Health Technology, AI
Article | July 18, 2023
“Health care is different, the data here is emotional! If you tell me you were buying a fishing rod online and were emotional about it, I’d say you are lying. But I do frequently see people helpless and confused when it comes to receiving health care, managing its costs, making sense of its data.”
- Senior Product Leader inOptum Global Solutions Pvt. Ltd.
Yes, health care is different, and so is product management in it. This piece highlights the top 4 product management trends that are specific to health care and serve beyond being just a list of technologies making their way into health care.
Health care consumerism
Lance broke his ankle in a bicycle accident and is now in hospital waiting for surgery. Which of these words would describe him more aptly— a ‘patient’ or a ‘health care consumer’? The fact that Lance holds a high-deductible health plan, manages an interactive relationship with his primary doctor, keenly monitors his fitness through his smartwatch, and learns about healthier diet plans and recipes online — I can say he isn’t just receiving health care, but making active choices on how to pay for and manage his health. This choice and responsibility that people demand, is ‘health care consumerism’. This trend has been growing since 2015 when value-based care started picking up in the US.
What does this imply for products/PMs?
These are challenging and exciting times to be a product manager (PM) in health tech. This is because people are now demanding an experience equivalent to what they’re used to from other products in their lives, such as e-commerce, streaming platforms, and digital payments, to name a few. Any consumer-facing product (a mobile app, a web-based patient portal, a tech-enabled service) needs to meet high expectations. Flexible employer-sponsored health plans options, health reimbursement arrangements, price transparency products for drugs and medical expenses, remote health care services, and government's push to strengthen data and privacy rights — all point to opportunities for building innovative products with ‘health care consumerism’ as a key product philosophy.
Wellness
COVID-19 has tested health care systems to their limits. In most countries, these systems failed disastrously in providing adequate, timely medical assistance to many infected people. Prevention is of course better than cure, but people were now forced to learn it the hard way when cure became both inaccessible and uncertain. With lockdowns and social isolation, prevention, fitness, diet, and mental wellbeing all took center stage.
Wellness means taking a ‘whole-person approach’ to health care — one where people recognize the need to improve and sustain health, not only when they are unwell, but also when they’re making health care decisions that concern their long-term physical and mental health. A McKinsey study notes that consumers look at wellness from 6 dimensions beyond sick-care— health, fitness, nutrition, appearance, sleep, and mindfulness. Most countries in the study show that wellness has gained priority by at least 35% in the last 2–3 years. And wellness services like nutritionists, care managers, fitness training, psychotherapy consultants contribute 30% of the overall wellness spend.
So, what do health-tech PMs need to remember about wellness?
The first principle is, “Move to care out of the hospital, and into people’s homes”. A patient discharged after knee surgery has high chance of getting readmitted if he/she has high risk of falling in his/her house, or is unable to afford post-discharge at-home care with a physiotherapist. This leads us PMs to build products that recognize every person’s social determinants of health and create support systems that consider care at the hospital and care at home as a continuum.
The second principle is, “Don’t be limited by a narrow view of ‘what business we are in’, as wellness is broad, and as a health tech company, we are in health-care, not sick-care”. Wellness products and services include — fitness and nutrition apps, medical devices, telemedicine, sleep trackers, wellness-oriented apparel, beauty products, and meditation-oriented offerings, to name just a few. Recent regulations in many countries require health care providers to treat behavioural health services at par with treating for physical conditions, and this is just a start.
Equitable AI
Last month, WHO released a report titled “Ethics and Governance of Artificial Intelligence for Health”. The report cautions researchers and health tech companies to never design AI algorithms with a single population in mind. One example I read was, “AI systems that are primarily trained on data collected from patients in high-income settings will not perform as effectively for individuals in low or middle-income communities.” During COVID-19, we came across countless studies that talked about the disproportionate impact on minorities in terms of infections, hospitalizations, and mortality. A student at MIT discovered that a popular out-of-the-box AI algorithm that projects patient mortality for those admitted in hospitals, makes significantly different predictions based on race — and this may have adversely moved hospital resources away from some patients who had higher risks of mortality.
How should I think about health equity as an AI health-tech PM?
Health equity means that everyone should have a fair chance at being healthy. As a PM, it’s my job to make sure that every AI-assisted feature in my product is crafted to be re-iterative and inclusive, to serve any community or subpopulation, and is validated across many geographies. To prevent any inequitable AI from getting shipped, it is important to ensure that the underlying AI model is transparent and intelligible. This means knowing what data goes into it, how it learns, which features does it weigh over others, and how does the model handles unique features that characterize minorities.
