Welcome back for a summary of Day 2 of HxRefactored which featured keynotes and breakout sessions around the design of healthcare processes, systems, and technologies. Matthew Holt, Chairman of Health 2.0, returned to the stage to kick things off with a keynote on the current changes taking place in Washington, D.C. and the potential impact those changes will have on healthcare systems and policies. A key takeaway of his discussion was the claim that under the AHCA, as a result of tax cuts to the rich and reduced subsidies for Medicaid recipients, those making less than $50,000 per year may end up paying disproportionately more for their healthcare.
Matthew was followed by Robin Farmanfarmaian, author of The Patient as CEO and a familiar face from the Exponential Medicine stage, and Bakul Patel, Associate Director of Digital Health at the FDA. Robin spoke about how technology is raising the bar on interactions between patients and physicians and gave examples of how new technologies, like virtual and augmented reality, are shaping the future of patient education and therapy. One specific example is how VR is currently being used to help patients struggling to cope with phobias. Bakul followed with a short history lesson and review of the FDA’s current position on digital health technologies.
In summary, there are three tiers to how the FDA looks at mobile apps: (1) mobile apps that are not considered medical devices , (2) lower risk mobile apps that meet the definition of a medical device but are not considered mobile medical applications (MMA) and are not regulated, and (3) mobile apps that are considered MMA and are therefore regulated. Bakul summarized that the approach was designed to be pragmatic and focus on higher risk functionalities and that would cause concern if the product in question did not work as planned. He also revealed that the FDA is currently reimagining a new paradigm for digital health regulation that better aligns with the timelines of technology development, the methods of development, and global healthcare trends. This reimagining is in part coming from a new unit at the FDA that is currently focusing purely on digital health and has been taking a stronger look at software. We’ll keep a look out for updates to current regulations that Bakul mentioned that should be expected in the coming months.
Before pausing for the first of two rounds of breakout sessions, Matthew and Amy Cueva of Mad*Pow returned to the stage to announce Health Payment Systems as the winner of the third annual Design for Health Award. Motivated by the idea that patients shouldn’t need to be CFOs to understand their health bills, Health Payment Systems eliminates healthcare billing confusion by consolidating a consumer’s healthcare bills and explanation of benefits into a single statement.
The first series of breakout sessions for the day covered topics ranging from data security and privacy to navigating the health system. The second breakout session touched on innovation within pharma as well as technology for aging populations. One session that Medgadget had a chance to participate in covered blockchain technology and its applications to healthcare.
The session began with moderator Michael Dillhyon, CCO of Graftworx, setting the scene of the session as a discussion on how to create benefits around blockchain technology focused on gaps in healthcare. Michael made a point that blockchain innovators’ goal right now should not focus on creating new models for healthcare but on fixing the underlying issues that exist today and, once that has been achieved, build models around those solutions. He went on to outline four corrections to popular myths permeating the conversation around the potential for blockchain technology: (1) the blockchain, in and of itself, cannot be used as a universal health data repository, (2) the blockchain does not enable patient data ownership or provenance, (3) enterprises are in fact interested in data sharing, and (4) one blockchain does not fit all and all data does not fit on the blockchain. Michael ended his introduction with a concept echoed for the duration of the session: the blockchain is not a panacea solution but a tool around which applications can be built.
Jay Marehalli, an Information Security Advisor from Aetna Global Security, was the first panelist to present. Jay spoke about how Aetna is thinking of using blockchain technology for member identification and access. Specifically, a desire for better user experience, member protection, and fraud prevention are driving an effort to eliminate reliance on traditional usernames and passwords. In addition to being annoying to recall, alternatives such as password managers and multifactor authentication add more steps to the user experience and can be expensive to support. So where do we go from here? Jay laid out a vision of authentication that is no longer an event but something integrated into the user experience through decentralization, cognitive biometrics, real-time authorization, and analytics powered by a risk-based engine. The opportunities for collaboration across industries in such a model is compelling. For example, if a healthcare organization is participating on a blockchain with financial services, a financial service, through a credit card transaction can say, “I’ve identified and authenticated this individual.” Aetna can then turn around and say, “OK, maybe I trust you a little so let me check with someone else to confirm.” The combination of confirmations from multiple financial services can then be used to affirm the legitimate authentication of an individual, eschewing the need for a username, password, or ID card. Today, Aetna is using these principles and ideas to build an Authentication Hub based on FIDO, an open standard for security.
Next up was Diego Espinosa, CEO of healthcoin, a company trying to address the network challenge of chronic disease. Imagine the stakeholders and resources supporting a patient as a network of nodes. The root of the problem, according to Diego, is that a chronic condition cannot be addressed at any given node because the healthcare system is oriented around episodic treatment of disease. Chronic conditions are continuous issues that are poorly addressed with episodic interventions. To address chronic conditions in this network, you’d effectively need to change the entire network rather than any give node, which isn’t really feasible. As a general rule, blockchains are used to solve network problems by organizing and coordinating the components of those networks in a more effective or efficient way.
