Day 2 in Silicon Valley: a doctor in your pocket!
Today was a real Silicon Valley day. We traveled to visit techies in the field of home monitoring for the chronically ill and video consultations in healthcare. Located among major companies such as Facebook, eBay, Google and Apple there are many startups in the healthcare field. The first thing that struck me, which is something I often see in the Netherlands as well, is that these startups are located all over the place except.... in the vicinity of the healthcare itself.
Plenty of technology, too little care
The stories we heard are full of promises concerning technology. And I must admit that there are certainly some fine and promising technologies which I would like to see in the Netherlands in combination with our cVitals App. Unfortunately, in the United States, the more you start talking about partnerships, the more non-disclosure agreements (NDAs) you're asked to sign, so I am unable to share many details.
But one thing that did strike me was how difficult it is for American companies to try out the technologies they develop in the field of monitoring. There are strict rules for anyone wishing to get a foot in the door with the big healthcare organizations, like Kaiser Permanente and other Health Management Organizations (see yesterday's blog). This makes sense, because there are so many technical innovations that it's impossible to explore every single one of them. This means that startups sometimes spend more than a year on acquisition processes before being able to try out their technologies. We were told several stories involving great technology but little care, for the simple reason that it is very difficult to quickly and easily try things out in real clinical settings, from both a commercial and a legal perspective.
The Netherlands as a center of validation
I think there is a huge opportunity for the Netherlands in this area as a 'center of validation'. And perhaps even as a hub for brining such product innovations to the rest of Europe. "In her doctoral research, Martine looks at the validity of many of the excellent monitoring technologies that are being developed" Through FocusCura's Futurelab for Care, we recently teamed up with Professor Kalkman (Anesthesiologist at UMC Utrecht) to start a doctoral program with Martine Breteler, a recent graduate in Technical Medicine from the University of Twente, who in her doctoral research will examine the validity of many of the excellent monitoring techniques being developed. But what impact do these technologies have in the clinical setting? And what happens when vulnerable people, such as the chronically ill or the elderly, suddenly have to 'operate' modern technologies to monitor all kinds of vital signs? Are the measurements produced in such cases correct and reliable? We made some interesting contacts to collaborate with people in Silicon Valley in this area, essentially exploring the clinical value and patient experience of the many ‘hospital to home’ promises we have encountered here.
Am I allowed to eat this?
An example of something the Americans are very enthusiastic about, which fits in the wellness and prevention category, is an application that enables users to take pictures of their meals and share them in real-time with their dietitian. It's a real hype in some places, with people with obesity or nutritional problems receiving direct feedback from their dietitian or coach after they have taken a picture of what they plan to eat. I'm not sure whether such an app would be successful in the Netherlands, but we can make good agreements on the use of this technology as an element in our cVitals App for Teledermatology on which we are working with dermatologist Dr. van der Waal from TerGooi Hospital.
Video doctors, an economy in and of itself
In the afternoon, we focused specifically on a different segment: the use of video consultations in healthcare. This is something in which I have a big interest myself, and which we soon discovered is really breaking through in United States, in a number of fields in hospitals as well as under the management of five rapidly growing commercial businesses (Tel-a-Doc, Doctors On Demand, HealthTap, MDLive and AmericanWell). In effect, these organizations offer the possibility of setting up a video link with an available doctor quickly and easily via a computer or cellphone. "For the patient, the main motivating factor behind these consultations is the convenience of being able to speak to a doctor from home combined with the financial advantages this offers" For the patient, the main motivating factor behind these consultations is the convenience of being able to speak to a doctor from home combined with the financial advantages this offers. People usually pay a 'copayment' of $40 to $80 (with the remaining $40 to $80 covered by insurance). The video consultations with doctors are sometimes covered by insurance, but in most cases people pay an amount themselves which is lower than the copayment for a normal consultation. The services are very popular, with the top three formed by questions concerning symptoms of illness in children, minor questions for which we can visit our family doctor, and questions for which people prefer to seek 'anonymous' advice (such as sexually transmitted diseases).
I was very surprised to hear that the doctors who offer these consultations often do so without having access to the patient's medical records, particularly considering the American 'compensation culture', but apparently this seems to work for the situations in which it is used.
A new role for pharmacies and supermarkets
With regard to the developments concerning video doctors, in addition to the commercial examples, we also heard some compelling examples from hospitals. It was nice to see a lot of similarities to how we are currently using our PatientHub in the Netherlands. There were numerous examples of the use of video consultations by Davita for home dialysis patients in the United States. This is something we do in the VieCurie Teledialysis project, so we were able to share our experiences with each other.
As well as healthcare organizations that regularly use video consultations in family medicine, palliative care and for follow-up consultations, we were also given examples of employers and an American version of a remote occupational health and safety service. The most fascinating example concerned the application of telemedicine in supermarkets and at the Walgreens drugstore and pharmacy chain. Walgreens offers an app that enables patients to ask pharmacists questions about medication 24/7, as well as access their medical records and even do healthy exercises to earn rewards points for discounts in the stores. At the end of 2014, the app was expanded with the possibility of video consultations with doctors, after which a whopping two million new Walgreens customers per day signed up for the service, which is now being expanded with telemedicine services (self-monitoring). Perhaps this could inspire pharmacists and other healthcare providers in the Netherlands.
Practice what you preach
In short, I think these are interesting examples in which video consultations are really used as part of the healthcare and service. These possibilities are used to directly change and improve the customer experience, which I wrote about in my first blog this week, from the patient's perspective. And the fact that one of our partners in Silicon Valley genuinely believes in this 'virtualization' in this area is evidenced by their own approach. Besides the fact that almost 100% of their sales now concern virtual transactions, they terminated their office lease a year ago and became a completely virtual company. With programmers from all over the world, they work together in self-managing teams in a virtual environment, with some of the programmers never even having met each other in real life. It was a bizarre experience to attend one of their team meetings, with people appearing one by one on a large screen by means of video links with various regions in the United States, Canada, Belarus, Singapore, China and the Philippines. Who said anything about practicing what you preach….?
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Tomorrow we will shift from technology back to real 'healthcare' as we meet with several doctors at Stanford University, visit the Center on Longevity to Improve the Fitness of People at All Ages, and talk to a lawyer about doing business in the United States.
This blog was previously published on Skipr.nl.