Integrated and interoperable
In every article that I read on topics such as digital platforms, SaaS, or connectivity with EMRs, I always find the words: ‘integrated’ and ‘interoperable’ therein. Most large and conventional health tech companies started by offering point-solutions that were often inextensible, monolithic, and worked with isolated on-prem servers and databases. To give a consistent user experience, leverage economies of scope, and scale products to meet other needs of their customers, started an exodus from fragmented point-solutions to interoperable, integrated solutions. The popularization of service-oriented architectures (SOAs) and cloud vendors like AWS, Azure, and GCP has also helped.
The what and how of integrated-interoperable solutions for PMs:
Integrated solutions (IS), as I see them, are of two kinds — one, in which as a health tech company, we help our customers (health systems, insurance companies, direct to consumers) accomplish not just one, but most/all tasks in a business process. For example, a B2B IS in value-based care contract management would mean that we help our customers and health systems by giving an end-to-end solution that helps them enter into, negotiate, plan for, manage, get payments for their value-based contracts with health plans.
In the second type of IS, we offer products that can be easily customized to different types of customers. For example, a health management app that people can subscribe to for different programs such as obesity, diabetes, hypertension, cholesterol management, as needed. The app works with different datasets for these programs and uses different analyses and clinical repositories in its backend, but still delivers a consistent user experience across programs to a user who enrolled in multiple programs, say diabetes and weight management.
‘Interoperable’ simply means that one product should be able to talk to other products both in and out of the company. For example, if product-A can alert a doctor about any drug-drug interactions or allergies a patient might have, while she is writing prescriptions for the patient in product-B (an EMR), then product-A does talk to product-B, and hence, is interoperable. This trend is picking up further with the growth of IoT devices, and industry-wide participation in adopting common standards for data exchange.
Conclusion
Though the article derives much of its context from US health care, I have tried to keep a global lens while choosing these topics. For developing economies like India, digitization is the number one trend as much of the health system is still moving from manual records to digitally store patient and medical data in EMRs. The good news is that India is booming with health-tech innovation and that is where consumerism, wellness, and equitable AI make sense. Once companies develop enough point-solutions for different health system needs and use-cases, Indian health tech will see a move towards creating integrated, interoperable (IGIO) systems as well.
There are some other trends such as — use of non-AI emerging tech such as Blockchain in health information management, cloud infrastructure for health tech innovation, big data and analytics to improve operational efficiency in areas such as claims management and compliance reporting, Agile product management for co-developing with and continuously delivering to clients etc. — but I see them either as too nascent, or too old to feature in this list.
Finally, as a health tech product manager, you can use the following questions to assess your products against the above trends — (Consumerism) do the products that I manage, empower consumers with choice, information, and actionability? (Wellness) Does my product emphasize keeping them out-of-hospitals and healthy in the first place? (Equitable AI) Am I sure that my product doesn’t discriminate against individuals belonging to underserved populations? (IGIO) And finally, is my product scalable, integrated and interoperable to expand to a platform, in the true sense?
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Digital Healthcare
Article | November 29, 2023
As consumers, we crave convenience and simplicity, and across an array of industries, technology has made it increasingly easy to search for and purchase products and services. From getting a pizza delivered to buying a car online, the process often involves entering a few pieces of information, hitting send, and waiting for a confirmation email.
A Changing Landscape
Unsurprisingly, people want this same level of convenience and simplicitywhen they're seeking care. This change in consumer demand for convenience is further compounded by fundamental shifts in the healthcare ecosystem. Among these shifts are cost-sharing models that have increased patient out-of-pocket expenses, healthcare systems that are increasingly shifting toward delivering value-based care, and innovations in digital health solutions.
While patients want to play an active role in managing their well-being, that is often easier said than done in a system that uses a combination of manual processes and non-integrated point solutions to try and meet consumer demand. Disparate and burdensome methods of managing patient engagement often lead to inefficiencies within provider organizations, resulting in missed appointments, increased registration and eligibility-based denials, incomplete payments, higher collections and write-offs, and low patient satisfaction.
Consumer Dissatisfaction
Healthcare consumers today feel like they're fighting an uphill battle. According to Change Healthcare's 2020 Harris Poll Consumer Experience Index, 67% of respondents agreed that it “feels like every step of the healthcare process is a chore.” A similar percentage, 62%, agreed that “the healthcare system feels like it is set up to be confusing.”
Furthermore, if consumers don’t receive the level of convenience and digitization they want from their current provider, they’re more than willing to seek it out elsewhere. In a recent Black Book survey, 80% of respondents indicated they would be willing to change providers for more convenience even if they were receiving good care from their current provider. An even higher percentage of patients,90%, do not think they have to continue seeing a provider if that provider does not “deliver an overall satisfactory digital experience.”