Switching focus to his work at healthcoin, Diego described how the company uses blockchain to give patients the keys to their own data and, through certificates and smart contracts, allows them to control who, when, and how third parties gain access to that data. For example, proof of disease prevention or improvement in a patient’s health may exist today but that information is often siloed. Health certificates create transactable proof that an individual could reveal, without sharing all of their personal health data, to an employer, insurer, or community incentive program, to trigger a reward for achieving a goal. Similarly, if a pharmacy company wanted to offer a research license to use a patient’s genome, a smart contract could be executed for limited commercial use that would allow access to the data for research purposes only and would generate a lawsuit if the genome was used for anything else.
Despite the fact that personal health records (PHRs) have historically failed to scale successfully, Diego believes the time is ripe for a new type of PHR due to the backlash against the selling of de-identified data without the patient’s consent, value-based care driving an impetus for change around chronic disease management, and the opportunity to create viable business models around the new technology. On the last point, what Diego effectively described is a token-based model where patients are charging tolls for information over which they have no pricing power. Therefore, the only way to increase the value of the toll is to increase the value of the network, ultimately aligning the interests of both the business and the network.
VP of Engineering at Gem, Siva Kannan, followed Diego to speak about his company’s platform for simplifying complex data sharing and exchange. Echoing a key takeaway of Michael’s introduction, Siva clarified how the blockchain interacts with data. Instead of storing data directly on the blockchain, the blockchain is used to establish identifies which are then associated with data from different sources and locations. Putting it another way, data can be stored anywhere but the existence of the data and who it is associated with is stored on the blockchain. Once that is achieved, collaboration and exchange of that data is possible. In Gem’s case, this takes place through GemOS, a Data and Identity Collaboration and Exchange Platform (DICE) that sits on top of the blockchain. Some of the key product features of GemOS include being able to view lists of transactions happening on the blockchain as a participant in the network, an API viewer that lets the user see what kind of APIs they can exercise on the blockchain, and a resource viewer that shows how a given set of data is linked with other data sources on the network. Siva touched on some Gem projects already in the works including a partnership with Philips for patient-centric care coordination and another with Capital One for revenue cycle management.
Wrapping up this deep dive was Denise Gosnell, Senior Technical Evangelist at PokitDok. Much to the edification of the audience, Denise began by clarifying the concept of what smart contracts really mean. Smart contracts give control, in a decentralized manner, to those who inherently do not trust the network. They function as a digitally signable, computable agreement between two or more entities that relies on a consensus system to reduce vulnerabilities. Denise next spoke about how her company, PokitDok, set out to create a way to pass information around any entity in healthcare. Their vision is to drive a new economic model as claims are adjusted with context and executed via smart contracts, ultimately reducing the time needed to amend claims down the road. In terms of security, Denise reminded the audience that only the access grants to various pieces of information are written to the blockchain public ledger while the details themselves, such as claims and eligibility information, are cryptographically secured and stored off chain. Having designed and created smart contracts herself, Denise also commented on the need to separate healthcare policy from the design mechanics of healthcare systems. She believes innovators should be allowed to develop the blockchain and explore what it has to offer while policy is developed in the context of these new offerings.
Following the breakout sessions, attendees reconvened for two more keynotes that touched on two nontraditional approaches to improving patient health: music and relaxation. First up was Kathleen Howland, Professor at the Berklee College of Music speaking about the healing power of music. Kathleen backed up her claims with neuroscience evidence showing that patients who sing, especially those who sing with others, see increased brain activity and activation.
Next up was Jay Gupta, President of RxRelax, an organization working to combine the knowledge of Western medicine with research-based, integrative health practices such as meditation and yoga. Jay encouraged the idea that polypharmic trends can be reversed with appropriate applications of proven strategies to improve patient health and wellness without drug interventions. Jay also made a point to juxtapose the Western definition of yoga, which often emphasizes strenuous contortion, with the original tenants of the practice which include self-reflection and breathing exercises.
With a final sign off by Matthew and Amy, we’re at the end of this year’s HxRefactored conference. It’s been a concise two days of conversations and insights that will hopefully inspire new opportunities to apply design thinking methodologies to the experience of healthcare. While this is one of the smaller conferences this editor has covered in recent history, the intimate nature of the event lowers the barrier to connecting with many of the keynote speakers and thought leaders in attendance. A quick shoutout is also in order to Bizzabo that provided a mobile app to help attendees navigate and connect during this year’s event. It was a great experience to directly contact and schedule side bars with other attendees and potential collaborators based on areas of mutual interest. Speaking of those very conversations, make sure to go back and check out Medgadget‘s interview with dacadoo, a digital health company demoing at this year’s event.