The thing formerly known as the PHR

PUBLISHED ON  January 6, 2014

WRITTEN BY  Roni Zeiger

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While I don’t think anything called a personal health record or PHR will succeed — too much baggage with that term — the start of 2014 seems like a good time to reflect on the future of the-thing-formerly-known-as-the-PHR.

The biggest success story here has been Kaiser, where nearly 2/3 of users use its “personal health record”. I put the term in quotes because the usage isn’t really about the record at all, it’s about specific functionality, namely getting a prescription refilled, emailing your doctor, or scheduling an appointment. The only part that has anything to do with health records is looking up test results, and that’s usually just about whether your latest results are ok or not.

So it’s about helping real people solve real health problems, about getting health stuff done in the right context. (Quick side note: the PHR I worked on at Google failed fundamentally because it didn’t help many people solve real problems.) When the context is interacting with your doctor for a refill or appointment, patient portals like Kaiser’s are outstanding. What about all of the other contexts that matter for our health?

I expect to see more “vertical” tools and solutions that tackle specific problems exceptionally well. While in the health world we tend to want one solution that does everything, the consumer technology world suggests that the commitment and focus of innovators who are passionate about their problem leads to winning products. I’ll bet on Misfit Wearables over Nike in the self-tracking space, and while I can’t live without Gmail or Google Docs, if I need a nearby restaurant I go to Yelp.

We’ll see someone — perhaps CareDox — do an awesome job with immunization tracking + school and camp forms, because that’s a pain point and doctor’s offices don’t have enough incentive to do it really well on their own. My favorite (and biased) example is Hula, a service which helps you get STD testing, retrieve the results, AND share the verified results with someone before having sex with them. Might sound crazy to some, but think about the number of people for whom this should be a touch point for health and prevention. I said biased because I’m an advisor to Hula, though I’ll also mention that I asked them if I could be an advisor, not the other way around.

Let’s get vertical.

Pharma Can Sing Like a Virgin

PUBLISHED ON  December 26, 2013

WRITTEN BY  Roni Zeiger

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After watching the entertaining AND educational Virgin Airlines safety video a couple times at 30,000 feet over the holidays, I started thinking… if Virgin can buck the decades-long trend of tedious and probably useless safety demonstrations — despite being highly regulated by the FAA — what might an analogy be for pharma and the FDA?

Obviously Virgin pulled in expertise far outside of those who simply know the FAA rules. They asked, what are we really trying to accomplish here? Absolutely, we need to check a regulatory box. Some engaging educational material – great idea. (Has anyone studied yet knowledge retention of the new video compared to a traditional one?) Entertainment while people are stuck in their seats? That sounds good for business.

This approach might be applied to the design of drug inserts or informed consent forms for clinical trials. Are FDA constraints tougher than FAA’s? Then we just need to be more creative. Also think about how low the bar is: how often does someone learn something useful from a drug insert or actually get informed by informed consent?

The biggest lesson here for me is about iteration. The sexy 2013 safety video referenced above has gotten tons of buzz including 8 million YouTube views so far. But this started with Virgin’s cute cartoon 2008 safety video with “only” 100,00 YouTube views.

Let’s iterate!

Collaboration is Sexy

PUBLISHED ON  December 1, 2013

WRITTEN BY  Roni Zeiger

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Medical breakthroughs can be sexy. They can also distract us from life-saving, low-hanging fruit.

A new drug often makes waves in the headlines and the stock market when it’s shown to improve relevant outcomes. Somehow it’s not quite as newsworthy when remission rates increase from 55% to 68% in kids with Crohn’s disease… if it happens simply by improved communication among doctors. I believe more improvements in healthcare in the coming years will come from this kind of “systems thinking” than from traditional drug development.

To be sure, it’s easier to focus on improving one piece of the system, and financial incentives are stronger for developing a drug that works in an artificially constrained context, than for making un-patentable improvements to the way we deliver care.

But we’re starting to see just how sexy the opportunities can be. Atul Gawande has millions of fans savoring his stories about interventions as mundane as using checklists to make sure the surgeon, nurse, and anesthesiologist talk to each other before starting surgery.

It’s daunting — and exciting — that the many systems we depend on for health care are so complex, it’s almost silly to focus on point solutions. Even more exciting is that patients are not only part of the system, but that they can and must be part of the solution. A simple and delightful example: when Sweden’s emergency response services saw they didn’t have the manpower to provide prompt CPR to all cardiac emergencies, they invited lay people trained in CPR to respond to emergency calls. Which was more brilliant: the simple design of the system which sends a text message to all CPR-trained volunteers within 500 meters of the emergency, or the cultural innovation that allows non-experts to help?

Why is it so hard for a system designed to be about knowledge flowing from scientists and physicians to patients, to evolve into a more collaborative one? Perhaps Machiavelli explains it best: “It must be remembered that there is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage than a new system. For the initiator has the enmity of all who would profit by the preservation of the old institution and merely lukewarm defenders in those who gain by the new ones.

More simply, change sucks, especially for those who have (and like) power. But change is in the air, and I think it’s because we’re seeing beautiful things happen if improvements are allowed to come from non-experts. Not only might a patient-driven improvement be a good one, but the fact it originates from the patient can start a virtuous cycle of self-efficacy.

Psychology aside, it’s a no-brainer that we need to let patients help. There are countless smart ones who are able and willing to help us take better care of them — take better care of each other. And once the ideas start flowing, next thing you know we’ll have doormen in Manhattan volunteering to help keep the elderly living safely and independently. That’s sexy.