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Doctors and Disaster Relief: the Value of Technology and Data for HealthTap

Posted on February 2, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

In November 2015, when Tamil areas of southwestern India suffered from serious monsoon-related flooding that killed hundreds and caused the major city Chennai to essentially shut down for a week, local residents asked for help from an unusual source: HealthTap, the online service that offers medical advice and concierge care. This article explains the unique technical and organizational resources HealthTap offered, making it a valuable source of information for anyone in the disaster area with a cell phone or Internet access. At the end I will ask: what can public health institutions do to replicate HealthTap’s success in aiding the people of Chennai?

Disaster response from an unusual quarter
HealthTap, an online service connecting doctors and patients, has grown gradually but steadily in scope over the five years since its launch. It began by providing personalized answers, directly from practicing doctors, to individuals dealing with routine health issues such as pregnancy. HealthTap supported an ever-growing library of answers and continually added new services, leading to a concierge service. It expanded its services for doctors as well, providing easy consultations and discussion forums. It added a corporate (B-to-B) service that companies could offer to all their employees. And now, generalizing from their experience in Chennai, they have launched HealthTap SOS for disaster relief.

The Chennai intervention was requested by one of HealthTap’s clients, a company called Flex that had some employees in Chennai. When HealthTap started looking around for doctors in its network who had flood-related expertise, it turned up so much useful help that even the HealthTap leadership was surprised. CEO Ron Gutman explained to me that many doctors grew up in India, perhaps even got their degrees and practiced there, then moved to the US and joined HealthTap’s network. They are now able to help their country and local communities without actually traveling back.

HealthTap then discovered that their 85,000 doctors, located primarily in the United States, have come from 101 countries. Many languages are spoken, and many doctors intimately understand the cultures of other countries, as well as the medical conditions and disaster-related problems faced in them. HealthTap even organized psychiatrists and psychologists to advise and calm residents in the disaster area.

The organizational and technical elements of marshalling expertise
Public health and disaster agencies have networks of experts too, of course. But Gutman explained that these institutions can’t maintain a network as large and diverse as HealthTap just to prepare for occasional disasters. HealthTap’s strength is that it can redeploy a network developed to handle everyday medical conditions and turn it into a resource for communities struck by flooding or other disasters.

Doing so depends on the generosity and humane response of the doctors, of course, but it also requires a detailed understanding of the expertise offered by each of the 85,000 doctors in the network. According to HealthTap, they obtained crucial information on disaster recovery through crowdsourcing: they reached out to their network and asked the doctors to provide tips and checklists for managing during disaster situations. This turned up an abundance of information and offers to help.

Thus, HealthTap exemplifies the highly connected, intelligent expert network described in Beth Simone Noveck’s book Smart Citizens, Smarter State: The Technologies of Expertise and the Future of Governing. Such a network is more than a loose association of people in a given discipline: it is highly structured using details provided by individuals about themselves, or information collected from routine interactions.

In addition to this information-rich database of physicians, HealthTap has developed another technical advantage–once again, a set of tools they developed rigorously over time to facilitate routine care, but that also proves invaluable in emergencies. Their sophisticated search service can turn up information quickly that is relevant to the person logged into the system, based on information that the person reveals about himself or herself. HealthTap’s rating system (similar to those used on travel sites or other crowdsourced recommendation systems) brings up the best information out of millions of potential answers in their database. Although most of the Chennai residents asking for help found answers quickly in HealthTap’s database, HealthTap can also connect a person quickly with a clinician for one-to-one service. Because of the immense value of personalization, HealthTap suggests that public health workers set up an account with HealthTap before emergencies develop (an account they offer for a very modest charge).

General lessons
HealthTap did a great thing in Chennai, and their SOS service promises to be widely useful, especially in a world increasingly hit by climate change. But a private company such as HealthTap shouldn’t be the only institution with these resources for public health. Public agencies should take a leaf from Noveck’s book to set up expert networks with background on potentially useful experts.

Public health agencies already offer information during emergencies over the phone, broadcast media (do you ever hear “The following is just a test” announcements on the radio?), and popular information dissemination networks such as Twitter, but they could collect more information (voluntarily) from residents and allow them to connect to experts to answer specific questions when there is a need. For instance, if you depend on a medication and are running low in the aftermath of a major storm, you could find out from a specialist how to cope without it.

Technology and modern social organization offer a lot of tools to help the world deal with emergencies. Consider the well-known Ushahidi service, created in 2008 to coordinate input from local residents suffering from political violence and now used in a variety of situations. OpenStreetMap has also served disaster relief, used as resource along with Ushahidi during the 2010 Haiti earthquake. Public health agencies can learn from organizations such as these, along with HealthTap, to save lives.

