Digital Health IT for putting patients first

Using IT to put patients first

Dr. Aniruddha Malpani

MedTech advances

• EMRs and PHRs• Apps and Chatbots• Telemedicine ad mHealth• VR , AR and 3D imaging• Robotics• Genomics, Informatics and Biotechnology• Big Data and Cloud Computing• Blockchain• Sensors and Implants

Digital disruption

• Will Dr Watson make doctors obsolete ?

Doctors are reinventing themselves!

Toys for Boys

• Playing with cutting edge advances is cool • Often this is a problem in search of a

solution• Dreaming big is fine , but start small• Focus on basics

The google smart contact lens fiasco

What does a doctor want ?

•More patients !

Low hanging fruit

• Patients use Dr Google !• Create websites for doctors so

they can reach out to patients• EMRs and PHRs

Doctors are confused and worried

• Will a website be considered to be advertising ?• Can I do a consultation online ? Will I

be legally liable if anything goes wrong ?

Help the doctor to become more productive !

• Respect the doctor’s workflow• Healthcare interoperability is a huge pain

– none of the EMRs/PHRs talk to one another !• UX is not user-friendly• No redundancy and backups• Offline and online hybrid models needed

Doctors use smartphones more than they use stethoscopes !

• Everyone uses Whatsapp -- both for patient care; and for socialising• They can do a lot more with

the computer in your pocket !

The next generation !

Heartbuds – using the smartphone as a stethoscope

Peek – Smartphone-based Eye-testing kit

Hope, hype and harm• Engineers fall In love with the

newest shiny new object• Some doctors also want to be the

first to use the latest tech toys • Tendency to overuse, abuse and

misuse technology

• Solve one pain point at a time• Hard to change behaviour• Doctors have burned their fingers in

the past – don’t trust engineers• Think they don’t understand

anything about patient care

Alert Fatigue: A Clear and Present Danger• One month in UCSF ICUs (70 beds)

– 2,558,760 alerts– One audible alert every 7 minutes– What would get a nurse scared?

• vs. Boeing’s thoughtful approach to alerts– The principles of user-centered design

Drew B. Plos One 2014

Adaptive vs. Technical Problems

“… problems that require people themselves to change. In adaptive problems, the people are the problem and the people are the solution.

– Ronald Heifetz, Kennedy School of Government

Partner with doctors

• Get them to mentor healthcare startups so you can teach and learn from them

• Doctors as an angel investors• Help them to remain on the cutting edge

of medicine !

Doctor vs EngineerBridge the gap !

• Doctors are conservative – if it’s not broken, why fix it ? Cannot afford to experiment with our patients !

• Engineers want to break stuff and put it apart again !

• But not at the expense of patients !

“The difference between a doctor and a machine is like the

difference between a private banker and an ATM machine”

- Walter De Brouwer

Helping patients directly

• Patient engagement is the holy grail• Patients will usually do what their doctor says• Most are not active or empowered to do stuff

for themselves

What do patients use smartphones for ?

Fetal monitor at home

Smartphone based ECG monitor

Well vs ill• Don’t confuse the two !

Corporate wellness

• Who will pay ? • Seen as a cost center• Health Insurers • HRAs• ROI unproven

Doctor at Home - Qualcomm Tricorder XPRIZE

competition

Wearables

• Hype is dying out• High drop out rate• Used by a very small minority

Healthcare apps

• App fatigue• Focussed disease specific apps are

helpful• How do they make money ?

Where are the HIT success stories ?

• No Olas and Flipkarts in the digital health world so far• Practo has been richly funded, but

where’s the ROI for the investors ?• Or for the patients and doctors ? • No change in quality of medical care

Digital health is dead• Rob Coppedge, CEO of Echo Health Ventures in

Seattle , has been investing and working in health care for 20 years.

• Since 2014, about $16 billion in VC funding has gone into over 800 digital health companies.

• Entrepreneurs and investors need to take a step back to see how this will play out over the next decade.

Verticals

• Health insurers – disease management• Hospitals• Pharma• Government• Medical R&D• Biotech

Health insurers• Population health management• Chronic diseases such as hypertension,

CCF and asthma are expensive. Need to keep the patient out of the hospital• Apps for diabetes and asthma, but

changing behaviour is hard

Pharma – beyond the pill

• Information Therapy for Patient education • Improve patient compliance• Medication reminders , tracking

and logging

Government needs to promote digital health

• Current health expenditure very low• Create a website which prescribes

Information Therapy - the right care to the patient at the right time• Empower patients, so they can find the

best doctor• Reduce wasteful health expenditure• Telemedicine