Dr. Joe Kvedar is the Residency Program Director of the Department of Dermatology at Harvard Medical School. He is also the Founder and Director of the Center for Connected Health, an organization whose provocative goal is to help patients “become their own primary care provider.” I caught up with Dr. Kvedar at a recent health conference, and asked him to explain what his company’s approach contributed to the healthcare landscape.
Dr. Val: What is the Center for Connected Health?
Dr. Kvedar: Connected Health’s mission is to empower patients to be maximally in control of their own health destiny. As much as possible, we’d like to see patients become their own primary care provider.
There are three principles that must work together to accomplish this: first you must have accurate information about the health behavior that you want to change. Measurements must rely on quantifiable data (like the step count of a pedometer) rather than more general self-reports of how physically active you are. Second, the report must be in a format that offers specific feedback to the individual. Trending of information is critical, but the trends must be understood in context. For example a patient with diabetes needs to see how their blood glucose levels are behaving over time, but more than that they need to see how their food intake was influencing these levels. And third, data-driven coaching inspires the application of data to real lifestyle improvements.
Giving accurate information about yourself (in a format that is contextually trended over time) to a person that you trust can inspire behavior change. People are more likely to change their unhealthy choices when they know they’re accountable to someone for them. An appropriate coach can be anyone from a friend in a social network to a digital avatar, to a doctor or nurse.
Dr. Val: So what’s the rate limiting step in getting this behavior change model adopted? Is it lack of financial incentives?
Dr. Kvedar: That’s certainly part of it, but it’s even more than that. Healthcare providers gravitate towards human resource-intensive solutions. Providers are simply not used to thinking of technology as a tool. Instead, they often perceive the solution to better patient compliance as an increase in staff to serve them. But this is not feasible given our provider shortage and increasing healthcare burden. It’s just really hard for doctors to imagine that patients could be coached effectively by an avatar, yet there are many examples of it working. Read more »
Dr. Joseph Heyman
Alright I admit it, that was a rather provocative title. The truth is that at the end of a recent interview with Dr. Joseph Heyman, the chair of the board of trustees of the AMA, I was in fact chided for having left full time clinical practice. Dr. Heyman was rather avuncular in his tone when he stated,
You are robbing patients of the opportunity to have a good clinician like you involved in their care. I guess it reflects badly on our profession that the best and brightest are making alternative career choices – practicing clinical medicine is becoming unbearable.
No amount of protest on my part (about my volunteer work at Walter Reed) would convince Dr. Heyman that I hadn’t abandoned my profession to some degree. And it touched a chord with me too – because taking care of patients is very gratifying for me in many ways. It was with a heavy heart that I chose to become a medical journalist instead.
And so back to the interview with Dr. Heyman. We had an interesting discussion about the concept of medical tourism:
You may listen to our conversation here, or read my summary below.
Dr. Val: Is medical tourism about people coming to the U.S. for care, or about patients leaving the U.S. to get more affordable care elsewhere?
Dr. Heyman: Historically, medical tourism has been about patients coming to the United States to get high quality care. Nowadays, people are realizing that there are wonderful places overseas where they can seek treatment. If they don’t have a very exotic illness, or require a highly specialized procedure, they can get appropriate care overseas. Hip replacements are a good example of a standard procedure that can be performed without too much difficulty. It wouldn’t be as much of a draw for patients who need hip replacements to come to the U.S. Read more »
Skip Brickley is the master mind behind the popular Consumer Health World conference series. He is a natural communicator, and a bundle of positive energy. I was pleased to have the chance to interview him last week about his provocative views on healthcare reform. Enjoy the conversation:
Dr. Val: Tell me about the importance of “community” in healthcare reform.
Brickley: I’ve been thinking about the healthcare problem in this country for many years. First of all, I believe that the wellness of a community is related to the economic health of that community. Therefore, improving healthcare is about improving the economic health of this country at the community level. Successful communities like Silicon Valley, Raleigh-Durham, and Cambridge, Massachusetts have similar underlying reasons for their success: they figured out what they’re good at, learned out how to monetize it, and then found the necessary support for a global reach. They involved all the key stakeholders (at the community level) in their singular purpose: educational institutions, government, consumers, businesses, and non-profit partners.