A Patient-Centric Approach
Improving the patient experiencestarts with humanizing revenue cycle management(RCM) —the administrative process that takes the patient from registration and appointment scheduling to the final payment of a balance. Simply making administrative touchpoints self-service and easy to understand throughout the patient’s financial journey can help humanize revenue cycle management for providers.
How is that possible? By thinking about the patients’ side of the administrative process and leveraging innovative technologies like artificial intelligence, robotic process automation (RPA), natural language processing (NLP), and machine learning. The more that providers’ staffs are able to automate repetitive tasks, the more time they're able to spend helping provide a seamless patient engagement journey that is focused on a patient’s specific needs. In other words, reducing human intervention throughout our technologies allows providers to infuse more human interaction with each patient as they navigate their healthcare journey.
According to Change Healthcare’s 2020 Harris Poll Consumer Experience Index, what patients really want is a retail-like shopping experience with modern, streamlined communication, as thevast majority (81%) agreed that “shopping for healthcare should be as easy as shopping for other common services” via a streamlined access point online. A clear majority (71%) also said they want their health insurance and healthcare providers (68%) to communicate with them using more-modern platforms.
Simplified Scheduling and Payment
The entire clinical-care journey is focused on the specific needs of the patient rather than the provider, so why shouldn’t the patient’s financial journey be handled the exact same way? From a patient-satisfaction perspective, patients are not separating their clinical journey from their financial journey, so providers should start viewing it the same way.
It should be easy to schedule an appointment and modify that appointment if needed. Patients should have to (securely) provide their personal and insurance information only once (digitally and in advance), then be squared away when they show up for their appointment with their provider. In addition, because of COVID-19 and the heightened awareness surrounding personal interaction, it’s important to provide patients with no-contact check-in and waiting room options.
By humanizing RCM, providers can achieve a cohesive end-to-end journey that allows patients to quickly and easily get the care they need complete with clear communication, price transparency , and a provider who truly takes the time to understand their unique situations. By putting the patient back at the center of their care journey, providers can improve care outcomes while also driving maximized business outcomes for their organizations.
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Health Technology, Digital Healthcare
Article | August 16, 2023
Embark on a journey into the frontier of healthcare innovation in this article. Discover how EHR telemedicine and remote patient monitoring serve as catalysts, driving forward a new era in healthcare.
Contents
1. Integration of EHRs in Telemedicine and Remote Patient Monitoring
2. Technical Challenges and Solutions in EHR Integration
3. Financial Analysis: Cost-Benefit Assessment of Integration
4. Data Privacy and Consent in Integrated EHR-Telemedicine Systems
5. Forging Stronger Patient-Clinician Relationships
1. Integration of EHRs in Telemedicine and Remote Patient Monitoring
EHR telemedicine and remote patient monitoring have reshaped healthcare delivery by seamlessly integrating electronic health records, allowing healthcare providers and patients to exchange information effortlessly, regardless of geographical barriers. This synergy empowers healthcare professionals to access patients' comprehensive medical histories in real time, facilitating more informed decision-making during virtual consultations.
During the spring of 2020, when pandemic restrictions kept most people in the US at home, the use of telehealth rose to about 51%.
[Source: Elation Health]
Moreover, it enhances the accuracy of remote patient monitoring by providing up-to-date data, enabling timely interventions and improving overall healthcare outcomes. Integrating EHR telemedicine systems enhances efficiency and ensures that patient care remains at the forefront of modern healthcare, transcending traditional physical boundaries.
2. Technical Challenges and Solutions in EHR Integration
Navigating telehealth EHR integration and remote patient monitoring solutions uncovers a range of technical challenges, each with its own set of potential remedies. These include interoperability issues, which can be mitigated by adopting standardized data formats like HL7 FHIR. EHR interoperability solutions may involve using data exchange protocols such as HL7's Consolidated Clinical Document Architecture (C-CDA) or developing custom APIs to facilitate seamless data exchange between EHRs and telemedicine platforms. Additionally, the imperative need for data security and privacy is achieved through robust encryption and adherence to regulations like HIPAA or GDPR. Data integration challenges arising from varying EHR data storage methods can be resolved using middleware or integration platforms. Investing in telecom infrastructure and developing offline-capable telemedicine apps can address limited connectivity in remote areas. Ensuring real-time data access involves optimizing EHR databases and creating low-latency systems. Other challenges encompass integrating data from medical devices, ensuring data accuracy, scalability, user-friendly interfaces, regulatory compliance, and cost management strategies.
