Persistence of vision: HIMSS and the evolution of patient engagement

The last time I attended HIMSS it was as part of a team from Eclipsys/HealthVision. The year was 2000 and we were debuting a futuristic new product called Cardiovision. Here is a quick list of goals and features we envisioned at the time:

The product was designed to reduce hospital re-admissions; to function like a "care net" for patients leaving the hospital after cardiac surgery.

The product integrated tools for  clinicians, but was envisioned for patients to use at home.

The product provided ongoing messaging, bi-weekly 3-way video teleconferencing appointments for patients with their doctors and care managers, as well as secure access to an electronic medical record.

We even used infographics for friendly display of progress/risk charts to patients and providers.

There was e-prescribing, but not just for medication. Learning and physical activity was prescribed as well, with the goal of promoting the patient's mental and physical healing. We even suggested a social network, a way to buddy up patients with walking partners.

On the behavioral side, we created a custom, lean content set designed for distribution to the patient via e-mail over a six-week period, the time when hospital readmission rates were the highest (most costly, and deadliest too).

The content was created to meet literacy levels anticipated in the community, and all manner of engagement was embedded into the program.  In addition to static articles, we created quizzes, audio and videos inspired by Prochaska's transtheoretical model of change.

The entire product vision was based on a belief that patients were capable of and desired taking an active role in recovery, so we built tracking capabilities that enabled user input of activities and sentiments. We asked how people were feeling about the recovery process, and probed for emotional status reports too.

The product packaged up game theory into incentives for patients too. I believe one of the prizes was a pair of Nike walking shoes ...

This was 2000, not 2012. There was no broadband, few mobile phones; data was not liberated, and there were few incentives aimed at igniting consumer demand for participatory medicines.  The word "start-up" had hardly made it into the vernacular.

The prototype received a very positive reception, though many thought we were crazy ... The lead physician on the team appeared on local evening news, a big deal at the time. ... I believed we were even cited as "Best of Show" and singled out by a VC company fishing for good ideas at the conference.

The product in its entirety did not scale, though certain features were pulled out and developed further.


This trip down memory lane reminds me that the standout features of all tech-health products are their emotional features, Tracy Kidder's "Soul of the New Machine" so to speak. So at HIMSS 2012 what's so cool to me is that Biz Stone is speaking, and Regina Holliday is painting, and e-Patient Dave is electrifying listeners, and Jane Sarsohn-Kahn is guiding and Fred Trotter is gamifying ... what this means is that the soul of patient engagement has become as ALIVE as the financial market surrounding it.  The metabolism of the space is rising!

So, here's to change and to visionaries old and new. Here's to prototyping and ongoing dialogs about empowerment and seeking ways to liberate dependencies on outdated business models.

Here's to art and science, to conversation and caring. And, above all else, here's to the persistence of vision that technology and tools can be put to good use creating compassionate solutions to ease human suffering.


Vineet Nayar's thoughts on Davos make good sense for health care too

It used to be "hard power" applied from the top that got things done. In turn, it became "soft power" -- the achievement of change by persuasion. And today? [World Economic Forum founder and executive chairman Klaus] Schwab believes our future rests on "collaborative power" -- that is, "the integration of empowered newcomers" into the decision-making process.   Read the post from Vineet Nayar, CNN Money

When it comes to changing the culture of health, many will outwardly embrace the "empowered newcomer" while continuing business as usual.  All of us have wrestled with this dynamic and I propose that the wrestling is about keeping the discomfort of "not knowing" what the newcomer wants at bay.  Here's how it works:

Co-mingling empowered newcomers into mature business processes makes us anxious and awkward, some of us just a little, others a lot.

There is rarely adequate time to move through the awkward feelings meeting a newcomer brings up in time to establish a rapport a professional context.  This can take years because we approach the situation with blind spots.

One blind spot or preconceived limit is that there simply is not room for a newcomer's perspective. Why? Because some feel that newbies don't "get it", cannot "articulate it" or simply slow things down to such a point that empowered stakeholders are impatient to return to business as usual.

Squirm as we may, until chaired leaders become skilled at tolerating the anxiety and uncertainty of newcomer encounters, the conversation about innovation will leave a tremendous raw energy source untapped.  ...

It's an irrational season in American health care.  This season of seduction keeps calling us to envision care in new ways.

We hear the siren song of apps, big data, information, tools, treatments and processes promising to take us closer to healing, to loving, and to the care we received from our mothers and fathers (or did not receive).

The promises of the future are intoxicating, the needs are overwhelming, the technology nothing but mind-blowing. And yet, will we come close to realizing the potential this moment offers? ... I ask myself: 
  • How might we unleash and package the power of the individual? 
  • How might we establish trust as a product platform?  
  • How might we foster and ignite humility within the re-imagining of health and wellness?
  • How might we learn to perceive the individual's ability to "not know" as a sign of advanced thinking?
  • How might we germinate these ideas within?
  • How might we apply these ideas to a single relationship?
  • How might  we grow these ideas into a fluid layer of dialog globally?
It is the individual that powers the network and it is the individual who seeds our increasingly global, fluid kinship system.

As Vineet Mayar suggests, it's a ready acceptance of what is new or feared that may ultimately extend an individual's or group's vitality and relevance.

Reflecting on my own style in these contexts, I view my readiness to seek out the newcomer's P.O.V. to the health of my growth mindset.  When looked at this way, I see the whole exchange one of co-empowerment.

Rather than welcoming someone into the elite, we give away the idea of elite in exchange for something raw and less abstract.

By re-framing the exchange between newcomer and stakeholders as one of co-empowerment, we create a supply of related but distinct exponential thinkers over time. It's a way to accelerate the positive impact we can make on the world together.

Re-written 2/9 after conversations with Alex Jadad, MD, PhD 2/6-9, 2012, #Future Med