It started 20 years ago with a vision to leverage technology to improve access to care and efficiency. But instead of the iPhones and FitBits that are driving care today, it was a camera the size of a shoebox that offered game-changing potential. Today, Partners HealthCare Connected Health continues to push the envelope by transforming healthcare through tools like remote monitoring and virtual care. In this interview, Joe Kvedar, MD, talks about how the organization has evolved to meet the changing needs of patients and providers, why telemedicine is finally rising to the top, and the problem with statistics around patient engagement. He also discusses what encourages him most as a physician, and how CIOs can navigate this brave new world.
- The term “Connected Health”
- Telehealth’s struggles, then surge
- “Facetime and Skype changed the way we think about video.”
- Understanding doctors — “We are very methodical creatures.”
- Payers & retail as drivers of mobile health
- Remote monitoring on the rise
- Mobile tools for patient engagement — “It’s a journey.”
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Most of the time we’re talking about the same thing, and most of the time our choice of words has to do with our viewpoint. For us, we thought connectivity was a big part of what made this special. The initial vision was time and place independent, and you had to have connectivity for that.
We do things very methodically. If we translate that into the world of moving from face to face to digital, video seems like a comfortable environment, because even though you’re not in my office, I can see you, I can talk to you, and I can take a history.
Reimbursement is happening. People used to feel like they had to wait for that to be all nailed down, and now all of a sudden, they’re saying, ‘We know it’s going to happen so we better get going, and we’ll figure that out as we go along.’
Other industries have done this already for years. You check yourself in at the airport. You pump your own gas. You buy things online. You do your travel planning over a website. But in healthcare, we still think the only way we can add value is for you to come visit us in an office. We have to make that leap, and it gets into the idea of using mobile engagement tools, and eventually, artificial intelligence.
Gamble: When you talk about Connected Health, what came to mind for me was mobile health, but that’s just one aspect of it.
Kvedar: The naming thing has always been a problem in this space, and I contributed to it — not with malice. I mentioned earlier we called ourselves telemedicine in the beginning. Some people in the mid-90s came in and said, ‘We ought to call it telehealth because if we call it telehealth, we can talk about educational activities and other things and broaden the scope.’ And so we had this debate. Parenthetically, I was president of American Telemedicine Association about 10 years ago, and we spent a whole board meeting debating whether we should change our name to telehealth or stay at telemedicine.
So it was a big deal. It’s hard to believe this because it’s so hot right now, but 10 to 12 years ago, telemedicine was a bit like a millstone around your neck. We were doing all these other things with what we now call wearables — we didn’t have that term then — home monitoring and sensors, stuff like that. We coined the term ‘connected health’ in 2006 because we needed a new way of talking about what we were doing, and so that became another term that’s now well adopted in the industry. Other people still say it’s mobile health, and the term often used these days is digital health.
The only thing I would say about it all is that most of the time we’re talking about the same thing, and most of the time our choice of words has to do with our viewpoint. For us, we thought connectivity was a big part of what made this special. The initial vision was time and place independent, and you had to have connectivity for that.
When you get into the modern day with all the innovators doing ‘digital health,’ they’re doing everything from new ways of claims processing and new ways of getting people eligible for programs, to new ways of helping device companies market to doctors. All of this is under the rubric of digital health. The vision was to inspire you as a consumer or patient to take better care of yourself using these technologies, and that’s why we have stuck with connected health.
Gamble: It’s interesting what just using a different word can do, but I definitely understand what you’re saying. With telehealth, it’s interesting because that’s something that appears to be picking up more steam now especially with where the industry is headed. Are you seeing a renewed focus on telehealth?
Kvedar: Yes. As I said, it’s hot right now. It’s hard to believe that 10 or 12 years ago we were shunning the term. But if you go back 12 years — that puts us in 2004, 2005 — we didn’t have something called an iPhone yet. There were smartphones, but they were very clumsy and their interface really wasn’t great. It was the way the iPhone was designed that changed the world and that changed the notion of how people thought about communication. You have to give Apple credit — Facetime and Skype really changed the way we thought about video.
What happens is doctors are very methodical creatures on purpose. We don’t want to put you at risk. For example, I’m a dermatologist. If you come see me and you say, ‘I have a spot on my arm,’ I will do the same exam starting with your scalp all the way down to your toes, and then I’ll look at your arm. It’s just the way we’re trained. We do things very methodically. If we translate that into the world of moving from face to face to digital, video seems like a comfortable environment, because even though you’re not in my office, I can see you, I can talk to you, and I can take a history. And by the way, if you’re a mental health patient, I can do my exam, because it’s the same.