3. Financial Analysis: Cost-Benefit Assessment of Integration
When contemplating the integration of EHR telemedicine and remote patient monitoring systems, conducting a comprehensive cost-benefit analysis is crucial. This assessment covers financial aspects, including initial implementation costs (software development, hardware upgrades, training, and data migration), ongoing operational expenses (maintenance and data storage), and potential efficiency gains (streamlined workflows and improved data accessibility). It also evaluates the impact on patient outcomes, satisfaction, and financial benefits of enhanced healthcare quality, reduced readmissions, and increased patient engagement. Healthcare organizations can estimate cost savings in remote patient monitoring and explore expanding telemedicine services to underserved populations to make informed financial decisions.
Additionally, this analysis considers long-term financial viability and alignment with organizational goals, including regulatory compliance costs, risk assessment, scalability considerations, and the competitive advantages of integrated telemedicine services. By calculating ROI and assessing potential risks, healthcare entities can develop risk mitigation strategies, ensuring that EHR integration in telemedicine and remote patient monitoring enhances healthcare delivery and aligns with the organization's financial sustainability and long-term success.
4. Data Privacy and Consent in Integrated EHR-Telemedicine Systems
Data privacy and obtaining informed consent are paramount in integrated EHR and telemedicine systems. Patients should provide explicit consent, understanding the data collected and its intended use, with strict encryption protocols safeguarding data during transmission. Access controls and data minimization practices restrict unauthorized access, while patient portals enable individuals to manage their data-sharing preferences and revoke consent if needed. Compliance with regulations such as HIPAA or GDPR is crucial, as is maintaining comprehensive audit trails to track data access. Training, awareness, and robust incident response plans fortify data privacy efforts, fostering trust and transparency in these integrated systems where healthcare organizations and patients share responsibility for secure data handling.
5. Forging Stronger Patient-Clinician Relationships
Integrating EHR telemedicine and remote monitoring systems goes beyond mere efficiency and accessibility objectives. It serves as a catalyst for nurturing more substantial and meaningful patient-clinician relationships. This fusion of technology and healthcare has the capacity to bridge physical distances, allowing clinicians to truly understand and engage with their patients on a deeper level. Patients, armed with increased access to their health data, become more active participants in their healthcare, while clinicians, with their comprehensive information, can offer more personalized and informed guidance. The potential of EHR telemedicine reaches far beyond the digital screen; it empowers both patients and clinicians to collaborate in pursuit of improved health outcomes, ushering in a new era of patient-centric care grounded in trust, communication, and shared knowledge.
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Future of Healthcare
Article | January 8, 2021
Prioritizing health and managing it, has become highly important because our lifestyle is continuously evolving in ways that take a toll on us mentally, physically, and emotionally. However, the major issue for the patients lies in the inaccuracy of treatment due to the lack of complete health records in any hospital. With the recent changes in privacy legislation and data management, patients are even unable to retrieve their own health records.
For example, someone had an accident and was taken to the emergency room. The first thing they will need to do in their condition is to fill the hospital’s form. Then, for the treatment, if the injured person is conscious enough, doctors ask questions like if they are allergic to some medicines or do they suffer from diabetes or any other disease. Besides, what if the individual denies having allergies or diabetes in their half-conscious state? And the previous hospitals where they have already had treatment before have denied sharing the medical details of the person either due to privacy issues or data corruption. Well, it can create a lot of fuzz.
Solely, to improve the health industry without compromising the security of the individuals, blockchain has remained in the discussion. It has the potential to address the operability challenges present in the healthcare industry. But, what is blockchain, what are its underlying fundamentals, why blockchain, and what are its advantages?
Today’s blog will help in understanding every aspect of blockchain and its impact on the healthcare industry. So let’s get started!
What is Blockchain?
Blockchain is a P2P or peer-to-peer distributed or decentralized ledger technology. It stores a chain of data called blocks of information. These blocks are chained together by cryptographic signatures. These signatures are called hash that is stored in the shared ledger and backed by a connected processes network - node. These nodes reserve a copy of the complete chain and get continually updated by synchronization. Though, to include blockchain in the process it’s necessary to hire a developer who has prior experience and knowledge about its architecture and can work with the components efficiently as blockchain is a designed pattern that consists of three major constituents - a distributed network, a shared ledger, and all the digital transactions.
a. Distributed Network
As discussed before, blockchain is built on peer-to-peer networks. While having no central point of storage, it makes the information on the network less vulnerable to being lost or exploited.