Although I don’t agree with Hillary Clinton on her approach to healthcare reform, I think she’s right about starting at the community level. Our education system must teach people to value their health as their #1 asset, to provide them with the tools and training necessary to manage their personal finance, and to create ongoing programs to keep the community focus in the forefront. People need to feel that their health choices don’t just affect them, but it impact their entire community.
For example, when we realized that second-hand smoke could be deadly to others, we were able to enact legislation to ban smoking from common areas, and dramatically reduce the population’s overall exposure to cigarette smoke. We need to make that leap in healthcare too – for example, eating two Big Macs at a time is like second-hand smoking for those around you. Because that kind of lifestyle choice is going to cost your community a lot in the future when they have to pay for the inevitable health consequences of such behavior.
When the individual consumer has no contract in the health relationship, any health initiative is doomed to fail. Community leaders must rise up to help us change the culture of health in America. We must align healthcare with community economics – providing incentives for behavior change, and effective education to make people aware that bad choices affect us all. Cowtowing to the whims of consumers is what caused our current financial crisis – we need leaders who will do what’s best for communities, rather than follow faddish trends.
Dr. Val: What is “Health 3.0?”
Brickley: Health 3.0 is where the consumer and the provider engage online together. If providers don’t connect with consumers online, there will be no trust developed and the two groups will continue to exist in parallel universes.
Dr. Val: What inspired you to create the Consumer Health World conference?
Brickley: I wanted the conference to be a catalyst for change. I’m a conversation facilitator – and the event brings together key healthcare stakeholders so they can plan a multi-faceted, community-based approach to healthcare reform. If we can inspire communities to organize themselves around personal responsibility, teamwork between providers and patients online, and legislated incentives for behavior modification – all the while using the “Silicon Valley model” to encourage entrepreneurial, local economic development – we can reform healthcare and improve the health of this country, one community at a time. Consumer Health World stimulates discussion amongst the people who have the power to make these changes a reality. I can’t wait to witness the fruit of these discussions.
The “Health 2.0” movement is about “consumer directed healthcare” and proposes to empower patients with online tools and technologies to help them manage their care and take control of their health. Some Health 2.0 initiatives have been quite popular – though many suffer from lack of participation on the part of consumers. Having your own personal health record sounds great – but when you’re the one who has to manually enter the majority of the data into it, only the most motivated patients will participate. Access to online physician ratings is appealing – but when everyone wants to read the ratings, but no one takes the time to complete the ratings questionnaire, the value of the tool is lost.
Over the past few years there have been a number of regularly repeating conferences created to unify key stakeholders around healthcare’s digital agenda – Health 2.0, Health Care Consumerism, The Healthcare Globalization Summit, Health 3.0, New Media Expo, Blog World Expo, Health 4.0, the AMA’s Medical Communications Conference, and more. Thankfully, these disparate groups with overlapping agendas are beginning to consolidate – offering new mega conferences that simplify the learning and relationship-building process.
My observation as an attendee of several of these conferences is that providers and patients are still not coming together as they should. Online healthcare solutions tend to be created in a lopsided manner – either by consumer/patient groups without much provider input, or by providers/health plans/governmental agencies without much patient/consumer input. The result tends to produce two types of products 1) active online groups and tools that facilitate both helpful information and misinformation or 2) products that advance good concepts, but have low participation due to lack of user-friendliness.
The current conference version “arms race” (to attract the most powerful vendors and largest audience possible) is not terribly helpful. Whether you associate with Health 2.0, 3.0 or 4.0 – the bottom line is that the Internet is a powerful force in healthcare. It can provide many different kinds of tools that make valuable contributions to health education, care management, behavior modification, emotional support, and improved quality outcomes. In the wrong hands it can also mislead patients, promote snake oil, sensationalize health news, confound research efforts, misinform, and mislead.
There is no more critical time than this for providers and patients to join forces to guide the development of new online health initiatives. The successful execution of digital health platforms requires a patient-provider partnership – I can only hope that upcoming conferences will embrace this view more fully.
In my next few blog posts, I’ll provide you with some fascinating interviews with key opinion leaders from the recent Consumer Health World mega-conference in Arlington, Virginia. The interviews are as follows, so stay tuned:
1. Skip Brickley, founder of Consumer Health World
2. Joseph Heyman, M.D., Chair, Board of Trustees, the American Medical Association
3. Emme Levin Deland, Senior Vice president, Strategy, New York Presbyterian Hospital
4. Joseph Kvedar, M.D., Director, Center For Connected Health, Partners Healthcare