Personal Connected Health: 7 Questions with Dr. Joe Kvedar
by Michael Joseph | @HealthData4All
- Would you share your professional journey as a leading evangelist and practitioner of personal connected health, as well as the origins of Partners HealthCare? What are your top priorities in your current position?
I am a dermatologist, and I started my career after my residency as a laboratory investigator. Then, in 1994, I took a pretty abrupt turn and started looking for something else to be passionate about in the academic world. I had a number of projects and among them was one evaluating the feasibility of digital imaging as a tool in dermatology. It was during that time that I got excited about the idea of “time-and-place-independent care.” Once I recognized that, it quickly became obvious that we must pursue it as soon as possible. At the same time, my clinical boss was not only chair of dermatology, but he also had a leadership role in the formation of Partners HealthCare, which brought together Brigham and Women's Hospital and Massachusetts General Hospital, Harvard Medical School teaching hospitals. As part of a strategic planning process at MGH, he and another department chair convinced leadership that telemedicine must be a strategic priority. That executive commitment opened the door for me to become more involved, and I happened to be available and interested.
So, I embarked on this journey and have not looked back. It has become my major professional commitment now for 22 years. I always felt like once I had that epiphany, it became so obvious that we really have to do this. But we really had no idea how we were going to make it happen.
Partners and our affiliated institutions became an incubator for the concept. Academic teaching hospitals are places where you can do innovative things, sometimes crazy things, and sometimes ahead-of-the-curve things, and you'll still be able to get support from your colleagues and administrators, and often keep your job. People are respectful of innovative thinking, even if it isn't always obvious how it's going to fit into the market and when. But if it sounds like something we should be learning about, if only from a scholarly perspective, we always had leadership buy-in and steadfast executive support. It was a shared belief that this type of care delivery would be important to how we deliver care at some point in the future. And it's starting to come true now.
As we've been immersed into this world of value-based reimbursement, accountable care and the like, it has become even more compelling to establish connected health as part of the care delivery model. There's ever more opportunity for us to use these tools, not just as a way to extend access, but as a way to render care more efficiently. So I think those are the reasons that Partners got involved. Our current staff at Partners Connected Health is about 60 people, and it's squarely in the camp of innovation. We have our own ideas; we also have collaborators, corporate sponsors and stakeholders who bring ideas. We flesh them out, build prototypes and iterate to make sure that they’re usable. We perform validation testing and support clinical trials to determine how they’re going to impact outcomes and costs, and then someone on the other end of that gets to commercialize a product or program. Sometimes it's us; sometimes it's our corporate partner. To complete the journey, we also have a team of people who go into our primary care practices throughout the Partners network and help our doctors implement these solutions, when they make sense. Typically, we have something that's licensable, and we do a lot of work with corporate partners, so from the very beginning we have IP sharing arrangements in place. Other times, we write grants and generate our own intellectual property, which could result in spin-offs or in licensable intellectual property. It just depends on the deal.
- What does "digital transformation" mean to you? As related to personal connected health, how would you characterize the pace of digital transformation in healthcare? Why is it lagging practically every other industry?
Digital transformation really means that you're conducting aspects of your business on a digital platform where you previously were not, and doing it in a way that opens new markets or creates efficiencies and business models that establish new bonds with your customers. The transformation aspect must be something fundamentally different than the status quo.
Healthcare is lagging, in part, because we have convinced ourselves, as an industry, that high human touch is critical to our success and that patients must be seen in person. This perception clouds the judgment of decision makers in conceptualizing virtual patient interactions via digital solutions. Because of this, they can list ten reasons supporting these assumptions without taking the empirical approach of trying it. Here at Partners, we have challenged this perception and shown that personal connected health isn't about “low touch.” It’s about supporting and enhancing the doctor-patient relationship.
