicated resources and support from the top, it’s a real challenge.

How do you see the gap between your clients’ innovative technology and adoption by providers and payers (if they’re targeting insurance companies too)?

There are different challenges. If you’re developing a product for use in hospitals it can be an uphill battle, particularly if the product needs to integrate with the hospital’s EHR. Hospital IT teams are necessarily risk averse and often not up to date on cutting edge technologies. They’re not entrepreneurial, so there can be a culture conflict. But it’s not rocket science to integrate with an EHR. I would say the challenges in working with hospitals are more bureaucratic than they are technical.

Working with clinics and smaller practices has its own challenges. These folks have tight budgets and no cushion. If your product doesn’t save time – or worse, takes time – it will be a tough sell. If implementation takes time away from providing care, it’s costing the practice money. Your product may improve care but if it makes a simple clinical step complicated and time-consuming it’s going to be a tough decision for them to adopt it. It’s very hard to justify a product that may provide huge long-term benefits if it cuts into today’s bottom line.

Image: Kate Schafer – provided by Kate Schafer

Feb 25 2014

New approach to low cost simulation, e-learning style: meet SIMTICS Founder John Windsor

Professor John Windsor chose to specialize in pancreatic surgery because he saw this vital and difficult-to-reach organ as “the last frontier of general surgery, with huge challenges and still much to learn.” This gives you an idea of Windsor’s curiosity and drive — two qualities that led him to found SIMTICS.

SIMTICS is an innovative e-learning company that uses online simulation technology to train students in medical procedures. Windsor, who is Professor of Surgery at the University of Auckland, New Zealand, knew that you can’t teach practical procedures in a classroom and in the hospital. With the random presentation of patients it is not possible to plan systematic training. What is more, patients are less happy to be trained on. A new approach was needed and Windsor set out, with his colleagues, to develop a new way to train large numbers, even in remote areas, through low cost, high tech web-based simulation.

Windsor was inspired by the success of flight simulation for effectively training people in the high-risk aviation industry. In a similar way SIMTICS is using web technology to train for performing complex procedures while reducing risks to patients. Students can learn at their own pace from anywhere and are no longer as reliant on the availability of suitable patients and teachers.

Windsor joined me for an enlightening Q&A on his perspectives on education and innovation; how e-learning is revolutionizing medical training; and his motivations, concepts and experiences behind SIMTICS.

What has influenced your approach to medical procedure training?

An important influence was homeschooling our five children until they were teenagers which taught my wife and I a lot about learning. We learned about differential readiness and different learning styles. We learned about how periods, classes, assigned topics, and homework and didactics are barriers to learning. A child who is learning will keep running with something they are interested in. They’ll be more spontaneous because they enjoy their learning. To force a kid to take a step they’re not ready for will turn them off. In homeschooling the learning is self-paced. That allows a child to stay on task and keep mining that opportunity for as long as they like. The success of homeschooling, which was a radical departure from traditional education, gave me courage to try something new with teaching in medical school.

Another important input for me was being involved from the very beginning of the laparoscopic revolution. This was a game changer. For the first time we had digital images of entire procedures, but we also had a whole surgical workforce deficient in essential new skills for the new technique. My return to New Zealand in 1991 meant that I had the opportunity to develop and build a skills training and simulation center–the first in Australasia. But ultimately this too influenced me because of the increasing cost of providing skills and procedural training by short courses and refresher courses. Without huge subsidies it is difficult to provide a sustainable training program through dedicated skills centers with expensive hardware-based virtual reality simulators and there is the problem of ‘tutor fatigue.’ Taking people out of the work force for training also reduces service output.

So I have a lot of experience in the development, delivery and assessment of short courses to teach clinical skills and procedures. I learnt about how technology often drove courses, how courses needed to be repeated to address knowledge decay, how courses take people out of the work place and how expensive they are. I also learnt through my international travel and teaching about education faddism. Every self-respecting institution wanted their own multi-million dollar skills laboratory even before there was evidence for the reliability, validity and cost-benefits of simulation training. We still do not know if patients do better (the final and most important outcome variable) because of the new ways we teach.

How does the e-learning model fit with medical education?

