Keynote presentation “Wearables – the future looks bright” by Prof. Dr. Koen Kas at Belgian Dermatology Days, Feb 16, 2016

Advance.Healthcare partner, Prof. Dr. Koen Kas, will deliver a keynote presentation “Wearables – the future looks bright” at Belgian Dermatology Days on February 16, 2016.  This conference is organised by the Belgian dermatology and venereology association. Find out more about the conference here:

http://www.belgian-dermatology-days.be/sitecore/content/be-bruga/bdd/home.aspx

Bart Collet over e-health: “Technologie in functie van betere ouderenzorg”

Als zaakvoerder van Woonzorgcentrum Huis Vandecruys zoekt Bart Collet dagelijks naar manieren om ouderenzorg betaalbaar én comfortabeler te maken. E-health – lees de implementatie van technologische vooruitgang – speelt daarin een belangrijke rol.

Huis Vandecruys werd in 1981 opgestart door Barts moeder die als verpleegkundige een alternatief wilde bieden voor de zorg die ouderen op dat moment in Antwerpen konden krijgen. Bart groeide op tussen de bewoners van het WZC – wat zijn spontane contact met de ouderen vandaag wellicht verklaart. In 1995 nam hij de fakkel over en sindsdien tracht hij als innovatieve zaakvoerder elke dag opnieuw het passieproject van zijn moeder te verbeteren waar het kan.

Technologie als opstap naar comfort

Bart Collet: “De voorbije jaren liepen technologie en verbetering van onze dienstverlening hand in hand. Al snel hab ik de de papieren administratie vervangen door een systeem met een centrale server. Dat was een primitieve voorloper van het intranet dat we vandaag hebben. Elke zorgkundige, kinesist of fysiotherapeut heeft een tablet met alle patiëntengegevens bij de hand. Zo is het overzicht van alle medicatie, specifieke persoonlijke zorg, maar ook de agenda en alle contactgegevens van de familieleden met een enkele swipe raadpleegbaar. Moet Mariette volgende week voor een onderzoek naar de specialist? Dan komt dat in de gedeelde digitale kalender. Daardoor weet de kinesist dat Mariette die ochtend niet aanwezig is, de zorgkundige weet dat hij Mariette moet klaarmaken voor het vervoer, en Mariette zelf kan bij iedereen navragen wanneer haar afspraak is.

Dat digitale systeem bespaart ons enorm veel tijd. Dat is noodzakelijk, want we moeten steeds meer zorg verstrekken met steeds minder personeel. Dat is een uitdaging waar de zorgsector voor staat.”

Betere zorg, lagere kost

“Ik ben ook voortdurend op zoek naar manieren om onze bewoners betere zorg te bieden die minder kost. Een voorbeeld? Heel veel van onze mensen dragen ’s nachts incontinentieluiers. De zorgkundigen van de nachtdienst controleren en vervangen die regelmatig, maar daarvoor moeten we de mensen wakker maken, wat natuurlijk vervelend is. Bij zo’n controle wordt ook een droge luier vervangen; dus veel luiers worden verspild.

Die routineklussen kunnen met de nodige technolgische hulp efficiënter én economischer. Stel je voor dat een elektrode in de luier aan de verpleger laat weten wanneer hij vervangen moet worden. Dat betekent snellere hulp bij een natte luier – hoger comfort dus– en geen verspilling van droge luiers – lagere kost. Die technologie komt eraan en is niet eens duur. Integendeel zelfs. Door de hogere efficiëntie kom je goedkoper uit.”

Bruggen slaan tussen zorg en technologie

Omdat er op dit moment nog een grote kloof blijkt te bestaan tussen de werelden van technologie en zorg, heeft Bart zelf heel wat pionierswerk laten doen voor Huis Vandecruys. Bart: “Als ik met collega’s praat over de mogelijkheden van technologie in de zorg, valt hun mond regelmatig open van verbazing. De meeste zijn er niet mee vertrouwd en gaan er daarom ook niet zelf naar op zoek. Bij mijn contactpersonen in de wereld van digitale ontwikkeling merk ik precies hetzelfde. Ze hebben een enorme knowhow van technologie, maar geen enkele voeling met de noden van de gezondheidszorg. De twee partijen vinden elkaar niet, terwijl de zorg- en de technologiesector samen prachtige verniewingen kunnen ontwikkelen!”