Unlike the traditional client-server model that has a centralized storage point or controlling party, all the information in the blockchain network is constantly recorded and transferred to the participants of the network that are also known as nodes or peers. These peers also own several identical copies of the information. That’s why blockchain is seen as a huge improvement to centralized models and is considered the future of data storage and ownership.
b. Shared Ledger
Each authorized participant in the network records the transactions into the shared ledger. If they want to add any transaction, it is important to run algorithms that evaluate and verify the transactions. If the majority of members agree to the transaction’s validity, a new transaction gets added to the shared ledger. The changes done in the shared ledger is reflected in minutes or even seconds in the copies of the blockchain. Once the transaction is added, there’s no way to modify or delete it. Also, as the copy is shared in the form of a ledger to each member, no single member can alter data.
c. Digital Transaction
Transactions are information i.e. data transmission to one block. During the process of data transmission, each node acts as a central point to generate and digitally sign the transaction. As the nodes connect each other in the network, each of them has to verify the transaction independently for its conflicts, validity, and compliance. Only after the transaction passes the verification, the information is added into the shared ledger. The major element that makes digital transactions successful is cryptographic hashing that encrypts the data for security.
Why Blockchain technology in healthcare?
It has happened so often that the patient remains unable to gather all of their previous medical records in one format from one place swiftly or sometimes cannot even collect the required information at all. Unfortunately, in most cases, the information of critical patients remains scattered across several different institutions of healthcare that too in different formats. Besides, the data management systems along with the security regulations also vary in different institutions making it difficult to trace and fix mistakes.
But, what can blockchain do?
A blockchain is a system used for storing and sharing information with security and transparency. Every block in the chain is an independent unit of its own and a dependent link among the collective chain that creates a network controlled by participants rather than a third party.
As blockchains are managed by network nodes instead of central authority, they are decentralized that prevents one entity from having complete control over the network. With the incorporation of blockchain, the need for a central administrator will be removed by cryptography. Healthcare providers will be able to promote data management processes beyond perception. It will help in collecting, analyzing, sharing, and securing medical records. It will provide the access to healthcare workers for retrieving health records with the cryptographic keys provided by patients from anywhere without creating any privacy or security problems.
Advantages of Healthcare Blockchain
Although applications of blockchain in the healthcare industry are inceptive, some early solutions have shown the possibility of reduced healthcare costs, improved access to information among different stakeholders, and streamlining the entire business process. So, keeping aside the buzz, let’s see the real advantages of blockchain in healthcare.
1. Master Patient Indexes
The master patient index helps in the identification of patients across separate administrative systems. It is often created within the EHR or electronic health record system. As these EHRs have different vendors, there are several irregularities of MPIs. In many cases, the data of a patient between these healthcare systems become mismatched. However, with the nature of decentralization in Blockchain, it possesses the ability to solve the issue. In the blockchain-based MPIs, the data will be hashed to the ledger and content will remain unique as only the authorized nodes of the data can make changes to the hashes while all parties with access can only check the related information.
2. Single, elongated patient records
Blockchain technology is potent to transform health care by placing patients at the center of the system while increasing the security and privacy of health records. It provides a new model for health information exchange by forming electronic elongated patient records secured and efficient. Additionally, the fact that the data is copied among all the nodes of the blockchain network creates an atmosphere of clarity and transparency that enables healthcare providers and patients to know how their data is handled by whom, how, and when. It can also help healthcare from potential frauds, data losses, or security attacks.
3. Supply Chain Management
Supply chain management in healthcare is a challenging aspect. With scattered settings for ordering drugs, medical supplies, and critical resources, there’s an inherent risk of compromising the supply chain that might impact patient safety. Indulgence of blockchain technology in the transactions can tap into the complete process of medicine or drug products movement. As all the transactions will be recorded onto the shared ledger with every block recording and maintaining every transaction, it will become easy to verify the vendor, distributor, and origin of the drug within a matter of seconds. It will also enable healthcare physicians and officials to check the authenticity of the supplier’s credentials.
4. Claims Justification
Currently, the insurance claim processes face difficulties like lack of transparency i.e. most customers don’t even know how insurance works; human errors and inefficiencies i.e. insurances are full of confusion along with human errors that create inefficiencies that lead to the increased cost to customers; higher frauds in claims. But, blockchain technology can simplify and enhance recordkeeping, payment processing, claims registration, contract management, and closure with its immutable ledger.
5. Interoperability
Interoperability is the capability of distinct healthcare information technology to interpret, exchange, and use data. Due to the privacy issues, the alphanumeric code to identify a patient has been revoked that caused problems in gathering the required record of the patient. Enforcing measurement standards for industry-wide interoperability is also a challenge in interoperability. With blockchain in healthcare interoperability, data can be shared in real-time on the trusted network and provides access to the patient’s record in a secured manner. Moreover, with the pri
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