You’re seeing this surge of interest in video, partly driven by the payer community. The see it as a stay-in-business, table-stakes type of offering now, partly driven by retail pharmacy extending clinics into the virtual space. And you’re seeing healthcare providers around the country saying, ‘We’ve got to get on the bandwagon here because in the same way patients are expected that they can use Seamless or Uber, they’re expecting healthcare to have some components of that ‘right in your mobile phone when you want it’ experience. The first phase of that is video, and yes, reimbursement is falling in line. The technology is relatively easy now, so it’s starting to feel like a snowball rolling downhill, for sure.
Gamble: It seems to be another example of how things like Connected Health have seen such huge growth but that hasn’t always translated into high adoption in healthcare. Much has been made of that and for good reasons, but there are different barriers when it comes to healthcare and that’s something that can’t be overlooked.
Kvedar: It’s interesting. The resurgence of virtual visits or video care has several components, one that for years was viewed as holding it back. We always had our classic barriers of workflow, reimbursement, and liability. All of a sudden, even though reimbursement isn’t quite figured out, people are moving ahead because they feel like they have to. It’s the fear of missing out — ‘everyone else is doing this. We’ve got to get onboard or we’re going to be left behind.’
When you see that tipping point in any adoption curve, it’s an interesting time, and I dare say we’re at that tipping point for the use of video for patient care. Of course, now there are multiple, well established firms who will handle all this for you. We just happen to be doing an RFP and an RFI around this topic here at Partners. I’m reviewing them as I have time, and we’re meeting tomorrow to review responses to an RFP. So it’s quite timely.
If you look at what the industry offers, it’s easy technology. They offer physician networks now that are licensed all over the country so that if you want to open yourself up to video that’s really place-independent, you can. If it’s not your doctor, you’ll be able to get a doctor on the phone to talk to that person that’s licensed in the state. The world’s changing pretty rapidly, and as I said, it’s largely being driven by people feeling like if they don’t get onboard, they’ll be a dinosaur.
The interesting thing is that reimbursement is happening. People used to feel like they had to wait for that to be all nailed down, and now all of a sudden, they’re saying, ‘We know it’s going to happen, so we better get going, and we’ll figure that out as we go along.’
Gamble: When you talked about taking on more risk, what we’re hearing is that hospitals are moving towards it but very cautiously. What are your thoughts on that and how that’s going to start to change?
Kvedar: Again, I think in the realm of video, it’s a future that they can easily comprehend. It doesn’t give people the willies. The way other end of the spectrum is artificial intelligence driving clinical decision making and driving patient interactions, whether it’s something like Amazon’s Alexa, or what have you. That gives people the willies because they say, ‘Is my job threatened? What does that mean? Don’t I have relationships with my patients? Aren’t I smart? Is this computer really smarter than me?’ All those gut level fears come into play when you start talking about the state of the future. Whereas if you just say, ‘you know what? Instead of doing your sore throat check-up/follow-up in-person, let’s try doing it by video.’ And maybe if the person has a blood pressure cuff you can do a blood pressure check that way. And yes, we’ll find a way to pay you for it, and yes, we’ll integrate it into EMR.’ All of sudden, people are saying, that makes sense.
It’s a journey. And I think the next thing after video is going to be remote monitoring for medical illness like blood pressure and heart failure. In some ways, heart failure is already pretty well established as a disease that is very responsive to this kind of approach, both in terms of decreased readmissions and improved mortality. We’ve even demonstrated lower total medical expense if you do heart failure monitoring, so that seems to be poised for growth.
The third one that I talk about is what do I do if I’m a clinician with a patient who’s eager to upload their Fitbit data and what am I going to do with wearables and mobile apps? Do I recommend a certain mobile app? I’m worried that if I recommend it and it’s not right, then there’s no way for me to curate them. All of that anxiety has got to be fixed.
Then the fourth part of the journey, in my opinion, is using mobile tools for patient engagement, which takes a leap of some of the work that I do as a doctor, and gives it to patients to do that work. Other industries have done this already for years. You check yourself in at the airport. You pump your own gas. You buy things online. You do your travel planning over a website. But in healthcare, we still think the only way we can add value is for you to come visit us in an office. We have to make that leap, and it gets into the idea of using mobile engagement tools, and eventually, artificial intelligence.
It’s a journey. We’ve still got a few miles to go, but it’s very encouraging to see this early phase excitement about virtual visits, because that’s going to really push us to accelerate adoption of some of these other things.
Gamble: When you alluded to the interest in innovation, is a good portion of that focused on things like mobile tools like texting or is it really just all over the road as far as what innovators are trying to do?
Kvedar: Our own group is focused on the latter, which is engagement and using engagement in thinking about how to design software that puts you in charge and inspires you to better health rather than having to passively involve a doctor for everything. That’s our passion and focus.
In the industry, people are trying to use the same platform that’s revolutionized everything from travel to how you hail a cab and how you order food. People see all of those innovations and they want to see which ones apply to healthcare. So there’s a very broad palette of things going on overall.