Our education and frameworks are still last century. The learning space, the learning journey is more complex than it used to be. With the Internet, we should be designing things that are simpler and much more efficient. I don’t think we’ve been radical enough in thinking how learning might be.

We are moving into the age of personalized medicine and I think this needs to be matched with personalized learning. There are some extremely exciting developments in education theory and practice, which are often overshadowed by educational technology. Further, the use of the web as a platform for the delivery of education in healthcare is in its infancy. As such e-learning has tended to be an add-on to existing frameworks and pedagogy, and has not been used to re-invent the learning paradigm.

The biggest challenge of e-learning is getting past the limited mindset and current approach (limited to words and images) to incorporate interaction, simulation, decision-making, assessment and feedback. These are all possible. We should be supporting more personalized learning off-campus, so that teacher face-time can focus on higher-value activities, and in particular identify specific training needs through e-learning. That has been one of our goals at SIMTICS.

What motivated you to change the medical education delivery model?

The frustration of learning how to do clinical procedures and operations was apparent from the beginning of my training. Learning is reliant on the random admission of cases. It might be months before one saw a second similar case to practice what she had learnt the first time around. Not ideal for reinforcing learning. Further it is difficult to integrate all the inputs, which come at different times from past experience, experts, books, videos, conferences. To bring all learning media together on one learning platform was our goal.

So we started brainstorming about how procedural skills might be learnt in a cost-effective, individualized, durable, and accessible way that integrates and extends existing curricula and takes advantage of the internet and the cloud. The need drove a vision.

How did these experiences all add up to the formation of SIMTICS?

There were three of us at the beginning: a frustrated South African surgeon who was compelled to re-sit his surgical exams in New Zealand, a pediatrician who was a computer and IT expert, and there was me as surgical educator. It was the surgeon who suggested that it would be nice to bring all the learning materials together in one place to facilitate learning. It was the pediatrician who convinced us it could be done in an integrated and educationally sound way. So we sketched out, on a napkin, the computer interface that brought the core media elements together.

The surgeon missed his exam, the pediatrician retired and I was left standing, but not before we made some real progress with the concept. We did enough to win a national award and were offered a two-year residency in the IceHouse business incubator. This gave us the opportunity to build a business around the idea.

Why is cognitive simulation the cornerstone of SIMTICS technology?

Cognitive simulation is a point of difference for us, as it emphasizes that much of procedural learning is a mental process. And that much learning can take place before actually doing the procedure. There is an excellent study which demonstrates that mental rehearsal is just as effective as repeated practical courses for maintaining procedural skills, which emphasizes the importance of the cognitive element of procedural learning.

The SIMTICS integrated cognitive simulator allows the student to read the steps of the procedure and understand the basis for it, to watch an expert perform it, to interact with the anatomy relevant to the procedure, and then to do the procedure, with visual clues. The latter guided learning can be turned off and the procedure repeated as an assessment. This can all take place before the procedure is done in a patient. The procedure might be putting in a urinary catheter or a chest drain, performing a lumbar puncture or suturing a wound. And the learning experience can ensure that the right thing is done at the right time and in the right way to ensure a safe and efficient outcome for the patient. The learner gains confidence with competence.

The simulation component is special because of its simplicity. Rather than breaking the bank with a fully interactive state of the art gaming technology, we realized that this is not required for learning. When a complex procedure is deconstructed and the steps taught in sequence, it is possible to capture these sequences. The can be used as ‘pre-rendered’ sequences which play out when the right decision is made, or not if the decision making is wrong.

SIMTICS was the result of identifying an urgent need and creating an innovative solution. What does it take to become an innovative thinker? Is it within everyone’s grasp?

Innovation starts with an idea, and is usually fueled by a need. Being aware of needs and being skeptical about common solutions is important. The reality is that truly original ideas are rare, like the splitting of the atom to release nuclear energy. Most innovations come from new applications of existing ideas, a sort of cross pollination. An example of this is the innovation of putting a light weight power generator in a soccer ball so that kids playing football in the dusty village square can provide electricity for lighting or the water pump for the family. The power generator technology is not new, but the application is innovative. I think we have done this at SIMTICS by bringing together ideas in education and technology and applying this within a new e-learning paradigm of cognitive simulation.

