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This is a short blog post on the way home from Connected Health 2009. I’m in the air on Virgin Atlantic typing on my iPhone connected to the web with inflight WiFi — that’s why it’s short and may have some typos.

First of all, Connected Health is a much bigger idea than the original idea of telemedicine, which was all about laying the painful last mile of technology to finally reach those with the greatest needs to communicate about health.

Connected Health, in contrast, is not about devices, sensors and gadgets. It is about the idea that how people connect with each other has a profound impact on health.

As Nicholas Christakis, author of “Connected”, reiterated in his keynote speech, our connections to each other, probably even more so that our connections to our doctors and nurses, has a measurable impact on our health.

Despite the big idea of connected health, too many of the Connected Health sessions followed the same format:

1. Most of the trillions in health spending is the result of chronic illness which in turn is the consequence of our lifestyle and behavior.

2. There is compelling evidence that connected health can improve quality and reduce the cost of care, referring to proactive care models that coach and monitor patients at home.

3. The only barrier to widespread adoption of a more rational model of connected care that will save our health system from impending collapse is Medicare coverage of remote health monitoring technologies.

This is the same conversation we had six years ago when we introduced the first connected health ideas as part of the Medicare Modernization Act of 2003. Six years later, it seemed like nothing had changed.

In fact, much has changed, and the next few years will be profoundly different than the past six. The fact is, we are all becoming connected in a tighter web of relationships enabled by technology. 300 million of us are on Facebook, maintaining a constant awareness of how our social network is faring. Soon we all will be able to keep tabs on our most important relationships on our smartphones.

When Grandma is also on Facebook, and her friends and family know how she is doing and she knows they still care, do you think there will be fewer crises that lead to hospitalization? I think so.

In a world where we can blog and tweet from an airplane while watching satellite TV, we surely have the tools to create the kind of connection that will improve healthcare. It’s going to happen, not because of policies and reimbursement, but simply because connected health is far better for everyone than isolation.

This year, the US will spend $2.5 trillion on healthcare, and no one really understands where the money will go. All we know is that we will spend twice as much as the rest of the modern world and we apparently will get worse results. We also know that there are wide variations in how medicine is practiced within this country, and there seems to be no clear correlation between spending and quality.

Escalating healthcare costs and the current crisis in the healthcare system has something in common with the recent financial meltdown. Both crises are rooted in information challenges: The underlying systems have not been transparent, with too many opportunities to game the system, until eventually the inevitable crisis hits.

Much like subprime mortgage applications, the underlying healthcare data that might reveal the true status and risks of the system are buried on paper and in silos. As a result, the risk is misunderstood, mismanaged, mispriced and ultimately shifted to the next sucker, the last one always being the taxpayer.

Just as the mortgage crisis has its roots in policies designed to help more Americans buy a home, healthcare also is full of good intentions gone awry. The fact is, the system has become far too complex for our old information technologies and methods to handle. Without a new information model we will continue to fly blind.

New Models for Linked Data

In 1998, Tim Berners-Lee, the architect of the web standards that enabled the Internet to fundamentally change the way the world is wired, described his vision for the web:

The Web was designed as an information space, with the goal that it should be useful not only for human-human communication, but also that machines would be able to participate and help. One of the major obstacles to this has been the fact that most information on the Web is designed for human consumption, and even if it was derived from a database with well defined meanings (in at least some terms) for its columns, that the structure of the data is not evident to a robot browsing the web.

The original web enabled the documents of the world to be linked together, and now we can find the world’s smallest needle in the worlds largest haystack in milliseconds. The next generation of the web, as envisioned by Tim Berners-Lee, is about linking data and meaning in much the same way we have already linked documents. This web of linked data enables a marketplace of ideas competing to create smarter and more useful services – without needing loads of capital to redevelop or integrate the old systems. (more…)

Matthew Holt, the author of this presentation on Health 2.0, is the founder of The Health Care Blog and the Health 2.0 Conference, an event that has defined a new paradigm for ehealth and brings together a new generation of creative thought leaders. This year, the Health 2.0 Conference will be held jointly with the Center for Information Therapy on April 22-23, 2009 in Boston.

My Reaction to Health 2.0 and the Convergence with Information Therapy:

Health 2.0 makes Information Therapy practical and possible. Health 2.0 is about individuals creating and sharing more of themselves online in a way that improves their own health, the health of others they are connected to, and the health of the community as a whole.

Information therapy is based on the idea that what we think and believe — the content of our minds — can influence our health, either directly or through our behavior. We can change and influence the content of our minds and therefore also our health through information media.

Personalized health, however, is highly diverse, and if we had to design the right information therapy for the right person at the right time, we would never finish the job. So how does Health 2.0 make information therapy possible?

The needs in health care are complex, personalized, and ever changing. How can information therapy derived from a scripted template ever fully address them? Without Health 2.0, the greater the number and diversity of people with health needs, the more infinitely complex the situation becomes.

Health 2.0, on the other hand, changes the information therapy equation. The participants are co-creators, selectors, navigators, recommenders, and reviewers of content, so the more people involved and the greater their diversity, the more possible it is to meet an ever greater diversity of needs.

While some traditionalists might argue about the need for evidence-based information, the reality is that rich and diverse Health 2.0 communities are enabling an acceleration of evidence gathering. In the social media world, randomized controlled trials or A/B and multivariate experiments on the impact of information and ideas on user behavior are conducted every day.

This same quantitative and experimental methodology of the modern Web 2.0 Internet, when applied in Health 2.0, will start to advance our knowledge about information therapy, so that we may discover how the right information, at the right time, and in the right way can truly improve health.

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NEWS RELEASE: Health Hero Network Says Recent Successes of Deployments with Medicare, VA Signal New Era of Telehealth. Successful Multi-Year Trials at VA, Medicare Show Telehealth-based Health Care Interventions Can Improve Care, Reduce Costs.

PALO ALTO Ca., January 23, 2009 Health Hero Network said today that the first large-scale, multi-year rollouts and evaluations of its Health Buddy® System have shown success in helping improve the care of high-cost Medicare beneficiaries and veterans while reducing costs and hospitalizations — signaling a new era of telehealth that will reshape an American healthcare landscape strained by an aging population, a reduction in caregivers and shrinking financial resources.

VA Results reported in TELEMEDICINE and e-HEALTH, VOL. 14 NO. 10. Care Coordination/Home Telehealth: The Systematic Implementation of Health Informatics, Home Telehealth, and Disease Management to Support the Care of Veteran Patients with Chronic Conditions. Adam Darkins, M.D., Patricia Ryan, R.N., M.S., Rita Kobb, M.N., A.P.R.N., Linda Foster, M.S.N., R.N., Ellen Edmonson, R.N., M.P.H., Bonnie Wakefield, Ph.D., R.N., and Anne E. Lancaster, B.Sc. Department of Veterans Affairs, Office of Care Coordination Services, Washington, D.C.

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This presentation accompanied a talk I gave recently to a group of health care executives at an ABL Roundtable event in San Francisco. I was asked to discuss the meaning, importance and potential application of social media in health care.

Social media is often defined as “people having a conversation online.” In contrast to mass media produced by a few, social media is generated by grass roots efforts of millions of people. It has become the largest and most interesting use of the web.

Despite the fact that health care is one of the most information intensive fields, the health care industry notoriously lags behind every other industry in its adaptation of information technology. To get our initial bearings, we decided to kick off the discussion by asking the audience to describe their own personal use of social media.

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Intel Health Guide Blood Pressure Monitoring

After over three years of research, development, and market study, Intel announced the launch of the Intel Health Guide, an Intel-branded device for remotely monitoring and managing patients with chronic illness at home. From Intel’s demo one can see that the device is a laptop computer no keyboard and a reversed touch-screen. Patients can connect and upload blood pressure monitors and other medical devices to communicate results with remote health care providers. In addition to vital sign data collection, the health monitoring software also provides patient reminders, surveys, educational content, and other communication tools.

Although Intel appears to be targeting at the same chronic disease management market, the Health Guide from Intel adds features and functions far beyond its predecessor Health Buddy from Health Hero Network, now a division of Robert Bosch. It will be interesting to see whether or the enhanced functionality such as video conferencing and multimedia content will be the key to market adoption.

Intel Health Guide Home Health Monitor

The real barriers to adoption of remote monitoring and other chronic care strategies may be less about functionality than about institutional incentives and business models ingrained in our health care system. The health care market with Medicare in the lead still rewards health care providers far more for treating the complications of chronic illness than it does for proactive management and monitoring aimed at preventing them.

The incentive systems that determine the viability of new models of health care enabled by devices like the Intel Health Guide and the Health Hero Health Network Health Buddy could be about to change, however. With favorable results from the Medicare chronic care improvement demonstration project currently underway from Health Hero Network in Washington and Oregon, Medicare coverage for health care providers to offer home health monitoring services may be around the corner.

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Last week I spoke at the On Lok Lifeways Conference on October 22, 2008 in San Francisco, entitled “Sustainable Long Term Care: Ethics, Technology and International Perspectives.” The organizers asked me to draw insights from my experience in developing new models for chronic care as the founder and former CEO of Health Hero Network, and to compare that to what I had learned while traveling in Rwanda with Partners in Health last year. Here is my presentation.

In the most innovative models of care on both continents, health care providers have discovered that delivering better care with fewer resources can be possible with a proactive approach to supporting and monitoring patients at home rather than waiting for the inevitable complications of neglect. On both continents, healthcare providers have discovered that technology can be a useful tool to improve the effectiveness of care providers and to increase rather than replace personal touch.

In the United States, our healthcare system too often still penalizes rather than rewards prevention, especially in the largest fee-for-service system, Medicare. When it comes to innovation in disease management and prevention, we claim that we “can’t afford it,” while in a much poorer country in the heart of Africa, the government and the health system are working together to embrace innovation in home and community-based care because they can’t afford not to do it.

We have something to learn from innovations arising in places like Rwanda, where necessity truly is the mother of invention. Learning from such innovations can help us expose some of our own false dichotomies that too often have become an excuse to stifle innovation.

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