HealthStartup

“Samen met Leo Exter, die thuis is in de wereld van startups, begonnen we ideeën uit te werken om de kloof tussen zorg en technologie te verkleinen. We versterkten ons team de voorbije jaren met Frank Boermeester en Prof. Koen Kas en startten met HealthStartup.eu, een platform dat startups en belanghebbenden uit de gezondheidszorg met elkaar in contact brengt. We zoeken naar manieren om dat zo productief mogelijk te doen: niet door oppervlakkige contacten te leggen of lang te debatteren, maar door onmiddellijk pragmatisch te beginnen ‘werken’ aan projecten. Wie een idee wil lanceren moet van patiënten kunnen horen: ‘mooie technologie, maar ik zou het nooit gebruiken’. Of de kritiek van een ziekenhuisdirecteur kan zijn: ‘Lijkt me een handige tool, maar ik krijg dat nooit logistike georganiseerd in mijn instelling’. Dat is het soort feedback waarmee een startup aan de slag kan om de otnwikkelingsrichting verder te bepalen.”

Antwerpen wereldstad voor wearables

“Op het vlak van e-health beweegt er ondertussen heel wat. Op 24 september vindt in Antwerpen bijvoorbeeld Aging 2.0 plaats, een wereldwijd evenement waar startups ideeën pitchen rond ouderenzorg en technologie. Het Flanders Fashion Institute is volop bezig met wearables: technieken die technologie verweven in kledij. Je kleding zou dan je hartslag, bloeddruk en andere parameters kunnen meten. Ook dat opent heel veel mogelijkheden rond ouderenzorg! Antwerpen zou een voortrekker kunnen worden op het gebied van wearables, gezondheidszorg en mode. Dat zou een prachtige kruisbestuiving zijn. Maar we zullen snel moeten zijn, want voor je het weet kapen andere steden de kroon weg. Milaan en New York zijn ook al intensief met dat soort innovatie bezig.”

Original article at Ondernemen In Antwerpen

 

In defence of digital health

In a recent post Dr Saif Abed explains why he turned his back on the digital health sector and instead aligned himself with “enterprise scale healthcare IT infrastructure vendors”.  A sampling of the argument: digital health products are “gizmos”, they have “no impact on the practice of medicine or the management of patients”, they lack “evidence” in the sense of proven business models, they’re not interoperable, they’re “anti-doctor”, and they’re “skewed to app-only solutions.”

Some of the criticism is valid. But in my mind he’s confusing the issues and overstating the so-called schism between digital health and healthcare IT. There are at least three distinct issues here that need untangling:

Digital health as anti-doctor: Many digital health proponents (but not all) are concerned with patient rights and see open/cheaper/consumer technologies as an opportunity to improve those rights. The point for such folks is not to improve the ‘management of patients’ by people with ‘clinical experience’ but to develop tools that give ordinary people more power and control over their health and healthcare. Yes, that’s anti-doctor, but that’s fine and legitimate.

Digital health as unproven consumer technologies: Consumer technologies in the health sphere have lacked validation, scale and impact, true enough, but that’s changing as 1. major scientific institutes get in the game (e.g. Imec’s wearable health division), and 2. such institutes start partnering with major consumer technology companies (e.g. Imec-Samsung partnership), to 3. bring more robust, scalable, and open tech ‘platforms’ on the market (e.g. samsung Simband), giving startups/app developers (and healthcare providers) better tools to work with. Also, this platform trend should help solve the interoperability issues Dr Abed refers to. Robust consumer technologies (wearable sensors in particular) will HAVE to be connected to “enterprise” (hospital/doctor) systems. Interoperability is a challenge to be solved, not a reason to dismiss digital health. Furthermore, it takes two to tango. Enterprise-grade platforms may be big but that doesn’t make them interoperable.

Digital health versus Enterprise IT: Dr Abed argues that the digital health inspired focus on ’startups’ and ‘accelerators’ (the latter of which tend to select ‘easy-to-market’ and ‘app-only solutions’), have led to the neglect of ‘robust enterprise-grade platforms’ that tackle the ‘difficult healthcare IT issues’. Yes, a lot of flunky startups are receiving unwarranted attention, but there are many others who are tackling the difficult issues, in partnership with ‘enterprise’ customers (e.g. New York Digital Health Accelerator as a case in point http://digitalhealthaccelerator.com/portfolio/).

New innovative startups warrant attention because  a few ultimately do manage to expose the limitations and weaknesses of the incumbents, and thereby put in motion a process of creative destruction. The enterprise ICT sector has seen tremendous progress thanks to companies that used to be dismissed as ‘startups’ not fit for enterprise-grade needs (e.g. salesforce.com, amazon, Red Hat, Skype, etc). Incumbent  ICT companies have suffered (e.g. SAP) or have been prodded into action (e.g. Microsoft) because new competitors with cloud/saas/opensource/mobile/internet-based business models emerged, proving to customers that they could deliver equally robust & scalable solutions, solutions that moreover were cheaper, more flexible and more user friendly.

Furthermore, that old distinction between “startup” and “incumbent” is in decline. Most incumbents are trying to behave more like startups and cannot but embrace the underlying technological drivers of the startup movement. Also, they’re working more closely with startups, supporting and funding them, and even bringing them into their HQs.  Most large technology and pharmaceutical companies have initiatives in place to work with and learn from startups (e.g. Bayer’s Grants4Apps initiative  https://www.grants4apps.com).

The “us versus them” narrative isn’t helpful anymore. Digital health, eHealth, health ICT, call it what you want, ultimately we’re all just trying to figure out how technology can make a difference to people’s health and healthcare.

Mountains versus mole hills: what are the BIG ideas in digital health?

Your correspondent is in the Dolomites region admiring the mountains. Being a Flemish polder dweller, accustomed to flat horizons, these mountains really make an impression. They’re staggering. Huge, imposing and majestic. You can’t ignore them. In fact, they define this place – the landscape, the weather, the people, the lifestyles.

That marvelous view sparked a question. Where are those giant peaks, those all embracing bulks of rock in the world of digital health? Because in some ways, the digital health scene resembles more a patchwork of mole hills on a typical Flemish meadow.

What are (or what will be) the digital tools that will change forever the way we look after our health and practice medicine? What will be the giants, the staggering mountains, that define the future of healthcare? What will be the tools that every household or every doctor will need (as opposed to simply ‘want’), akin to the home thermometer and doctor’s stethoscope?

Here’s some thoughts on this.

An all-purpose home diagnostics device.

Consumers want simplicity. While today you can buy distinct devices for measuring body temperature, blood pressure, blood glucose, heart rate, body weight and body fat percentage, in the near future one or two devices will suffice to measure, track and interpret all of these. There will be a time soon when you can throw out all those old thermometers.

Companies to watch: Scanadu (developer of the Scanadu Scout, a multi-sensor device with tricorder ambitions),Withings (makes smart scales, activity trackers, sleep trackers, heart products and so on) and don’t ignore the incumbents such as Philips and Siemens.

A cradle-to-grave personal health management tool.

Today some of us use body trackers and a few of us may even make use of a personal health record of some form. Most of that activity is driven by specific health goals (e.g. losing weight), a chronic illness (e.g. medication and symptom tracking) or an atypical interest in self-tracking (Quantified Self advocates).

What’s missing today is a cradle-to-grave health management tool that helps people proactively manage their health and healthcare, encompassing features that are now still scattered among a multitude of different tools, covering health records, scheduling tools, health coaching, body tracking and aggregating/integrating/platform tools to bind it all together.

Interesting companies & concepts: OneLife.me, iChip and Hello Doctor (personal health record services that collect data from doctors and analyses data to provide insight), Dacadoo, Nuffield HealthScore, Higi and One Health Score (tools to track and manage your all-round health using an aggregated health score, Higi is also rolling out a network of health-assessment stations at pharmacies in the US), Validic (middleware platform offering easy connection to a wide range of body monitoring devices), Apple HealthKit and its companion app Apple Health (health dashboard that integrates data from third party devices, fitness apps and health records, also a platform for developers), Microsoft HealthVault (personal health record that connects to third party apps and devices, also serves as a platform for developers to build apps on).

A healthcare system navigator.

Companies like Zocdoc, DocPlanner and Castlight are showing the way here. Finding and buying healthcare services is set to change fundamentally as we gain access to ever more cost, quality and outcomes data. While Zocdoc and others are still pretty local (home market only) and niched in terms of the service they provide (booking a GP) I expect that at some point we will all be navigating the healthcare system, especially specialised services, in a very different way, more akin to how we’re buying travel products, music or books. Another company to watch is HealthTap, which has evolved from a Q&A site where doctors can build their reputations and patients find answers, to a far more ambitious platform incorporating online doctor consultations and health coaching. HealthTap’s model suggests that the distinction between the ‘navigation’ part and the ‘personal health management’ aspects may blur in time too.

An all-purpose doctor’s application.

Today most doctors rely on a medical record system (ranging from paper-based systems, to desktop-based to SaaS solutions), an appointment system (again, ranging from a paper-based agenda to a web-based calendar application allowing patients to set their own appointments), and a range of other information services and decision support tools (ranging from the classic medical textbook to decision support apps and doctors’ social networks). Looking ahead, telemonitoring dashboards and tele-consultation platforms should become pretty standard too. But ultimately all or most of these currently distinctly services will probably be wrapped in a single platform. Expect a battle of the giants as network effects take hold and synergies between medical records and decision support tools become viable (mining records for insight).

Interesting companies & concepts: PracticeFusion (free cloud EHR for GPs, major Big Data opportunity here, also has a patient portal called PatientFusion), Epic (major EHR supplier to hospitals, claims to cover over 100 million lives, developing mobile apps for providers and patients), InfoBionic (telemonitoring dashboard for doctors),SnapDx and MedX (clinical decision support tools), HealthTap (mentioned above too, it launched an online consultation service built on a vibrant Q&A community).

It’s a useful intellectual exercise. Are you building a mole hill (to be clear, there’s nothing wrong with a niche product) or a giant mountain that will change healthcare forever? Or another way of looking at it, apply the thermometer test: will you product attain total ubiquity? Will it be found in every household (or doctor’s cabinet)?

Any other big ideas out there? Let us know below or pitch them to the HealthStartup community as a project.

A Digital Health Manifesto

It’s easy to get excited about the future of healthcare. Thanks to advances in web and mobile technologies there is tremendous potential to create exciting new health services. Hundreds if not thousands of apps are being developed that touch on practically all aspects of healthcare, targeting patients-consumers, clinicians, administrators, insurance companies, researchers and healthcare authorities.

Something is clearly happening in healthcare, but a more fundamental question is, will technology enable a radical improvement in the quality, productivity and accessibility of healthcare. It’s an important question because the future of healthcare, from a budgeting and staffing perspective, is in fact not looking good. In most developed nations healthcare costs have been increasing rapidly (and faster than GDP) due to the rising costs of drug development and the increasing prevalence of chronic illness (in turn due to ageing populations). Those cost drivers aren’t about to disappear–and this while the world economy itself is suffering from chronic illness.

The future of healthcare may look exciting from a gadget perspective but there is in fact a real danger that healthcare in many countries will first get worse before it gets better. Hence the importance of the question: will technology-driven innovation be the right medicine, radically improving quality and productivity just when we need it? Unfortunately, the answer to that question isn’t simple. There are technical issues, legal issues, policy issues and business model issues to address.

However, looking at the state of technology and medical science today, it is  possible to imagine a radically different and vastly improved healthcare experience, especially from a consumer-patient perspective. It is a healthcare experience that should, in principle, be possible today if we found a way to deal with the various obstacles more rapidly.

Looking at the state of technology and medical science today, it is  possible to imagine a radically different and vastly improved healthcare experience

 

Let’s call this vision of a better healthcare experience a digital health manifesto (feel free to contribute to the manifesto – comment below or via Twitter and Facebook and we’ll update the text).

A Digital Health Manifesto

1. A transparent market for healthcare services, based on cost, outcomes and reputations

We expect access to a transparent market of healthcare services provided by hospitals, clinics, GPs, psychologist, life/health coaches and so on.  With ‘transparent’ we mean knowing who they are, how (cost)effective they are based on objectively gathered costs and outcomes data and how satisfied their customers/patients are. Ideally, we will be using one of several competing recommendation engines that suggest caregivers and healthcare programs relevant to my current health needs and location.

2. Access to remote/mobile health services

We expect many if not most of our interactions with healthcare providers to be done on a remote basis via online tools. This means we reduce the number of face-to-face interactions (and thus reduce travel, time spent in waiting rooms), while simultaneously increasing the total amount of time ‘connected’ to the healthcare system via remote monitoring technology and diagnostic services. An obsolete reimbursement model and regulatory framework should not be the reason why we have to sit in waiting rooms and neither should it prevent us from gaining access to more frequent and/or ongoing services that can be provided efficiently on a remote basis.  Thus, we expect access to a globally competitive market of remote diagnostic services, including genetic testing, tele-consultations and remote monitoring of health indicators (e.g. cardiac, blood pressure, sleep, etc).  We are willing to give these services access to our medical records and data if it improves their diagnostic and predictive power. And if we are chronically ill (or in need of geriatric care) we expect to stay at home for as long as is medically and technologically possible. We are willing to take more responsibility for our care, if we have the (monitoring/tele-health) tools and information to be able to do so.

3. Access to updated/complete electronic health records, medical knowledge and decision support tools

We expect our care givers to have access to the best and most up to date clinical information and medical decision making tools. These include accurate and always-up-to-date medical records, diagnostic tools, treatment guidelines and research results.  As patients we also expect to have access to such information, as a basis for constructive doctor-patient communication.  We do not tolerate medical errors.  We expect data-driven care; and we expect to have access to that data too.

5. Access to certified personal health record services, devices and wellness apps that integrate with electronic medical records and are accepted by clinicians

We expect access to a competitive market of certified and interoperable personal health record systems, devices and wellness services that can help us achieve our personal health and fitness goals.  ‘Certified and interoperable’ in the sense that these services can plug into clinical medical record systems and are accepted by clinicians. We want to take a more proactive and goal-orientated approach to our health, and we expect our general practitioner to help us in that regard.

6. All my anonymous health data available to researchers

We expect medical researchers and scientists to have access to our health records data – it is our data and it should be put to good (and meaningful) use.

The trouble with health data transparency

It’s disconcerting that the vision described above isn’t yet a reality.  It could be and it should be. The data is out there.  Also, there are thousands of developers and entrepreneurs clamoring to create powerful, user friendly health devices and apps.  The trouble is, a lot of the data while ‘out there’ isn’t yet accessible or being used optimally (meaningfully). Medical records are locked up in closed legacy IT systems. Doctors and hospitals have few incentives to share data and invest in open technologies. Current reimbursement models, privacy legislation and security concerns deter investment in new technologies and new ways of working.  A lack of standards and the fact that most new gadgets and apps are single-purpose products means that we’re not yet seeing powerful ‘ecosystems’ of synergistic products and services emerge.

Where are the platforms?

Looking at the history of recent technological progress it is clear that open standards and APIs (e.g. TCP/IP and HTTP for the web, Apple’s iOS for mobile apps, Facebook’s API for social gaming) have been instrumental in unleashing waves of innovation. Something similar is needed in healthcare. Imagine if developers had access to open or partially open data platforms that link up health/medical records, medical research data/results, treatment guidelines, and body-monitoring data.  The resulting boom in clinical informatics, clinical decision making tools, collaborative EHRs and other ‘Dropbox for health‘ type tools will put us on the path to data-driven care and likely lead to radical gains in healthcare quality and productivity. It will make our digital health manifesto a reality as opposed to a dream.

We all have responsibilities

To get there, all stakeholders in the system have responsibilities:

Policy makers need to focus on standards setting, ‘open data’ services and improved reimbursement systems (creating the right incentives).

Healthcare providers and their IT partners need to start opening up their systems and transition from a document management approach toward a patient-relationship/communication approach.

Medical information publishers such as academic journals and medical associations need to take a more innovative approach to IP and content distribution, so that the world’s medical knowledge is made instantly available to those who need it.

Startups need to think beyond single-purpose products and explore how they can plug into the existing healthcare plumbing and link up with other synergistic developers.

Progress certainly is being made. For example, the US government has introduced legislation to encourage the interoperability of health information while other public authorities are building open data service platforms (e.g. Almere Data Capital/the Dutch Health Hub).

Healthcare providers are taking steps to open up their systems (e.g. the US Department of Veterans Affairs’ blue button initiative).  EHR providers too are beginning to open up their datasets to external developers (e.g. EHR company PracticeFusion is working with Prior Knowledge to open up the dataset to developers and entrepreneurs).  And EHR providers like Avado and PatientsKnowBest are trying to build systems that are more patient-doctor collaboration tools than clinical document management or bill-generating tools.

Startups too are beginning to think about APIs.  For example, data storage and file sharing company FolderGrid is not only focused on building a secure (HIPAA-compliant) system but is also trying to create an open platform on which other IT developers can build.  Makers of body-monitoring gadgets like GreenGooseare releasing APIs so that 3rd party developers can build apps on top of their platform.

And the path to data-driven care is being cleared by companies such as HumedicaArchimedes and Predilytics who are developing advanced analytical and decision-making tools for doctors and providers.

Initiatives such as these are exciting but the digital health revolution, from a data integration perspective, is still clearly in the starting blocks. Many challenges around technology, business models, strategy and policy remain.

 

(Image credit: http://geoffmcdonald.com/the-manifesto-manifesto/)

Europe’s digital health scene: to stay or go? (Rock Health guest contribution)

Is Europe an attractive region for health startups – or should we all ship off to Silicon Valley?

by Frank Boermeester

The digital health scene is on a roll, no doubt. But this is mainly a U.S. story.  Have you heard of one European health startup that is really breaking through?  Probably not.  We know of Withings (a maker of personal body monitors) and Scanadu (developing personal diagnostic devices). To call Scanadu European would be a stretch – it has Belgian roots but set up shop in Silicon Valley at its founding.  Will this export of talent and ideas to the U.S. be the fate of Europe’s digital health sector?  Or will European stars like Skype and Spotify show us the way?

… (check out the full article on Rock health here)