Images: John Windsor, SIMTICS

Jan 13 2014

How to Pitch a Healthcare Influencer: Q&A with Forbes Columnist &Tech Innovator Robert Szczerba

“Rocket Science meets Brain Surgery” is the attention-grabbing personal slogan of Healthcare innovator Robert J. Szczerba. And he can back it up: Szczerba started out in Electrical and Computer Engineering at the University of Notre Dame, where he performed research with the Jet Propulsion Laboratory. He then spent more than 15 years at Lockheed Martin as a Chief Engineer and later Corporate Director of Healthcare and Life Sciences.

Today, Szczerba is out to revolutionize Healthcare through advanced technologies. He left Lockheed in 2013 to form X Tech Ventures, a company built on William Gibson’s famous quote: “The future is already here, it’s just not evenly distributed.” For Szczerba, this quote captures “a simple message: that the answers to some of our most complex problems may not be light years away but may simply require a more informed look at the present.”

Why did Szczerba turn his focus from aerospace to healthcare? “My interest in healthcare arose about 6 years ago when my son was diagnosed with autism,” he explains. “That experience gave me insights into the deficiencies of the healthcare industry and also motivated me to find ways to improve it.”

At X Tech Ventures, Szczerba oversees incubation and acceleration of technologies for diverse companies. He also writes a column at Forbes exploring the “intersection of technology, innovation, and healthcare.” I did a Q&A with Szczerba to learn how healthcare PR pros can connect and collaborate with industry thought leaders and innovators.

Do you see the Forbes column as a media trend, where industry executives–not journalists or editorial columnists–are viewed as thought leaders?

“I’d compare the media trend today of using industry executives as columnists with a similar situation in sports broadcasting from several years ago. In that case there was a lot of controversy when a professional player went directly from the field to the broadcast booth. The feeling from traditional broadcasters was that the player ‘didn’t pay his dues’ as they had. But the athletes became color commentators and were paired with traditional broadcasters to produce a higher quality product. I’m not a traditional journalist: I provide “color commentary” on the technology and healthcare space. I’m an opinion writer.”

What strikes you as good subject matter for a column?

“The subject matter that I’m most interested in revolves around looking at problems from different or unique perspectives…Can we take a common technology in one domain and apply it to another? Like the intersection of the aerospace and healthcare industries. Flight simulation is common in aviation to train pilots in very complex and stressful situations. You can test complicated scenarios on a simulator in a low-risk, low-cost environment.

So, what would happen if you built a ‘flight simulator’ for a hospital to train people on new procedures in the ICU or ER? Why should a nurse have to read a 200 page manual to learn how to use a new medical device when they could practice using the same device modeled on their smart phone?”

What do you find frustrating with PR people who contact you?

“I really don’t like ‘attack pieces.’ People often pitch me stories that attack another person, product, or concept. I have no issue with writing a critical piece about another person’s idea, as long as I have an alternative approach to put forward.

Destruction is easy; but creation is difficult. When people pitch ideas that criticize products or concepts I always ask what their approach is and why it’s better. Unfortunately, more often than not they rarely have a good answer.”

What do you find helpful?

“I appreciate it when someone sends me comments or suggested topic ideas, but not as part of a formal pitch. For example, sometimes people send me comments on my recent articles suggesting another article for me to look at that takes a different point of view.

I also appreciate it when PR people have done their homework on what I write about and are able to give a quick 30-second summary of why this topic might be of interest to my readers.”

Who or what is your ideal source?

“I don’t think my ideal source falls into any one particular category. I tend to reach out to people who are passionate about their topic. Someone who wants to change the world and is cocky enough to think they can. These are the people I want to talk with.

Who says that the greatest ideas need to come from the chief of surgery from a major hospital as opposed to a charge nurse in a rural clinic? The best ideas don’t always come from where you’d expect them.”

How do smaller companies grab your attention?

“For my columns, I don’t differentiate between large and small companies; I only differentiate between large and small ideas.”

Image provided by Robert Szczerba: