I spent the much of the weekend at a special event preceding this year’s Health 2.0 conference in San Francisco that started last night. This was the Health 2.0 Developer Challenge Code-a-thon. I made a short presentation on Saturday and got asked to be a judge on Sunday. The event runs for two days and all the coders there are running on fumes and have caffeine tremors but rally amazingly to come up with great code and solutions. Here are some of the solutions presented.
The future of doctor visits?
Recoverty’s project: Here to cure alcoholism today! Definitely a huge public health problem. Right now there are 2.2 meetings a week on average for about 2 million AA groups. But the best online tool for that now is a chat room, so this group set out to improve on that situation. They are trying to leverage all of today’s technology for this cause — including online social support, mentorship programs, creating groups by similar background, and expanding into mobile platforms. People who have been sober for a longer time can help those who are struggling now. Users can log on and choose a room. Options include “dry dock, or “daily reflections.” It includes video for up to ten people. You can choose options for sharing, including muting. And it could be used for a variety of health approaches, but AA provides a framework for beginning this platform, which could be modified and rolled out to other areas.
Health Task Manager starts with a medical student’s overview of what it’s like now to manage tasks in a busy in-patient day. Hand-off is a vulnerable and frantic time. The medical problems are lost during the discussion of tasks to be performed, instead of talking about the patient. The issues and risks are quite high if errors occur. Their tool is an app that allows tasks to be pushed from one phone to another phone, with the tasks prioritized by urgency. It also allows for completed tasks to be listed (which are often “lost” in the manual approach to lists of tasks). Another team member (such as a nurse) can add a task to someone’s list. And there is also a global view, so that a person can see all the tasks for all the patients on a team. You can also sort by patient. When a patient is coding (a medical ‘code’ or emergency), this would allow one to see what has been done in the last 12 hours (which could be incredibly important). Hopefully could be synched up with electronic medical records in the future. Tasks can be just as important as medications, with errors that are equally devastating.
Comply Reply is an app for medication compliance. It is a suite of applications, intended to extend care beyond the office wall. The app for docs is called comply and the patient app is called reply. The vision is that this can be tailored based on feedback from clinicians and patients based on what works and doesn’t work. Today’s presentation is that they’ve hacked a bunch of fresh options into the app, but more could be possible. Interaction search is included for physicians, who then can ask the patient if they want sms or smartphone reminders (opt in) with, for example, a photo of the drug. The app can also include alert options for clinician to notify patients, or get alerts if something is outside of set parameters.
Inspirent Health takes a similar management approach, their demo focused on the differentiators. Aggregation of care teams on the fly is an emerging part of healthcare – essentially bundled care. Their app is for care coordination post-acute care. The core approach involves care bundling. The demo showed a start with a patient’s name and email, and diagnosis group. This brought up a pre-populated care list. Next popped up a pre-set list of provider networks. A message is then sent out saying a patient needs post-acute care. The contacted team could then respond to the message and “take” this patient – in other words, aggregate a care team on the fly. The discharge plan included a task list for the patient (not a passive discharge) as well as assignments for who is supposed to be helping them with this. The app bundles a bunch of activities, with a price tag assigned to each, and includes an active task discharge list and escalating notifications when those tasks aren’t done.
RxPact’s premise is based on C. Everet Koop’s statement that “medicines don’t work if you don’t take them.” There are a lot of apps out there that are supposed to remind you to take meds, but none of them have a social element. RxPact is medication reminder with a social twist. It has a screen with meds on one side, including images and, if you click on it, you can see the package insert. The right side is the social side. This demo uses feeding a cat as a prompt for the patient taking her meds, and includes her social network. Once she clicks that she has taken her meds, she gets a bit of social reward for doing so – in this case it’s a cat meowing and she gets a message from her son, along with a customized picture of her grandson, as well as a positive prompt. As she and her social network take their meds, more and more cats accumulate. One of her social network is lagging and she can “nudge” him to take his meds, with an sms message that prompts him to take his meds. Messages and photos for rewards. You have a collective quest to collect cats. No “dead” cats show up if you don’t take your meds (in other words, no cats were harmed in the making of this app!).
Generics is an Android app for medication affordability. Cost is the main reason patients don’t fill prescriptions. Surveys show it’s one out of three who don’t, and even among the insured, it’s one out of ten who don’t fill prescriptions because of cost. The team presented a case of a woman with diabetes and life-threatening blood pressure. All four of her medications were available for $4 per month, but she had no idea that was true. There is currently no android app with this functionality (to search for generics). They created an app on iPad, with a drug list. The screen with the drug by functionality is not yet made, but there are lists of drugs to pick from. There is a similar app for the iPhone, but not the Android. They get the generic information from feeds which are created manually from pdfs – the information is not easily available. This app detects changes from the pdf and then the data must be manually changed.
Rainbow Button team decided to create an innovation on the Blue Button concept. The Blue Button allows people to get their medical data from large systems (such as the VA). Their approach was to create a “green” button, where a user can de-identify their own health data. These developers called it the medical record converter. The value is in not just being able to pass along “blue button” type information, but also by being able to pass along information that another system can use. A patient might not want to share their psych history, or their military service history. This allows a person to choose what to share, and to possibly share for the greater good. It could be used if people want to share their medical history. The first step is to upload their file (the Blue Button) and then they can share the “sanitized version” using the Green Button. It can also turn the information into a more readable format, such changing the medication list/usage into an Excel spreadsheet. People can choose to donate their anonymized data for research purposes. Once shared, an item in their file can also be a prompt that then asks the user a survey question. These questions could be anything, but in the demo, they created questions about side effects or adverse events from one of the medications.
Droid Vital is an application that does mobile vital signs monitoring. They start with a personal component – in other words you can take your own vital signs. You could do your own recording from your phone. They use a bluetooth weight monitor. They used an off-the-shelf heart-rate monitor. Besides your own vitals, they also created a social app, which includes a carousel, and monitors vital signs which are shared with your closest family and friends. You could scroll through and check on a member of your social circle. It has a GPS module to give you turn-by-turn directions to wherever the person is. This could be used for a mobile nurse station, where a nurse could drive around and contact people in his/her virtual “ward.” There is also a chart option, for charting vital signs results. They did a live demo of the heart rate monitoring function. They created a receiver for the data, which was tiny and plugged into the port of the mobile device.
Health Timeline is focused on trying to encourage preventative care. Right now prevention is generally done once a year, with a one-time visit. Everything about it has to be done by the individual by themselves the rest of the year. The demo asks basic demographic data and then displays personal numbers over time for the individual and then shows the compiled data for the local area (by county) as well as showing family data. The person can give more information for their providers if they want. It boasts a simple platform, and the potential for more connections on one portal.
Healthy Hero is a “Foursquare for Health.” You are rewarded for eating healthy, fighting viruses and so on. You can earn badges based on activities and then share them on Facebook and keep earning different types of badges. The application not only rewards people for healthy behaviors, but also allows people to be connected with others who are sharing the same challenges or issues. The major goal of Foursquare is to beat others to be mayor, but this app is focused more on a circle of family and friends. The gamification of your health is the goal.
Ontrak is an application that emerged from one team member’s attempt to help manage his grandmother’s medications. Their goal is “simplifying/automating healthcare.” The average HIV patient is now on seven drugs. A major goal is figuring out what to take and how to take them. Their concept is to take the complexity away from the patient, into the cloud and then push it back down to the patient in a focused way. The family or provider can go onto the web to set up the reminders for the patient. The phone can manage the tasks of remembering the medication regime. Their demo has a nice visual of the pills for the family, patient and caregivers, with a visual notification for the reminder for the patient to take the medicine. It updates almost immediately onto the web. Family could also log on to see if the person is taking the medicine regularly. Physicians could take medicines out or modify them. Gives an instant “grey out” if the physician removes a medication. Gives real-time responses and allows providers to change medications in real time.
Boxteam is a physical device that was created during the two-day event! They want to stream healthcare outside the four walls of the hospital – to create a box for each patient that is easily shippable, and rentable. The goal is to improve outcomes for at risk patients. The team used a Pelican case and an Xbox Kinect, then built a post-discharge congestive heart failure exercise. They created a cloud data platform to manage therapies, with video appointments and a shared patient/physician dashboard. It uses a video portal to go over this data with a provider. There is a summary of the patient data and a note section for the provider to use.
Finally, CF/Cancer Companion is an application that focuses on patient monitoring systems. There aren’t a lot of apps addressing cancer, except for ones focused more for raising awareness or fundraising. Their application covers daily questionnaires on medications and symptoms. The symptom checklist includes adverse events checklists – and if there is an increased rate of an event, a list of options is given for notifying a provider. The cloud end allows someone to monitor a panel of people submitting data. The calendar and reminder section includes an android app for finding the best care, based on ratings from the NIH.