By Clinical Informatics News Staff  

November 3, 2014 | Last week on the downtown Boston waterfront, Boston Children’s Hospital convened its second annual Global Pediatric Innovation Summit, a conference with a strikingly futurist outlook to take on technologies and care models that challenge the way healthcare is conceived and delivered. Speakers like Fast Company founding editor Bill Taylor and Cisco Systems’ senior vice president and “technology evangelist” Carlos Dominguez gave broad-reaching addresses on cultures of innovation and the reasons successful organizations fail to adapt to changing consumer needs, while senior executives from IBM demonstrated some of the work their natural language processing supercomputer Watson is doing to assist physicians with diagnoses and treatment strategies.

One panel at the summit, held on Thursday morning to discuss mobile and digital health, illustrated the tension between technological promise and human limitations that innovators in the healthcare space are slowly learning to navigate. Moderator Scott Kirsner, who writes the Boston Globe’s Innovation Economy column, introduced the session by painting a half-joking picture of the “utopia” mobile health could soon bring about. “We’re all going to be wearing sensors,” he said. “These sensors are not just going to track our steps and our activity, but there’s even one sensor, called Pavlok, that can shock you if you’re going to sleep and you haven’t gone to the gym yet today. We’re going to take pill sensors, we’re going to have our microbiomes sequenced to understand what’s happening in our gastrointestinal tract, and our doctors and physicians’ assistants and nurses are going to care about all this data.”

In responding to that vision, panelist Mandira Singh, Senior Business Development Manager for cloud-based clinical management company athenahealth, zeroed in on the last part of the equation. “The view of so many consumers is that my provider doesn’t care about this data,” she said. “That is where we need to do a better job, and where the opportunity lies.” Singh argued that many mobile health companies, by catering to metrics like activity levels that are easy to gamify and which consumers enjoy tracking, have inadvertently contributed to this gulf between patients and providers by not taking into account whether physicians find their data useful. “There are plenty of startups and innovators out there that are making it right with the patient, but never including that third part of the continuum,” she said.

Singh suggested that physicians will be most interested in out-of-range readings, for instance from blood pressure monitors, and in data that contradicts what they’re able to see during brief patient visits. This kind of single-event notification to physicians would be both highly relevant to developing care strategies, and easier to absorb and parse than running tallies of daily activity.

 

Yet even this kind of discrete, physician-facing data collection can find itself disconnected from the realities of care. At one point, the panel discussed GlowCaps, devices attached to pill bottles that alert patients to take their medication and record the bottles being opened. Panel members were supportive of the product, but when Kirsner asked the audience whether this data would be practical, he was answered by a physician who had worked in a large hospice where patients arrived on as many as 40 different medications. Medication adherence with this kind of population is an issue not so much because of absent-mindedness, but because of the real difficulty of contending with such a poorly-coordinated drug regimen.

The implication seemed to be that, while adherence may seem to physicians like a problem that could be solved by better tracking, it really fits into a paradigm of placing the burden on patients to deal with often confounding medical advice. As Kirsner went on to say, “We’re seeing so much interesting stuff on the consumer pull side… I feel like there’s a complete failure on the part of my insurance company, any doctor that I see, any hospital, to communicate in an interesting way that engages me.”

Panelist Joseph Kvedar, Director of the Center for Connected Health at Partners HealthCare, had a slightly different view of how new mobile health technologies should touch patients’ lives. (For more on Partners HealthCare’s digital health initiatives, see “Thinking Outside the Office Visit at the Center for Connected Health.”) Rather than use new devices to enforce already-dominant methods of care, Kvedar believes we should use devices to increase awareness of general health, and to some extent trust that the incentive for interventions will follow.

“We’re at the very beginning of a point in history where healthcare will become a continuous function in your life,” he said. “Think about if high blood pressure were like a broken arm. You can feel a broken arm, you can seek care for that, but your blood pressure might be 160 systolic and you wouldn’t know. In an era of sensors you’re going to know.”

Like other sessions at the Innovation Summit, this one could be bold in its embrace of technologies that still seem somewhat eerie and alien today. “The wearables are very interim,” said panelist Nick Negroponte of MIT Media Labs, speculating about devices that could pave the way for truly widespread adoption of mobile health. “It’s going to be ingested. There’s no other way. It’s going to live in your bloodstream, there will be microrobots running around.”

“Having to wear something is like putting a thermostat outside your house,” he added. “It’s doesn’t make sense. It should be inside your house.”

One thing all the panelists could agree on was that the culture of today’s care providers is fundamentally an obstacle to a smarter health system. Because physicians want to emphasize preventive measures, like dietary changes and exercise, but lack the ability to message that in a routine and repeatable way, the interaction with patients is almost set up to be hostile and demanding. At the same time, issues like convenience and accessibility are deemphasized because there is little feeling that providers should work to attract patients, rather than simply dealing reactively with the ones who show up. “We are primed for disruption,” said Kvedar. “Minute Clinic has done a great job disrupting primary care, and others will follow.”

While mobile health developers can give physicians new tools for engaging with patients, and integrating healthcare more closely into our lifestyles, ultimately providers need to recognize that this also entails surrendering some power and agency to patients as managers of the doctor-patient relationship. While mobile health should respond to metrics that physicians can use and want to see, it must also offer immediate and tangible value to the end users. Said panelist Ido Schoenberg, whose company American Well offers 24-hour online access to physician consults, “We’re seeing a rebirth of the patient as a consumer.”