Another phenomenon is that healthcare providers tend to like to solve problems by hiring more staff. And I don't know why. I've suggested technology solutions in meetings, and it's usually greeted with a tepid response. Just look at the self-service in other industries. When I go to Home Depot, there's one person for five check-out lanes, and if I don't need that person, I can just swipe my items, insert my card and I’m on my way. If I do need that person, they are right there and, on average, they can cover five check-out lanes just fine. When I go to my doctor, I typically see five people before I get to my doctor. So it's the exact opposite. We just haven't embraced automation as healthcare practitioners the way other industries have. As I’ve said, a lot of this is rooted in this untested assumption that we have to have high touch interactions with patients.
In so many other industries, especially with mobile technology, we've learned that having the device and the connectivity to the service provider in the palm of your hand enables new ways of doing business -- whether it's Seamless, Uber or other businesses that use mobile in really clever ways. Retailers are doing clever things with the Internet of Things and mobile, where they know that you've purchased something for your home and when you arrive at the store, because they can geolocate you, they can direct you to a part of the store where there's some matching accessory. There are all kinds of interesting things going on that enable us to use technology to enhance relationships. But in healthcare, they say, “I have to see the patient and the patient only wants to see me in person.” So, it's a mindset problem.
- As a dermatologist, have you utilized telehealth in your own practice?
Yes, indeed, we have a number of examples. I regularly do what's called “live and interactive telemedicine” with Nantucket Cottage Hospital, serving a small island community about 100 miles south of Boston, where it's essentially like a clinic. The patients come into the clinic, and they appear in front of a high-resolution video camera with a nurse to guide them. Or, for primary care doctors in our system, they can capture a patient image on their iPhone and link it into our medical records so that we, as dermatologists, can help them triage those patients and provide appropriate clinical advice or interventions. So, we can get patients into specialty care quickly, but we also try to keep people who don't need to see a specialist in the hands of primary care providers.
- Are there any proven AI solutions that can accurately recognize skin lesions and formulate diagnoses from an image?
There isn’t anything in the market quite like that yet. But there is a research paper recently published in Nature entitled, “Dermatologist-level Classification of Skin Cancer with Deep Neural Networks,” by researchers at the dermatology and computer science departments at Stanford. They trained a deep neural network to recognize cancer skin lesions and do it as accurately as doctors can. So, this is becoming a reality.
- Aside from the obvious synergies, what are your expectations in merging the Partners Connected Symposium with PCHAlliance’s Connected Health Conference?
Well, it's really a case of one plus one equals many more than three. Both events have very complimentary talents and audiences. There is a real thirst for high quality thought-leading content in the marketplace, so we can certainly deliver that. And, together, we can attract an audience of decision makers, quality speakers, and a very interesting floor of exhibitors and sponsors to get people acquainted with what's coming in the marketplace. Plus, there's plenty of opportunity in the fast-growing Boston Seaport District with lots of innovation. We're going to take over the Seaport World Trade Center in Boston, and I'm sure people will have a very positive experience.
- Where do you see the state of personal connected health, or digital health, 10 years from now?
Well, Yogi Berra said it's tough to make predictions, especially about the future. Right now, I’m seeing Amazon's Echo and Alexa come into focus. What they've done is they've managed to get artificial intelligence into an ecosystem with which people want to interact. And I've felt, for the last few years, that we need that in healthcare. Not necessarily only to say, “Alexa get my prescription refilled,” or “Alexa what does it mean that I have a sore hip?” But the ability to have a virtual medical assistant, as I describe in my book, The Internet of Healthy Things, that will preempt and guide you to the healthiest behaviors in a way that keeps individuals engaged and inspired. That's what's going to happen in the next 10 years, and it will look something like Amazon Echo. It will have similar features, and you won’t think of it as a health-only device.
- Do you see any adverse consequences of this brave new world?
We, as stewards of the industry, have to manage that. The argument always comes up that healthcare is different, and it is different. I believe there are enough checks and balances in the healthcare system that we won't get too whacky. That's my belief. If anything, we’re overcautious and we move more slowly than we should. So, I'm confident we can do the right thing. We fully believe in the power of human relationships and that the relationships patients have with their doctors are just going to drive everything. It's just that right now there's one hammer we have for every nail. And we really want to look for some different strategies to support that relationship, to extend it and to enhance it.