My Optimism for Healthcare IT in 2016

Posted on January 1, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In yesterday’s post about physician EHR dissatisfaction in 2015 that there are many reasons to be optimistic about where healthcare is heading. I really am optimistic about healthcare IT in 2016. Here’s a look at some of the reasons I’m optimistic about 2016 improving healthcare and improving life for doctors.

Medical Knowledge Sharing – Platforms like Figure 1 are changing how medical knowledge is learned and shared. It’s impossible for any 1 person to keep up with the body of medical knowledge that’s available. That’s why crowdsourced platforms like Figure 1 are so exciting. Add in the AI developments like Watson and there’s a lot of cause for excitement about how patients will benefit from doctors getting the right information they need to provide the best care. I’m also excited by efforts to share best practices and clinical decision support findings between institutions. I’m hopeful that 2016 will mark a banner year for this type of sharing between medical professionals.

Meaningful Use Shackles are Broken – We’ll see if the government shuts down the meaningful use program or if doctors will essentially shut down the meaningful use program by not participating. Either way, I predict that 2016 will put meaningful use in our rear view mirror. The shackles of meaningful use will be broken and we’ll be able to start focusing EHR on things that matter to doctors and patients: improved care, improved productivity, and lower costs.

Data Sharing Starts Providing Value – Value based reimbursement and associated trends are pushing data sharing and I believe healthcare organizations are finally on board. No, 2016 won’t bring one central repository of all your healthcare data that any health care provider can access anytime. No, 2016 won’t bring ubiquitous sharing of all your healthcare data in exact the right place it’s needed at the right time. Those will both take more time. However, we’re going to see targeted sharing that makes patients lives better and lowers costs.

Patient Activism – The waves of sensors and high deductible plans is changing patients from passive viewers of their healthcare into active patients. Many won’t have a choice but to be involved in their healthcare since they can’t afford to not be involved. This will require some doctors some angst, but will ultimately be embraced and appreciated by most. This change in patient behavior is going to inspire a whole new breed of technology that enables patients and changes our view of healthcare.

New Care Models – A wide variety of new models have started in healthcare. Direct primary care and concierge medicine are two that have gotten a lot of attention. However, I’m not sure those will scale across all of healthcare. However, combine those with trends in telemedicine (which I believe is inevitable) and platforms like HealthTap which open up health care services in new, creative ways.

Healthcare Communication – It still shocks me how poorly health care has implemented the communication that’s available every where else in society today. I realize that privacy concerns has been used as the excuse for why healthcare is further behind, but that’s a poor excuse. I’m not trying to discount the need for applying appropriate privacy and security principles in these applications. I am suggesting that it’s possible to implement the latest communication technologies in healthcare in a HIPAA private and secure manner. There’s so much opportunity for health care to benefit from better communication that’s facilitated by technology that it’s impossible for this not to improve in 2016.

Those are a few of the things which have me optimistic for healthcare in 2016. I’d love to hear your thoughts in the comments. What will 2016 bring us?

HealthTap’s Integrated, Patient-Centered, Data-Rich Care

Posted on November 18, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Health reformers dream of integrated health delivery systems that leap across the barriers between providers, employers, insurers, and various supporting groups such as pharmacies and test labs. People who have investigated this goal realize that it can be achieved only by putting data in the hands of the patients. HealthTap recently announced a “health operating system” that suggests what this much-anticipated integration will look like.

In this article I’ll look at some of the building blocks HealthTap put in place, and then delve a bit into features of the health care landscape that support their work.

HealthTap has built an integrated health delivery system over a five-year period. They started with an audacious enough goal in its own right: signing up doctors to answer questions from the public. A couple dozen other capabilities were tacked on over time, such as ratings, various personalization features, and then checklists and a recommendation system for apps.

Doctor-to-doctor interaction is also built into HealthTap, echoing proposals in a 2012 book called #SOCIALQI. Doctors can check how peers handle cases similar to theirs, do online consultations, and carry out literal reviews online. Founder and CEO Ron Gutman describes the combined process as “virtual grand rounds.” And in a glowing endorsement by the medical establishment, HealthTap has won the right to grant CME to doctors for conducting these routine activities on its system.

Now the integrated impact of all these initiatives can be seen. Health care delivered through HealthTap might look something like this.

  1. An individual creates a HealthTap account directly with HealthTap, or in a private system that her clinic, hospital, or employer creates based on HealthTap. This brings the patient into the system, where information and other forms of communication take place. The provision of private environments run by single hospital or clinic is a recent innovation by HealthTap.

  2. The individual optionally adds information about personal data such as age, and conditions she is suffering from. HealthTap uses this to direct educational content at her, and to answer her questions in a personalized manner that is more informative than a typical web search. For instance, the query “Is aspirin good or bad for me?” would trigger answers that take the patient’s particular health information into account. HealthTap’s Personal Health Record (PHR) becomes the key component that links together the entire continuum of care.

  3. The patient can sign up for a reasonably-priced concierge service that allows her to request an online consultation with a doctor whenever she needs one. The doctor writes a SOAP note at the end of the consultation. He can also create a checklist of things to do (take medication every day, go to the gym, make a follow-up appointment in three months) and HealthTap will remind the patient to do these things in a way chosen by the patient to be convenient. HealthTap offers apps for both doctors and patients on all major mobile devices, including Apple Watch and Android Wear. Communications are HIPAA-compliant and have received SOC 2 Type II security certification, the highest level.

  4. A doctor can also order a lab test electronically. The patient can take the test and get results delivered directly and securely through HealthTap.

  5. All this information is stored in a record available to the patient. Therefore, data that used to be available only to institutions serving the patient (hospitals, insurers, labs, pharmacies), and was used only for marketing or improving service delivery, is now available to the patient.

  6. All the information ranging from patients’ online queries to test results become input into anonymized, aggregated sets that HealthTap gives health care providers. They can view dashboards of information about their patients, about people throughout their geographic area, about people with related conditions and demographics around the country, etc. Savvy institutions can use this data for value-based care and improving their outreach to at-risk patients.

Thus, a plethora of features that health care reformers are asking for appear in HealthTap, ranging from targeted educational materials to messages that promote compliance with treatment plans and even analytics. The service strives to make the experience as comfortable as possible for the patients, who have access to all their data.

The achievement of Ron Gutman, to whom I talked this week on the phone, and his crew is impressive. But we should also be aware that the technical infrastructure and features put in place by the health care industry play a crucial role. These include:

  • ePrescribing systems such as Surescripts, and electronic ordering for lab tests, along with coding standards to ensure the different parties can exchange messages

  • Electronic health records, which have become widespread only during the past five to six years since the start of Meaningful Use payments from the US government

  • Devices capable of secure messaging

  • Public health information provided by a number of government and private institutions

  • Analytics offered by a huge number of firms to health care providers

Thus, the health care ecosystem has been evolving for some time to create the possibility for an advance like HealthTap. Much more is needed throughout the healthcare system for instant communications and smooth data exchange. For instance, HealthTap hasn’t yet integrated fitness devices into its ecosystem. But HealthTap has built a huge service on existing system elements, which many more institutions could do so if we had a health care system as open and rich as exists in e-commerce.

Integrating Devices, Patients, and Doctors: HealthTap Releases an App for the Apple Watch

Posted on April 16, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Doesn’t HealthTap want the same thing as all the other web sites and apps crowding into the health space? Immediate and intimate connections between doctors and patients. Accurate information at your fingertips, tailored to your particular condition. Software that supports your goals where automation makes sense and gets out of the way at other times.

HealthTap pursues this common vision in its own fashion. This week, its announcement of an app for Apple Watch pulls together the foundations HealthTap has been building and cleverly uses the visceral experience that the device on your wrist offers to meet more of the goals of modern, integrated health care.
Read more..

HealthTap Offerings Track the Evolution of Health Care

Posted on August 15, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Health care evolves more quickly in the minds of the most visionary reformers than in real health care practices. But we are definitely entering on a new age:

  • Patients (or consumers, or whatever you want to call them–no good term has yet been developed for all of us regular people who want better lives) will make more of their own decisions and participate in health care.
  • Behavior change will be driven by immediate interventions into everyday life, and health care advice will be available instantly on demand instead of waiting for an annual visit to the doctor. Health care will be an integrated into life activities, not a distinct activity performed by a professional on a passive recipient.
  • Patient information will no longer be fragmented among the various health care providers with whom the patient comes in contact, but will be centralized with the patients themselves, integrated and able to support intelligent decision-making.
  • Mobile devices will be intimately entwined with daily behavior, able to provide instant feedback and nudges toward healthy alternatives.

I have seen this evolution in action over several years at HealthTap, a fascinating company that ties together more than 10 million patients a month and more than 62,000 doctors. I interviewed the charismatic founder, Ron Gutman, back in 2011 before they had even opened their virtual doors. At that time, I felt intrigued but considered them just a kind of social network tying together doctors and patients.

Gutman’s goals for health care were far greater than this, however, and he has resolutely added ratings, analytics, and other features to his service over the years. Most recently, HealthTap has moved from what I consider a social network to a health maintenance tool with continuous intervention into daily life–a tool that puts public health and patient empowerment at the top of its priorities. And it may go even farther–moving from seeking help on illness to promoting health, which Gutman describes simply and winningly as “feeling good.”

The center of the offering is a personal health record. Plenty of other organizations offer this, most famously Apple’s HealthKit. HealthTap’s personal health record is unique in supporting the service’s search feature, where patients can search for advice and get results tailored specifically to their age, medical conditions, etc.–not just the generic results one gets from a search engine. It also ties into HealthTap’s new services, including real time virtual consults with doctors.

09-TAKE-ACTION-Customized-Checklists-HealthTap
Sample update from HealthTap

Gutman is by no means interested in maintaining a walled garden for his users; he is looking for ways to integrate with other offerings such as HealthKit and with the electronic health records used by health providers. He says, “The only entity that will win the game is the one that adds the most value to the user.”

Other new features tied in to the HealthTap services include:

  • A recommendation system for apps that can improve health and well-being. The apps are rated by the doctors within the HealthTap system, must be in Apple App Store or Google Play, and must be approved by the FDA (unless they are part of the large, new category of apps that the FDA has chosen not to regulate).
  • Off-the-shelf checklists to help patients manage medication, keep track of healthy behaviors, etc. As part of HealthTap Prime, a concierge service ($99 per year for the first person and $10 for each additional family member), the user can get personalized checklists from doctors, as well.
  • With the concierge service, subscribers also have the opportunity to directly contact a doctor any time, 24/7, on all popular mobile platforms, using live video, voice, and text.
  • The “Get Help” module in the HealthTap app provides useful checklists through all mobile devices, and even Android wearables. Patients can get reminders, useful links to relevant content, and other content pushed to their devices, at a pace they choose.

Some of these features–such as the recommended apps and personalized checklists–go beyond advice and constitute a type of treatment that is subject to legal liability. HealthTap has covered all its bases insuring doctors have insurance against mistakes.

The numbers show that HealthTap is a big community; comments received from Gutman about patients who say they’ve saved their lives show that it is an effective one. I think the choices they’ve made are insightful and illustrate the changes all health care institutions will have to make in order to stay relevant in the twenty-first century.

The Online Medical Visit … For Free

Posted on January 3, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In every situation online it seems like at some point someone takes the business model as deep as it goes and then someone just finally says, “Let’s make it free.” Readers of this site will be familiar with the leading Free EHR companies Mitochon and Practice Fusion (both advertisers on this site). They both seem to be doing really well and are working on some really interesting business models.

With my familiarity with the Free EHR business model, I was intrigued when I read about HealthTap’s model for basically providing an online medical visit for free. This was particularly interesting since I knew that HealthTap had received $11.5 million in funding recently.

Andy Oram summarizes what HealthTap is trying to solve really well:

In this digital age, HealthTap asks, why should a patient have to make an appointment and drive to the clinic just to find out whether her symptoms are probably caused by a recent medication? And why should a doctor repeat the same advice for each patient when the patient can go online for it?

Plus, he makes two important observations of what HealthTap has found:
1. Doctors will take the time to post information online for free.
2. Doctors are willing to rate each other.

It’s pretty interesting when you think about how many doctors visits could be saved using something like HealthTap. On face, I’d think that a site like this wouldn’t make much sense. Although, as I think back on my medical experiences I can think of about a dozen or so times where I tapped into my physician friends before going to the doctor. Basically, I wanted to know if going to the doctor would be worth my time or not. In about 90% of those cases I ended up not going to the doctor since the doctor wouldn’t have really been able to do much for me anyway.

As I think through these experiences, I realize that many people aren’t lucky enough to be like me and have lots of physician friends around to ask the casual medical question. I could see how HealthTap could fill that role.

One key to this model is that it doesn’t always replace the visit to the physician. In fact, in a few cases I was told that I’d need an X-ray and that I better go see the doctor. In that case I was more likely to go to the physician since I knew I needed to get something done. I already knew the physician would do something for me when I went so I didn’t have the fear that they just tell me to take some Tylenol and be careful with it.

I’m not quite sure if doctors would be glad to actually have only people that are sick visiting their office or not. Maybe they enjoy the break of the easy patient that doesn’t require any effort on their part.

I think there are still questions about the quality of information that patients will get on HealthTap. This is going to be the most interesting issue to follow. No doubt they’re going to be toeing a fine line called medical advice. However, whether it’s HealthTap or some other online source that someone likely finds through Google, people are going to be looking for this kind of health information online. The idea of a free online medical visit sounds good to me.

Let’s also not be surprised if the Free EHR vendors eventually get into online visits as well. Seems like a natural progression for them to offer this service if they wanted to go that direction. From what I understand they have plenty on their plates right now, but a few years from now it could get pretty interesting.